Stress fractures

Doctors can sometimes diagnose a stress fracture from a medical history and a physical exam, but imaging tests are often needed.

• X-rays. Stress fractures often can't be seen on regular X-rays taken shortly after your pain begins. It can take several weeks — and sometimes longer than a month — for evidence of stress fractures to show on X-rays.
• Bone scan. A few hours before a bone scan, you'll receive a small dose of radioactive material through an intravenous line. The radioactive substance is heavily absorbed by areas where bones are being repaired — showing up on the scan image as a bright white spot. However, many types of bone problems look alike on bone scans, so the test isn't specific for stress fractures.
• Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to create detailed images of your bones and soft tissues. An MRI is considered the best way to diagnose stress fractures. It can visualize lower grade stress injuries (stress reactions) before an X-ray shows changes. This type of test is also better able to distinguish between stress fractures and soft tissue injuries.

To reduce the bone's weight-bearing load until healing occurs, you might need to wear a walking boot or brace or use crutches.

Although unusual, surgery is sometimes necessary to ensure complete healing of some types of stress fractures, especially those that occur in areas with a poor blood supply. Surgery also might be an option to help healing in elite athletes who want to return to their sport more quickly or laborers whose work involves the stress fracture site.

It's important to give the bone time to heal. This may take several months or even longer. In the meantime:

• Rest. Stay off the affected limb as directed by your doctor until you are cleared to bear normal weight.
• Ice. To reduce swelling and relieve pain, your doctor might recommend applying ice packs to the injured area as needed — 15 minutes every three hours.
• Resume activity slowly. When your doctor gives the OK, slowly progress from non-weight-bearing activities — such as swimming — to your usual activities. Resume running or other high-impact activities gradually, increasing time and distance slowly.

You're likely to start by seeing your primary care provider. If you are a competitive athlete, you might go directly to a doctor who specializes in musculoskeletal problems.

What you can do

Before the appointment, make a list of:

• Your symptoms, including any that seem unrelated to the reason for your appointment
• Key personal information, including your level and type of physical activity and whether you've increased training recently
• All medications, vitamins or other supplements you take, including doses
• Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given.

For stress fractures, basic questions to ask your doctor include:

• What is the likely cause of my symptoms?
• What tests do I need?
• Do I need to stop my activity? For how long?
• Should I see a specialist?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• When did your symptoms begin?
• Have you recently increased your physical activity?
• Have you broken bones in the past?
• Do you have regular menstrual periods?
• Do you take vitamin D and calcium supplements?