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Stress fractures in kids

Stress fractures in kids


Rosemary Marchese – Physiotherapist

A stress fracture ‘is not a break’. Have you ever heard that? I hear it all the time. However, a stress fracture IS a small crack in the bone, which develops from overuse over time. It commonly develops in the weight bearing bones of the lower leg and even the foot. When the muscles of the feet are stressed or overworked, they’re unable to absorb the stress and the stress is transferred to the bone. This results in a stress fracture.

Stress fractures can occur in adults and kids, but I am seeing a slight increase in the number of kids with overuse injuries in my clinic on the Northern Beaches. Often this is due to a rapid increase in the intensity of exercise. This leads to parents asking me ‘how much is too much?’

Other causes of stress fractures in kids, and even adults, may include:

  • Hard impacts on a hard surface
  • Improper footwear
  • Increased physical activity, especially if it’s sudden
  • Inadequate rest between workouts
  • Increasing activity without a suitable diet

Athletes that participate in sports with repetitive landings seem to be most at risk of stress fractures. This can include children playing sports such as basketball, cross country, tennis or gymnastics.


Are girls or boys more at risk of stress fractures?

Females tend to be at higher risk of developing stress fractures than males. Sometimes this is related to a condition known as the ‘female athlete triad’. This is a combination of eating disorders, osteoporosis (thinning of bones) and amenorrhoea (irregular menstrual cycle). Bone weight tends to decrease and the risk of stress fractures increases in these athletes.

What are the signs and symptoms of stress fractures?

  • The child complains of an ache or pain that gets worse with exercise and better with rest
  • Swelling
  • Bruising
  • General tenderness at the location

What do you need to do?

If you suspect your child has a stress fracture then you should visit your doctor for referral for an X-ray, and sometimes even an MRI is needed.

How are stress fractures treated?

Your doctor will advise you but often a non-surgical approach is satisfactory for a stress fracture. This includes rest and avoiding aggravating activities. Returning to activity too quickly results in poorer recovery. Sometimes the child may require a cast or crutches. In some instances surgery is required.

Visiting your physiotherapist will help you with:

  • Advice regarding return to activity
  • Cross training and prevention of further injury
  • Maintaining and regaining of a healthy walking pattern
  • Return of normal range of motion and strength
  • Reduction of swelling
  • Advice regarding appropriate footwear