Stress Fracture: Recovery & Healing Time (+Tips)

If you’ve experienced a stress fracture (in the foot, leg, femur, or upper limb), you might be wondering about the healing and recovery time. When is it reasonable to resume weight-bearing and return to sports?

As a physical therapist, I’ve compiled all the essential information on this topic!

Summary: The bone density after a stress fracture can take up to 6 months to return to its normal state. While it’s possible to gradually resume activities before this period, proper rest and, more importantly, a gradual reintroduction of weight-bearing are necessary to minimize the risk of recurrence.

Happy reading 🙂!

What is meant by the healing & recovery time of a stress fracture?

When a bone is broken, it loses its usual consistency at one or more locations. This is also the case with a stress fracture.

Here is an illustration of this: you can see in the images below that a part of this person’s fractured tibia is not like the rest of the bone.

The bone needs several weeks (and even months) to regain its usual consistency; this is what we call the healing time.

We often also refer to the recovery time. Recovery, for me, is something broader that rather means: how long does it take to resume one’s “life before”?

Regardless of the bone structure.

That’s why in the rest of the article, I will try to specify what I mean: consolidation time? Time needed to resume weight-bearing? Time needed for the return to sports?

Is the healing time the same for all stress fractures?

Various different factors influence the consolidation and healing time of a stress fracture:

The mechanism of occurrence; Genetic predispositions to recover more or less quickly; Your lifestyle: smoking and alcohol slow down consolidation; If you have any diseases.

Is the healing time also influenced by the precise location of the fracture (on which bone, at what location on the bone) or the type of fracture (is there displacement or not)?

Although there is little empirical data on this subject, it seems not.

A research team (Miller 2018) precisely addressed this question.

They found that among the 38 athletes who had one (or more) stress fractures, the expected time before returning to sports was the same regardless of the location or severity of the stress fracture: 12 to 13 weeks (about 3 months).

This is, of course, a small sample, making it difficult to generalize the results. But it is the best information available!

Especially, it does not mean they resumed sports without any issues.

I will detail this further, but the risk of stress fracture recurrence is quite high compared to other fractures.

There are, therefore, certain measures to put in place to limit this risk.

Various factors influence the consolidation and healing time of a stress fracture. Even knowing the precise location of your fracture, your health status, and lifestyle, it is challenging to make an accurate prognosis for the time it will take you to recover.

That’s why I will provide recovery time ranges (even if it’s frustrating, I’m aware of it!).

What is the healing time for the most common stress fractures?

Here are the healing times observed for the five most common stress fractures (May 2023).

Here are the observed consolidation times for the 5 most common stress fractures (May 2023).

Stress Fracture Location	Consolidation Time
Tibia (Shin) Stress Fracture	Up to 6 months (Jatsy 2021)
Tarsal Scaphoid (Foot) Stress Fracture	3 to 4 months (May 2023)
Metatarsal (Foot) Stress Fracture	Up to 4 and a half months (Smidt 2023)
Femoral Stress Fracture	3 to 4 months (May 2023)
Pelvic Stress Fracture	3 to 4 months (May 2023)

The healing time for a stress fracture is several months: often around 3 to 4 months, sometimes up to 6 months.

Can you work with a stress fracture?

It is often possible to work with a stress fracture if you have a “sedentary” professional activity where you are seated.

Sometimes, a sick leave may still be prescribed because moving with crutches or by car can be challenging in the first few weeks. This will free up time for you to establish a general physical maintenance routine during this consolidation period if it is important to you.

If your job requires standing, walking, or carrying things, a sick leave of several months is often necessary.

There is no standard duration for sick leave: your doctor discusses the best option with you based on your injury, profession, and your opinion on the matter.

Physical therapists cannot issue or extend a sick leave.

Can you walk with a stress fracture?

If your stress fracture is in the upper limb (hand, wrist, arm, shoulder), walking is generally possible.

If your stress fracture is in the lower limb (foot, leg, knee, thigh, hip, femur, pelvis), you will often be advised not to bear weight on the fractured lower limb.

However, walking without bearing weight is still possible, using crutches or another walking aid. See my guide: how to walk with crutches with or without weight bearing.

For how long is weight-bearing not allowed?

This depends on various factors. Even for the same stress fracture, the medical/surgical team and physiotherapist you encounter may not necessarily give you the same instructions.

In general, a follow-up X-ray, MRI, or CT scan is done to assess the progress of consolidation BEFORE you are allowed to bear weight again.

Partial or full weight-bearing is typically resumed after a stress fracture:

• sometimes immediately with crutches, but this is rare;
• sometimes after 2 weeks;
• most often after 6 to 8 weeks;
• occasionally, only after 2 to 3 months.

How to resume weight-bearing after a non-weight bearing period?

Generally, you are advised to use crutches initially to avoid putting too much weight suddenly on the fractured leg or foot.

Sometimes, a gradual resumption of weight-bearing is recommended. For example, you may be advised to increase the load by only 10 kg or 10% of your body weight per week.

I have created a comprehensive guide in text and video on resuming walking after non-weight-bearing.

Physiotherapy sessions are often prescribed to guide you through this step.

Can you drive with a stress fracture?

In France, the Highway Code like in USA, does not directly prohibit driving with a fracture.

The law simply states that you have the right to drive if you are capable of reacting at any moment.

Additionally, when pressing the pedals of a car, there is much less weight and stress on the leg than during walking because you are seated. There is not the full weight of the body.

Generally, driving is possible after a stress fracture.

Unless you have a cast or a walking boot that makes you uncomfortable with the steering wheel or pedals.

In any case, I recommend testing how you feel while stationary before considering driving. Also, limit the driving time initially to see if you tolerate it well.

For more information, read: Can you drive a car after a fracture (and how)?

What to do to reduce the risk of another stress fracture?

There is a fairly high risk of getting injured again after a stress fracture: 1 in 10 to 1 in 3 military personnel experiences a recurrence (Rauh 2006). This is what is known about it.

It also happens that stress fractures are not due to sports. But even in such cases, caution is advised when resuming physical activities.

Sports most at risk of stress fracture

Here are the sports with the highest number of stress fractures per number of participants:

These sports are at the highest risk:

• Running, especially endurance running (jogging, running);
• Gymnastics (for women only);
• Basketball;
• Outdoor athletics.

This means that if you engage in these activities, extra attention is advised when resuming sports.

Here is the type of stress fracture that occurs most often based on the sporting activity:

Sport	Type of Stress Fracture
Athletics	navicular bone, tibia, metatarsals
Long-distance running (half-marathon, marathon, 10k, etc.)	tibia and fibula (see tibia-fibula double fracture)
Dance	metatarsals
Military	calcaneus and metatarsals

How to Train to Minimize the Risk of Stress Fractures?

Here’s a summary of insights from research teams focusing on the causes of stress fractures in athletes and how to prevent them (Warden 2021).

1. Incorporate Rest Periods:
   • Include rest periods in every training program, with at least 1 day of rest per week and at least 1 week off every 3 months.
2. Pre-Puberty Recommendations:
   • Before puberty, avoid premature sports specialization to develop a robust skeleton optimized structurally to withstand loads in multiple directions.

How to Avoid Recurrences (Guerrière 2022):

1. Gradual Training Volume Increases:
   • Avoid rapid increases in training volume (e.g., don’t go from 3 running sessions per week at 30 minutes each to 5 sessions per week at 45 minutes each).
2. Limit Training Session Duration:
   • Limit the duration of training sessions; it’s better to increase training frequency gradually rather than the duration of sessions.
3. Incorporate Multidirectional Movements:
   • Include multidirectional movements in your practice. This involves exercises that engage muscles and joints in various directions.