Stress Fractures

A stress fracture is an overuse bone injury that typically affects active people.  In fact, it affects approximately 20% of runners!  80-95% of stress fractures occur in the lower limbs and the tibia is the most commonly affected bone.

stress fracture final

Suspicion of stress fracture is usually determined during the patient interview.  Factors such as training schedule, training surface, footwear, previous injury and overall bone health are some of the many important factors to consider.  Unfortunately, there are no reliable clinical tests that can definitively rule this condition in or out.

Tuning Fork Test

Tuning forks are often used in a clinical or field setting to detect the presence of a bone fracture.  To perform this test, the practitioner strikes an instrument called a tuning fork on a hard surface (like the bottom of a shoe) to get the instrument vibrating.  The fork is placed on the bone in question and an increase in pain may suggest the presence of a fracture.  The theory is that the vibration is sent through the bone from the fork and if there’s a fracture, the vibration in this area would be painful.  Surprisingly, the literature shows that there may be some slight validity to this test but it should not be used as a stand-alone diagnostic tool.  Stress fractures are diagnosed with imaging.

X-Rays for Stress Fractures

X-rays are not the best for detecting stress fractures.  Bone scan or MRI have been established as the best way to detect a stress fracture.  Although Doppler Ultrasound seems to be increasingly utilized in musculoskeletal medicine, it is not useful for detecting lower limb stress fractures.

Do you have leg pain?  Do you think it could be a stress fracture?  Our clinic doesn’t typically treat stress fractures, but we really like helping people figure out if they might have one.  Give us a call, we can help!


Schneiders AG, Sullivan SJ, Hendricks PA et al.  The ability of clinical tests to diagnose stress fractures: a systemative review and meta-analysis.  Journal of Orhtopaedic & Sports Physical Therapy 2012; 42(9):760-771.