The primary symptom of a stress fracture is pain and tenderness at the fracture site, though some stress fractures produce little to no symptoms at all until they progress to a more serious injury, such as a displaced fracture. 1 Wedro B. Stress fracture. eMedicineHealth.com. June 11, 2014:

Symptoms of stress fracture include, but are not limited to:

Nagging, aching pain that is felt deep within the foot, toe, ankle, shin, hip, or arm. The exact source of the pain may be difficult to pinpoint, such as a general ache in the entire foot or lower leg. 1 Wedro B. Stress fracture. eMedicineHealth.com. June 11, 2014: , 3 Stress Fractures. The American College of Foot & Ankle Orthopedics & Medicine. Available at http://www.acfaom.org/information-for-patients/common-conditions/stress-fractures. Accessed December 23, 2014.

Localized pain at night. Pain in a certain area, such as the foot, ankle, or hip that appears in the evening is often associated with stress fractures, even if the pain is not debilitating during sports activities. 2 American Orthopaedic Foot and Ankle Society. Stress fracture. FootCareMD.com. http://www.aofas.org/footcaremd/conditions/ailments-of-the-midfoot/Pages/Stress-Fractures.aspx. Accessed December 23, 2014.

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Pain that does not improve with rest or RICE protocol. Pain that resumes or remains constant despite taking time off to rest and/or using the RICE (rest, ice, compression, and elevation) protocol may be due to a stress fracture or other causes. 2 American Orthopaedic Foot and Ankle Society. Stress fracture. FootCareMD.com. http://www.aofas.org/footcaremd/conditions/ailments-of-the-midfoot/Pages/Stress-Fractures.aspx. Accessed December 23, 2014.

Learn more: The P.R.I.C.E. Protocol Principles

Pain in the back or sides. Nagging pain in the trunk can sometimes be an indicator of stress fractures in the rib cage and/or sternum, which can occur in athletes who participate in sports such as rowing, tennis, or baseball.

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Pain that progressively worsens over time. Pain that starts out as a dull ache which once only appeared during sports activity but has become constant and debilitating may be an indication of a developing stress fracture. Another concern is when a young, healthy patient requires crutches because of lower-extremity pain that developed gradually, as this can be a sign of a stress fracture.

Pain that appears shortly after a change in activity. Nagging pain that appears within 7 to 10 days of a significant increase in strenuous activity—such as enrolling in military boot camp—is frequently associated with stress fractures.

See Diagnosing a Scapula Fracture

Because stress fractures often only improve with rest, any athlete who experiences symptoms that indicate a possible stress fracture is advised to take a break from sports activity and see a doctor trained in sports medicine for an accurate diagnosis and treatment plan.

Dr. Adam Yanke is an orthopedic surgeon practicing in the sports medicine division at Midwest Orthopaedics at Rush. He also serves as an Assistant Professor at Rush University's Department of Orthopaedic Surgery and as the Director of Education overseeing the Rush University Sports Medicine Fellowship.

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