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Why is it so hard to tell if a person has a stress fracture or not? I saw two physical therapists (one was also an athletic trainer) and an orthopedic surgeon. No one could tell me what was wrong until I finally insisted on an MRI. And there it was! Couldn't they have at least taken an X-ray?

A stress fracture is a hairline crack in the bone that can grow larger over time if not treated properly. There are two types of stress fractures. Insufficiency fractures are breaks in abnormal bone under normal force. Fatigue fractures are breaks in normal bone that has been put under extreme force. Fatigue fractures are usually caused by new, strenuous, very repetitive activities, such as marching, jumping, or distance running. Stress fractures were once most common among military personnel who marched and ran day after day. But today, stress fractures are on the rise in athletes, from distance runners and sprinters to skaters, hurdlers, and tennis, volleyball, soccer, and basketball players. Dancers and gymnasts are not immune either. Men and women in these two sports who train more than five hours a day have been shown to be 16 times more likely to develop a stress fracture. X-rays don't usually show any sign of a stress fracture until four to six weeks after the injury when the bone shows signs of advanced bone repair. MRIs or bone scans are the most sensitive and accurate tests for bone pathology. But these are expensive and they aren't always available. It is widely known that lower limb stress fractures can be difficult to diagnose. There are so many other things that could be wrong: infection, soft tissue injuries, compartment syndrome, tibial stress syndrome, and periostitis are just a few that must be considered. Sometimes it does just take time and even the progression of a problem before the final diagnosis can be made.

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