Stress Fractures in Children and Teens

What are stress fractures?

Stress fractures are small cracks in a bone that are caused by repetitive activity such as jumping or running. Often called "overuse injuries," stress fractures tend to occur at the junction of muscles, tendons and bones.

Physical stress is important for musculoskeletal tissues to grow and develop. Children and adults become fit by adapting to graduated stresses. However, overuse injuries can be caused by repeated microtrauma that exceeds the body's ability to adapt and repair. Children and teens are at increased risk of stress fracture injuries because they are still growing.

Stress fractures may be caused by initial increased activity in the unfit athlete or by repetitive activity in the elite year-round athlete. These type of injuries are being found more frequently in younger children as competitive sports increase their training demands and many children, adolescents and young adults are now competing throughout the year.

Signs and symptoms

Stress fractures can produce pain, tenderness and swelling. Symptoms can come and go during activity and rest, but tend to worsen over time.

In most cases, your child can tell you where the pain comes from (i.e. right shin or left ankle), but may not recall how or when it was injured.

If your child's pain becomes severe or continues even when she is resting, you should contact your child's physician or an orthopaedic specialist for an assessment.


At Children's Hospital of Philadelphia (CHOP), stress fractures are treated by orthopaedic and sports medicine physicians who specialize in diagnosing and treating bone and muscle injuries in children, teens and young adults. 

Our expert doctors will examine your child, assess her pain, learn about your child's medical history and perform diagnostic imaging — such as X-rays, MRIs and bone scans — to diagnose the problem.

Then, we will work with you and your child to develop an individualized treatment and prevention program to prevent future stress fractures.

First, we will evaluate the athlete's current training and competition activities, diet, hormonal and social factors. Then, we will develop a customized program of rehabilitation exercises for each individual patient.

Our orthopaedic and sports medicine physicians and therapists also work with area coaches to ensure that your young athlete will receive appropriate training in an appropriate location.


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