What’s the best way to identify a stress fracture? Our 16-year old daughter has been complaining of groin and knee pain for weeks now. She’s still training as hard as ever. The coach suggested an X-ray to see if there’s a stress fracture.

A stress reaction or stress fracture occurs when normal bone is exposed to repetitive loads. This type of injury usually occurs with vigorous weight-bearing activity such as jogging, running, or marching. Military soldiers, track and field athletes, and long distance runners seem to have the most bone stress injuries.

The symptoms are often pain in a specific area that gets worse with activity. The patient can point to the exact spot that hurts. The pain is relieved by rest but comes right back as soon as the person starts weight-bearing activities again.

Studies show that magnetic resonance imaging (MRI) is the most accurate way to diagnose bone stress injuries. X-rays do not show stress fractures when they are first developing. It may be six to eight weeks before a change in the bone is seen with an X-ray. MRIs are very sensitive and show both bone and soft tissue damage.