Exercise Induced Stress Fractures

Rib fractures caused by stress in sports can happen to any athlete, in any sport. Although injuries may be more common in the lower limbs, your ribs aren't exempt.
Exercise Induced Stress Fractures

Last update: 01 February, 2021

When we talk about stress fractures in the ribs, we’re referring to a phenomenon where one or several ribs break as a result of repetitive force. Many times, this force is applied during exercise. For a stress fracture to occur, the force applied is less than the capacity of bone resistance.

This is to say that the tissue isn’t damaged as a result of direct trauma. Rather by the repetition of smaller traumas that consistently occur in the same location. After a certain point, the elasticity of the cells is penetrated and the fracture occurs.

The reason for fractured ribs during sports is fatigue. This term is commonly used, yet difficult to describe in this context. It doesn’t mean that they become tired in the same way as when we’re feeling worn out.

Fatigue of the bone tissues is linked to the repetition of supporting weight. Think, for example, of a kayaker, who trains every day making the same movements with the oars. In this case, the ribs are under continuous pressure from the thoracic muscles, until they can no longer support the force that’s being applied to them.

Under normal conditions, a small trauma is quickly repaired by the cells. However, with stress fractures, there’s not enough time for the tissues to scar and heal themselves before the movement happens again. This means that the fissure moves deeper and deeper into the bone, until the point where it causes the injury.

According to a recent study, the propagation of a stress fracture is different from the propagation of a common fracture caused by one traumatic incident. The ribs begin to break in a perpendicular manner first, and then in a parallel direction from the edge of the bone.

X ray of stress fracture

Rib pain is the most common symptom of a stress fracture. In the case of stress fractures caused by chronic fatigue, the pain can develop slowly and insidiously, without being sharp.

This pain increases when you take deep respiratory movements. Upon inhaling or exhaling air, but especially on the inhale, the rib axis becomes uncomfortable and can begin to bother you. In general, this pain is localized and doesn’t irritate other regions. However, if it causes a pinched nerve, this pain can also be felt in the sternum or back.

Inflammation is random. Some athletes notice a bulge in the area of the fracture, while others only feel pain. In the case where there’s an accumulation of liquid, it’s also possible that the skin will change color. It’s even possible for a hematoma to develop above the damaged rib.

If the stress fracture led to a muscle tear or vice versa, a hematoma is always present, though the size can vary. However, the case of a rower isn’t going to be the same as the case of a boxer, which isn’t going to be the same as someone who strength trains at the gym.

Risk factors for this injury

There are, of course, certain situations and risk factors that favor the occurrence of stress fractures. Some studies have shown that the injuries are almost always classified as “low grade.” That means that they’re unlikely to evolve into dangerous forms. Because of this, most will resolve themselves with rest.

In any case, being aware of the risk factors can help you try to prevent these stress fractures in the first place. The most common are the following:

  • Poor posture and bad technique: there are certain sports that have specific methods and techniques to follow in order to avoid injuries. If an athlete doesn’t follow these movements, they can put themselves at higher risk of injury.
  • Conditions of low bone density: people with osteopenia or osteoporosis have lower bone density. This means that their calcium and tissue fabric is deficient. In these situations, it makes sense that any stress they submit themselves to is capable of fracturing their bones.
  • Repetitive overwork: if an athlete repeats the same training over and over again without regulating their weight and force, it can tire areas of the body. This is why progressive models of physical fitness exist. The knowledge of physical trainers can also help guide your preparation.
Boxer hits ribs

What to do in case of a rib fracture

If you’re an athlete and you have a suspicion that you’re suffering from a stress fracture in your ribs, the first thing to do is to consult with a doctor. They can take an x-ray of the thorax to properly diagnose the injury and evaluate it’s extension.

One of the first recommendations for anyone with a stress fracture is to reduce or stop physical activity. This will give rib tissues time to scar and heal. Some doctors may also prescribe analgesics and anti-inflammatory drugs to help you manage the symptoms. The use of a bandage is usually only recommended for serious cases, as it can aid with stabilization.

Finally, you may have to plan a rehabilitation period that includes physical therapy. This is very important according to the scientific literature, as these exercises can help you strengthen the thoracic muscles so that you can avoid re-injury. Surgery is usually recommended for severe cases, such as rib displacement.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Lora Veramendi, Maylin. “Tratamiento fisioterapéutico en fractura de esternón y costillas.” (2018).
  • Torrengo, Federico, Vicente Paús, and Jorge Cédola. “Fracturas por estrés en deportistas.” Rev la Asoc argentina Traumatol del Deport (2010): 18-23.
  • del Arco, Jessica Grande. “Fracturas de estrés en atletas.” Revista Internacional de Ciencias Podológicas 12.2 (2018): 63.
  • Puyol, Sonia Galicia, et al. “Tipos de fracturas costales encontradas en traumatismos costales”. Seram (2018).

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.