STRESS FRACTURES: WHAT EVERY RUNNER SHOULD KNOW

Broken bones or traumatic fractures are actually quite rare in runners, unless you happen to be a certain friend of mine who tripped over a curb last year. Stress fractures however may occur in runners when their training changes or intensifies. These are part of the all too often “Too much, too soon, too fast” injury phenomenon seen in new marathoners or just those working on their 5K times a little too hard!

 
Stress fractures are truly an overuse injury like tendonitis, fasciitis, and shin splints. Bone normally breaks down and builds up in response to the stress of running. A fracture occurs when that stress accelerates faster than the body can respond with an increased ability to remodel and build up bone. This is why the 10% increase in mileage or intensity rule is so important.

 
Some runners are predisposed to getting stress fractures. In fact, studies show that 60% runners in which stress fractures occur have had one before. Some factors that are intrinsic (in other words, blame Mom) are low bone remodeling rate, extremes of body types (too large or too thin), skeletal alignment, and yes….being female! The “female triad” is well-documented in high school and college girls in which there is an eating disorder, amenorrhea, and osteoporosis…these girls need help and quickly! Other factors are extrinsic (yes, these you can change easily) including improper training, inappropriate shoe gear (not everyone should be in a light training shoe!), and running on irregular surfaces. Other factors are modifiable with some help; such as improper biomechanics, leg length discrepancies, and muscle strength and flexibility imbalances.

 
Symptoms: Localized bone tenderness not associated with distinct trauma. Pain that does not decrease with rest and doesn’t “warm up” when running. You may notice localized swelling, redness and distinct pain when pressing on the bone. I tell my patient’s I have X-ray vision in my thumb, because when you hit the spot…the patient jumps off the table. Remember, the X-rays may be negative for 10 days to 2 weeks after the onset of injury. Bone scans or an MRI can diagnose these fractures earlier, but usually are not necessary.

 
Treatment: Most will heal with time and yes….that rest no one wants to ever take…Ice and anti-inflammatories help with the symptoms, but some studies have shown anti-inflammatories like Motrin or Aleve actually can slow bone healing. You may need immobilization in a stiff shoe or walking cast. In very severe cases, crutches and a fiberglass cast are needed! (Usually because you didn’t listen to your doctor.) Surgery is only necessary when the fracture transitions from a stress crack to a true fracture and become misaligned.

 
Recovery requires no running, jumping or playing with the other kids! Cycling, deep-water running, and swimming are allowed, but no repetitive weight-bearing stress to the area. These usually take 6-8 weeks to heal.

 
Prevention: Once you have a stress fracture, you are at risk for developing another one. Things you can do to better your odds are don’t be stupid about your training  Review your recent training habits and shoe gear. Consult a coach if you need help with training patterns. Have a biomechanical assessment. Sometime physical therapy, chiropractic manipulation or orthotics are needed to correct imbalances. Take a multi-vitamin and a calcium supplement for women. And above all, start listening closer to your body. Lay off and/or slow down when you have muscle, tendon, or joint soreness.

 
Bottom line: Run smart, prepare correctly, and don’t hesitate to ask for professional help to achieve your running goals without getting hurt.