Stress Fractures from Running

WHAT IS A STRESS FRACTURE?

A stress fracture, also known as a hairline fracture, is an overuse injury, typically related to high-impact activities. Repetitive stress on the bone causes damage – small cracks or bruises.

A stress fracture occurs on weight-bearing bones, so it will be located in the lower body. It’s a small crack in the bone structure which gets worse and more painful if isn’t treated with enough care and attention. The most common bones affected by stress fracture are tibia, fibula and metatarsals. These are also easier and faster to heal. The femur and pelvis also can be affected by a stress fracture, however not that often and they need a bit more time and attention.

Stress Fracture Causes / Stress Fracture Symptoms / Stress Fracture Recovery / Stress Fracture Prevention / Stress Fracture FAQs

WHAT CAUSES A STRESS FRACTURE?

Which activities cause stress fractures? Generally high impact activities like running or jumping. Also, intensive walking could put that much pressure on the body. Of course, such damage doesn't happen overnight, and usually there are more factors involved in the process:

• Overtraining
  Running itself isn’t a problem, but running with pain for a long period of time might be highly damaging to your body. Stress fractures occur as a result of the repetitive accumulation of stress on the bones. Listen to your body respectfully and take a rest when needed. Remember to incorporate “easy / unloading” weeks during your training (usually a ratio of 3:1).
• Wrong footwear
  Lack of cushioning and/or not enough support in your running shoes can lead to a bigger issue in the future. Make sure that your shoes are properly fitted, especially if you overpronate and run on the pavement.
• Wrong technique
  Most of us land on the heel while running. But let’s be honest that’s not an ideal technique. Do a quick test and try to jump on the spot a few times on your heels. Afterwards switch to jumping on the ball of your feet. Can you feel the difference? Heel landing and over striding puts more stress on your body and sometimes the amount of cushioning and support in the shoes just isn’t sufficient enough. Some runners find it immensely helpful switching from heel-striking to midfoot landing. It reduces the impact on your joints and bones. Your knee and ankle work as a natural shock absorber, activating tendons to absorb the impact and generate powerful push-off. Find out more about running technique here. You can also book a training session with our technique coach Balavan Thomas.
• Lack of nutrients
  We can improve our bones’ density with a healthy and balanced diet. Make sure that your meals include lots of calcium (leafy green vegetables, beans, fish, almonds and many more). Don’t forget about Vitamin D. Daily sun exposure in summer and supplementation in the winter months will do the trick.
• Lack of strength training
  Your bones’ density can also increase over time if you do enough strength training. Of course, bones need more time than muscles or tendons to adapt, that’s why gradually increasing your training programme is so important. It just takes time. Resistance training strengthens not only bones, but also muscles and tendons, which makes your body more resilient to the high impact.

STRESS FRACTURE SYMPTOMS

How to know if you're running with a stress fracture? In the early stages you can feel aching at some point along the bone. Sometimes severe shin splits might feel like a stress fracture, but unlike shin splits or tendon injuries, the pain worsens as you run. Eventually the pain appears even with less impact (walking) or no impact at all (laying down, sitting). Sometimes when you touch your bone you can feel a small bump or swollen area.

If you have the symptoms above, we recommend you stop running, implement RICE (Rest, Ice, Compress, Elevate) and book an appointment with your doctor or podiatrist to establish whether damage has been done to your bone. Unfortunately, X-ray isn’t very accurate, so a bone scan or MRI might be more a reliable option, although it’s more expensive.

STRESS FRACTURE RECOVERY

Recovery time from a stress fracture depends mainly on the damaged area. We can separate stress fractures to low risk and high risk.

Low risk fractures are located on the lower leg and foot, usually the tibia, fibula or metatarsal bones. These are the most common stress fractures. They’re called ‘low risk’ because the healing time is fairly quick (usually 8 weeks) and in many cases they can be healed without the infamous boot.

High risk fractures, however, need more time to heal (around 12 weeks) and affect the pelvis and femur.

Of course, each situation is different, and your case might take less/more time than that. Sometimes you might need a few months, or maybe even a year. Basically, when you are able to walk without pain it’s a sign that you can start slowly(!) getting back to your regular activities. You must be very conscious though! Listen to your body and carefully and consult your doctor on any concerns about your recovery.

How to Return to Running After a Stress Fracture

The best answer is SLOWLY. Your doctor should give you advice regarding activities you could do to get back to running. Unfortunately, at the beginning, avoiding high-impact activities like jumping and running is must.

But don’t worry, there’s a lot you can do to get back stronger than ever! Implementing cross-training like aqua jogging or elliptical training might be a good idea, but this should be discussed with your doctor. Each case is different, and you certainly don’t want to make things worse. Check out our videos for strengthening your core and legs muscles without impact:

HOW TO PREVENT STRESS FRACTURES FROM RUNNING

• A consistent training programme
  Keep control over your mileage. Make sure that you’re not massively overreaching from one week to another. The suggestion is to increase no more than 10% of your mileage per week. Introduce an unloading week  e.g. the last week of the month) to your training, so your body can adapt and rebuild. Reduce your mileage by 30 – 40% that week. On the week after, come back to your previous mileage and slowly increase again. Remember: sometimes less is more.
• Properly fitted running shoes
  If you don’t remember when you bought your last pair of shoes or it’s been around a year since the purchase, then yes, probably you need new shoes. Pay a visit to a specialist running store for a professional fitting and you should feel an instant difference!
• Resistance training
  Prepare your body for high impact by strengthening bones, muscles and tendons. You don’t need to go to the gym, there are plenty of options for home-based exercises that make you stronger and help prevent injury. Check our videos of training you can easily perform in any environment.

STRESS FRACTURE FAQs

Can you run with a stress fracture?

You certainly can’t and you probably won’t even try to run because the pain caused by a stress fracture is really noticeable. Truly, the only way to heal is offering yourself the gift of time and patience.

Can you walk on a stress fracture?

It depends how severe the fracture is. If you feel pain during walking your doctor might put you in a boot or crutches. On some occasions you might stay in a bed to reduce the impact and speed up the healing.

What if a stress fracture has healed but still hurts?

For the stress fracture to heal you need a minimum of 6-12 weeks – it depends on the place. If you feel acute pain during this time it's absolutely normal. Sometimes the healing process takes longer than usual – even months, or rarely years. But if you still feel pain even though your bone fracture is completely healed (chronic pain) it might be a sign of nerve damage or scar-tissue development. Consulting your doctor is the best way to establish the reason and address the problem.

What happens if a stress fracture is left untreated?

It gets more and more painful. In the worst scenario it can lead to a non-union bone fracture, which is much harder to heal. The sooner you react, the better!

What is the fastest way to heal a stress fracture?

Reducing the impact on the bone – sometimes even walking might be too much. Listen to your doctor’s advice and get a closer look at your diet. Taking Vitamin D supplements, avoiding alcohol and smoking definitely helps too.

This general information is not intended to diagnose any medical condition or to replace your healthcare professional. If you experience any pain or difficulty with these exercises/advice, stop and consult your healthcare provider. Always seek the advice of a qualified healthcare professional with any questions you may have regarding this subject.