Out of all the injuries you want to avoid as a runner, a stress fracture will be high up there. It’s a sentence for rest and rehabilitation and can stop you running for months on end. On reflection, I think I may have had a stress fracture after the London Marathon in 2010; admittedly I never sought help and just managed it myself which I absolutely would not advise you to do! I couldn’t walk without pain, let alone run, for a long time and it was really debilitating. Perhaps if I hadn’t ignored all the warning signs, I may not have ended up in that situation at all. Stress fracture or not, I should have listened to my body.
What is a stress fracture and where do they occur?
Bones are constantly remodelling themselves to remain strong and be able to cope with the stresses applied to them. Stress fractures can occur for two reasons; If a healthy bone is overused, such as in long distance running where the bones are under more stress than normal, the bone may not be able to repair itself at the rate that it’s being damaged, leading to fractures. If a bone is abnormal, such as in osteoporosis, the bone can fracture even when under normal strain.
The most common site for stress fractures are in the shin bone (known as the tibia) and in the bones of the feet (known as the metatarsals.)
Who’s at risk of getting stress fractures?
Stress fractures are common in athletes but there are various factors that can make you more susceptible. Some of these will be environmental, meaning things you inflict on yourself, such as a training regime, while others will be personal to you and may well be out of your control, such as gender and your anatomy.
Certain factors in a training regime have been shown to contribute to a higher risk, such as a high mileage training programme, inadequate recovery between sessions, training on fatigued muscles, and running hills, especially down hill. Running on harder surfaces has been shown to increase the risk too.
Personal risk factors include being female, poor nutrition (particularly low calcium) and being a smoker. In a previous post I’ve talked about the effect of running on your periods, and in turn, your bone health. What’s often referred to as the female athlete triad; low bone density, irregular periods and low BMI, can put female runners at a higher risk of developing stress fractures.
How do stress fractures present?
Stress fractures cause pain in the bone which gradually worsens, presenting earlier in a training session. If it’s not treated, the pain will worsen further and be present in normal day to day activities. The area of bone will be tender when it’s touched and there may be swelling and bruising seen too. It can be diagnosed by various imaging such as X-ray or an MRI scan.
How can stress fractures be prevented?
Follow a structured training regime: As mentioned above, stress fractures are often caused by intense training regimes. That’s why it is so important to increase your training gradually and follow a structured plan. Many plans use something called periodisation where you increase your training over three weeks followed by a week of relative rest which allows the bones to recover. I’m not a running coach and would advise you to seek expert help before embarking on your training to make sure you get it right.
Run on soft surfaces: If possible, try and run on softer surfaces as this will reduce the impact on your bones. Find a trail or grassy area in your local park to mix up your training.
Nutrition: Good nutrition is essential for bone health. As well as maintaining an adequate calorie intake and normal BMI , we should all aim for around 1500mg calcium each day. If you’re not sure you’re getting this in your diet, consider taking a supplement; ask a dietician or your GP for advice on this.
Listen to your body: As with any injury, it’s essential that you assess it sooner rather than later, so if you’re developing bone pain, get it checked out! Over the years I’ve ignored enough injuries to know it’s really not worth it!
What can be done about a stress fracture?
The treatment of stress fractures vary depending on the type of fracture. Many can be managed by reducing sporting activity and adjusting risk factors, while some will need more intensive rehabilitation and even surgery.
I hope this has been useful for you. Writing this has actually made me think about my own nutrition and whether I’m getting enough calcium diet, so that’s something I’ll definitely be looking into.
I’d love to hear your experiences with injury and stress fractures, so feel free to comment below 🙂
References: BMJ 2012;344:e2511