How to Manage (And Prevent) Stress Fractures

Stress fracture: two words every runner dreads. They involve tiny bones and are caused by repeated stress, not big accidents. Nonetheless, they’re devastating—and devastating is not a word I use lightly. A stress fracture can be a season-ending injury. Worse yet, if not treated it can destroy a runner’s career.

I’ve had one. And I’m far from alone. Nearly two million American runners a year suffer a stress fracture. With numbers like that, stress fractures almost seem like a rite of passage for runners but they shouldn’t be. Here’s how to preventing this frustrating injury.

“Low Risk” And “High risk” Stress Fractures

A low-risk stress fracture typically heals on its own. You might not have to resort to a boot or crutches when it strikes. Most types of tibial or shin fractures and metatarsal stress fractures are considered low risk include.

When a high-risk stress fracture afflicts an area, healing takes more time because the injured area either lacks blood flow or because the fractured bone is a large one.

Fortunately, high-risk stress fractures are rare compared to their low-risk counterparts. But when they occur, stress fractures above the knee are particularly troubling. The femur, pelvis and lower back are among the strongest bones in the body and when they are injured it’s a big deal. In his book Injury-Free Running, chiropractor Dr. Thomas C. Michaud says stress fractures to these areas may indicate underlying medical problems. Overuse alone is unlikely to break our biggest, strongest bones.

Knowing When You’re at Risk

Bone, like muscles, adapt to stress. While running contributes to strong bones, it takes months for bone to strengthen under increased stress. In fact, there’s even a period where bone weakens in reaction to stress.

A stress fracture typically feels like an aching or burning pain. Usually, pressing on it hurts and the pain worsens as you run on it. Eventually, it’ll throb while laying your lying in bed or watching TV. If the stress fracture is along a bone that has a lot of muscles around it, like the tibia or femur, the muscles will feel very tight.

If you suspect a stress fracture, see an orthopedist immediately. Catching a stress fracture early can prevent a lot of pain. You might be able to save your bone from breaking if you act fast enough. When properly treated the early stages of stress fractures may only keep you from training for a few weeks weeks.

If your doctor tells you to rest, listen. Continuing to run on a stress fracture can cause it to become a real bone fracture. A real fracture will get you a one-way ticket to the couch and put future activity in real jeopardy.

What causes Stress Fractures?

It’s no secret that overuse is the chief culprit behind stress fractures.

Stress fractures usually happen when runners increased the volume or intensity of their training too quickly. It’s the classic case of too much, too soon—a mistake all too many of us make.

Athletes Who Are Susceptible to Stress Fractures

Novice Runners. People who don’t give their bodies enough time to readjust to the new training load are at high risk.

Female Runners. Research shows that female athletes are more likely to develop stress fracture than male athletes. One of the main culprits is the “female athlete triad” of menstrual dysfunction,low energy availability and decreased bone density caused by disordered eating.

Runners With Bone insufficiencies. Medical conditions that reduce bone strength and density like Osteoporosis can also lead to stress fractures. Research shows that stress fractures are more common in the winter which is believed to be linked to seasonal deficiency in Vitamin D.

Runners With Foot Abnormalities. Research shows that runners with anatomical foot abnormalities such as fallen arches have a higher risk of developing stress fractures than neutral arch runners.

Runners With Tight calves. According to research, stress fractures in the lower limbs can be caused by calf tightness. In fact, if you have tight calves, you are roughly five times more likely to sustain a metatarsal stress fracture according to a study published in The Journal of Sports Health.

Be Proactive, Not Reactive

Prevention is always better than treatment. Here’s how you can proactively avoid stress fractures.

Diet: Your diet has a huge impact on recovery speed. More importantly, it prevents injuries from happening in the first place. A two-year study conducted by the Clinical Research Center at Helen Hayes Hospital in New York found that high intake of dairy products was associated with a reduction in athletes’ stress fractures. More simply, just eat enough. Undereating is directly linked to increased rates of stress fractures in athletes.

Look at what might’ve gone wrong: Once you have a stress fracture, you are at a higher risk of re-injury. To prevent fractures from happening again, look at your training history and check for any sweeping changes in training volume or intensity that could have led to the onset of the initial fracture. If it looks like you did everything right, you might need to consult a sports physician to check for any strength imbalances, flexibility issues or biomechanical problems.

Strength Train: Muscle strength plays an essential role in the prevention of stress fractures. In an interesting study of muscle volume and the development of stress fractures, researchers determined that a 10-millimeter reduction in calf circumference was associated with an increase in the incidence of tibial stress fracture. However, if you strength train, make sure to do so correctly and within your limits. Strength training can be tricky and can lead to injuries so I always recommend doing having the guidance of a professional.