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Stressed About Stress Fractures

Posted by Filed Under: Running Injuries

injuries1.What exactly is a stress fracture?

A stress fracture occurs where there is an inability of the bones’ intrinsic repair process to keep up with the stresses applied to it over time. Ultimately, this leads to a break or fracture in the bone. In short, it results from an abnormally high stress placed on normal bone leading to fracture.

2.What are the causes/predisposing factors of this injury?

One of the most common causes is overtraining. Either too much volume or too much intensity, or both together, without the appropriate lead up can be so overwhelming that the increased workload causes bone failure over time.

Structural misalignments—such as overpronation from a flat foot or excessive supination from a high arched foot—can also lead to stress fractures since they can place high loads on bone. Footwear that is inappropriate or worn out can also cause higher than normal stresses on bones and cause stress fractures.

In women, diminished bone density can also predispose to stress fractures.

Poor diets that are low in calcium and other minerals required for bone health can also contribute to stress fractures.

3.What are the symptoms?

Stress fractures usually present as point tenderness over the fracture site. The pain may be felt at rest and intensifies with activity, especially weight bearing activity. Most stress fractures occur in the lower part of the body especially the tibia and foot, but can also occur in the fibula, pelvis and neck of the femur.

4.What can be done to prevent or treat this injury?

Proper training and preparation for activity is essential. Build up mileage by no more than 10 percent to 15 percent per week and do not do back-to-back hard days. Try not to run on overly hard surfaces all the time, vary runs on trails or grass or treadmill if possible.

Speedwork and high intensity training should be preceded by a warm up and a stretch, and followed by a cool-down.

Any biomechanical issues should be addressed with proper shoes and orthotics, if needed. Old shoes should be discarded, and optimally, two pairs of shoes should be rotated on alternate runs.

A diet with appropriate caloric and nutrient content is also important, especially calcium and vitamin D, which are critical for bone health.

Treatment consists of relative rest (non-weight-bearing activity) for up to eight weeks (more with femoral fractures). Activity during this time should be non-impact such as pool running or biking. A gradual return to weight-bearing activity can begin after two to three weeks of being pain free. Some studies suggest using an air splint (cast), but results are equivocal. Anti-inflammatories and icing may also be used to reduce pain and inflammation.

I also find that treating the muscles and soft tissues around the fracture site, to restore proper tone, strength and balance to be essential for a full recovery.

About Lee Miller D.C.

9536 - 87 Street Edmonton, Alberta T6C 3J1 Phone: (780) 426-6777 Fax: (780) 469-6930



5 Comments
  1. Anne on August 30th at 12:03 pm

    This article certainly speaks to me — and about me. I’ve been laid up all summer trying to heal from a stress fracture of the femoral neck. The advice you provide is very good — especially when it comes to nutrition. I’m lactose intolerant and over time my lack of dairy and scrimping on calcium-rich dark vegetables, combined with doing all my mileage on hard surfaces, contributed to my injury.

    I’d also add for those that suffer from my type of stress fracture — it initially may feel like a groin pull. That’s what I diagnosed and treated and then ran a marathon. Had I known I’d cracked my hip, I certainly would have done things differently. Beware.

  2. Dr. Lee Miller D.C. on August 30th at 2:46 pm

    Excellent point Anne. Femoral stress fractures usually present as a groin pull that continues to worsen. Pelvis stress fractures are also usually mistaken as soft tissue injuries too. Tibial stress fractures often are preceded by “shin splints” or what we now call medial tibial stress syndrome. When in doubt, ask for a bone scan which can generally speed up diagnosis.

  3. Melanie on July 10th at 5:43 pm

    Hi there,
    I’m onto my second stress fracture in a year! First one was femoral neck second is the other femor 14cm down.
    Ive not run for 6wks now just cycling and swimming,think I upped my distance to quickly.
    Could you please give me a basic programme for when I start running again so I don’t repeat my injuries.
    Thanks so much Mel

  4. Lee Miller on July 11th at 9:39 am

    Hi Melanie,
    The first question I would ask is have you had your bone density checked? This is critically important to see if this is more of an intrinsic problem with the bone versus overtraining. If your bone density is ok then you need to follow a graduated program to return to running. The general rules I give for returning to running are: no more than 15 to 20 minutes per session and no back to back days of running. So for week 1 you may only run 2 times per week for 15 to 20 minutes but have 2 days in between. Do this for 2 weeks. Week 3 may include a 3rd session of running of 15 to 20 minutes but runs are every 2nd day. If no problems persist after doing this for 2 weeks, then you may increase running time by 10% total per week. For example if you are running 3×20 minutes per week= 60 minutes, next week is 60 x 10%=66minutes or 3 x 22 minutes. If you can do this until you build up to 45 to 60 minutes per run, you should be ok.

    Hope this helps give you an idea of what a graduated return to running looks like.

  5. Melanie on July 11th at 6:33 pm

    Thank you Dr Miller for that information.
    Yes I have had my bone density checked and it seemed to be in the normal range for my age(37). I was sent to an endocrinologist by my sports Dr and he is going to further check my bone density as I have a history of disordered eating, currently I am at 47kgs and 5ft5 which he seemed ok about.
    Im hoping it was just something as simple as over training as I’m not good at rest days.
    Ive only been running for a couple of years and don’t want to have to give it up, but do tend to go hard out so I will give your program a go when I get the all clear, hopefully in about two weeks.
    I find it really hard when I see some people out there running every day and I seem to have these recurring injuries.
    Anyway the cycling and swimming are helping the cabin fever : )

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