The Running Physio
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TRP's Running Blog

All things running. Good info only.

What you need to know about...Stress Fractures

 Ouch. The worst.

Ouch. The worst.

The dreaded word. The dreaded runner’s injury. Stress fracture. Many of us are familiar with the concept of a stress fracture, but what does it really mean, how can we best treat it, and most importantly, how can we prevent it in the first place?

When we walk, run, lift weights, and exercise, our muscles and bones absorb the forces of these movements. This is normal and our skeletal system is well-equipped to do this as when we stop quickly after stopping the exercise, our bones recover, heal, and strengthen up to become more resilient. If you’ve ever broken a leg bone, you know you need to weight-bear even with crutches in order to kick-start the healing response. Our bones are designed to become stronger in a response to stress - which is pretty cool, but problems can arise when we don’t allow our bones enough time to recover in between stressful activities (like running). There is very rarely a specific moment where we develop a stress fracture - it is usually the cumulation of increasing the volume or intensity of your workouts too quickly, i.e, too much, too soon. Remember that anyone of any ability can get a stress fracture because the amount of tolerance that our bones has to running is variable. Someone who has been running for 10 years can do much more running without causing a stress fracture than someone who has been running for 10 months.

There are several grades of stress fractures. They range from a Grade 1 stress “reaction” - when the outermost layer of bone is irritated or inflamed, to Grade 4 - where a true fracture line can be seen on an X-ray. Most stress fractures are not this bad and will in fact show nothing at all on an X-ray. A good physiotherapist can confidently diagnose a stress fracture during a proper assessment in clinic - you don’t need imaging done to come and see us. If it looks like a stress fracture and smells like a stress fracture, it’s probably a stress fracture.

Many people think that you can’t do anything to heal stress fractures but wait. While this is partially true and a period of limited weight-bearing activity is recommended, a better approach is to use your time spent not running to identify underlying biomechanical patterns that may have contributed to the injury in the first place. For example, a common location for stress fracture is the inside shin bone, or the medial tibia. While this likely was somewhat due to a sudden change in running habits, other contributing causes can be poor shoe choice, weakness to muscles in the inside or outside of the shin, weakness to muscles in the foot or ankle, stiffness to the ankle, or even weakness or stiffness higher up the chain the glute muscles or deep core. So while it can really stink to be missing runs, it can also be an opportunity in disguise to take a good look at your mechanics to make yourself more bulletproof moving forwards!

Stress fractures can vary in how long they take to fully heal. The length of time depends on the grade of the fracture, as well as the location. Certain parts of the body are considered “high risk as they have less blood flow and therefore can take longer, while “low risk” bones have greater blood flow and therefore are a bit quicker. On average, stress fractures will require a runner to be off running for minimum 8 weeks. (Bummer. We know.) Hence - prevention is key!

Patience. Patience, patience, patience. A runner’s greatest asset is patience. Training your body to withstand the forces associated with running takes a very long time. We always recommend at very minimum recording how much you are running each week so that you don’t end up going extra far one week if you aren’t used to it. Also remember that faster or harder running is harder on those bones - never increase both speed workouts and distance workouts at the same time as even the healthiest body can have a very hard time keeping up with these increased demands. We know keeping up with a strength routine during the running season can be hard, but lifting weights can also improve bone resilience to the forces of running.

Keep yourself strong, keep yourself fast, and keep yourself stress-fracture free with a little bit of TRP guidance. We’re always here to help.

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Lauren Roberts