Training for a marathon can be exciting. New goals to set, new limits to push, new challenges to overcome.
But, if done the wrong way, training can also derail every single plan a runner had.
Most people know the signs and symptoms of runner’s knee as well as general treatments for the condition (if you don’t, click here). However, what they may not know much about are stress fractures–what are they and how do you prevent or treat them? Let’s cover it all here.
What are Stress Fractures?
Stress fractures are small breaks in the bones of the feet, legs, or hips due to pressure put on those areas. Runners tend to experience stress fractures when they increase their training for marathons or competitions. School-age athletes are also at a higher risk for developing stress fractures at the start of a season if they have not kept up with conditioning during their hiatus. If athletes increase their training too fast, the muscles strain to keep up and that puts stress on the bones that they cannot handle. The bones eventually crack under the pressure and the result is a stress fracture.
The first sign of a stress fracture is an isolated spot of pain. This spot will be directly over the point where the bone fractured. It is rare that the pain will spread over the whole area, especially if the area is allowed to rest once the injury is detected. If the pain spreads, it is more likely something other than a stress fracture but only a medical professional can be certain.
Stress fractures develop quickly and are not caused by any one specific injury. Athletes often won’t know they’re injured until the fracture becomes bad enough to affect the area around it and the pain spot develops. Discomfort will come and go until the fracture becomes larger. Runners may only notice the pain after they have been on a run for some time. But if they do not rest the injured area, the pain will come on faster with each run until it is constant whether or not they are on their feet.
While rest is the most common way to treat stress fractures, sufferers should see a doctor if pain becomes constant. Constant pain is a sign that the fracture is getting worse. Left untreated, stress fractures can lead to full breaks in the bone. These can take months to heal, rather than the weeks of rest required for a stress fracture.
As mentioned above, a sudden increase in training can lead to stress fractures. These are most common before a marathon or competition, or at the start of an athletic season. Sports medicine surgeons suggest that runners increase their training stress by no more than 10% a week in order to avoid this issue. The specific numbers vary from athlete to athlete, but the general guideline will keep runners on their feet and help craft a safer training schedule.
Any athletes who suffer from low bone density are also at a higher risk for stress fractures. This group can include female runners, older runners, and any runner who does not have a nutritionally round diet. New terrain will also put runners at a higher risk for fractures since the muscles are not used to the impact they must cope with. Inadequate shoes increase fracture risks for similar reasons.
There are two phases to the treatment of a stress fracture. Phase one is done at home. But, as with all sports injuries, it is better to see a medical professional if possible.
At-home stress fracture treatment reduces pain before the patient can get a doctor. It is not a substitute for medical advice. The basic guidelines are to follow the RICE protocol – Rest, Ice, Compression, Elevation.
Rest – Try to avoid putting any pressure on the injured area. Wear supportive shoes if complete rest is not possible.
Ice – Apply a cold pack to the injured area for no more than 20 minutes a time. Do this several times a day. This will reduce swelling to the area which will, in turn, reduce pain and avoid additional injury. Never apply ice directly to the skin.
Compression – We recommend something from our line of compression socks or sleeves. They’re designed to help prevent muscle from adding more strain to a fractured bone. Check them out below; you can even choose from different color schemes to match your outfits.
Elevation – If possible, raise the injured area above the heart. This is another way to reduce swelling since it reduces blood flow to the area. As with the “Ice” step, the area should only be elevated for about 20 minutes at a time. If elevation makes a person dizzy or short of breath, lower the injured area and report this to a doctor.
NSAIDs – over the counter pain medication – reduce swelling and pain. It is important, however, that athletes do not use painkillers just to get themselves back to training. This will lead to a more severe injury and, potentially, a completely broken bone.
At the Doctor’s
Even if an athlete is using the RICE method at home, they should still see a medical professional. A doctor will ask about the person’s medical history, activity level, and diet so that they have a full picture of the person’s fracture risks. They may also require blood tests to check calcium and vitamin D levels if a person has suffered multiple stress fractures.
Most stress fracture treatments are prescribed based on the level of pain the patient is experiencing. It is important that patients do not take painkillers before an evaluation appointment. If they must take painkillers, a log or journal of their pain level will be enough for most doctors to set up a treatment plan. Most treatment plans aim to reduce pain and swelling so that the injury can heal. Patients may not feel the effects right away, but ignoring a treatment plan can lead to further injury up to and including a fully broken bone.
X-rays are commonly used to diagnose stress fractures. Fresh fractures (between 4-6 weeks old) might be missed on an x-ray, however. If someone is sure they have a stress fracture, they can ask for a bone scan or MRI. Either procedure will find fresh fractures that x-rays may have missed.
After the Evaluation
Once an athlete has been diagnosed with a stress fracture, treatment can begin. Recovery typically takes 6-8 weeks. This time frame will be longer, however, if patients do not follow their treatment plan. If patients want to stay active, they can ask their doctors about swimming or bicycling as low-impact fitness alternatives.
Some doctors may recommend protective footwear. This can include special stiff-soled shoes, wooden-soled sandals, or a removable short-leg fracture brace. This final option is commonly referred to as a “boot” and is similar to the footwear worn by people who have broken a bone but are out of their cast.
Hard-to-heal bones, such as very fine bones in the foot and certain leg bones, require more support. If the fracture affects these bones, the doctor may recommend a full cast to prevent additional damage.
Severe stress fractures may require surgery. It is uncommon, but it does happen. Surgical treatment involves placing pins or fasteners in the bone to prevent them from moving while the bone heals. This is called ‘Internal Fixation’. Stress fractures this severe require a longer recovery period which only a medical professional can determine.
Doctors will often want to confirm that the fracture has healed through the use of x-rays, bone scans, or an MRI. Once they are certain the fracture has healed, they will clear their patient to return to a normal training schedule. Even with a doctor’s go-ahead, athletes will have to gradually return to their previous activity level or risk a new stress fracture.
Prevention and Risk Reduction
Stress fractures can be avoided, whether or not a runner has had them before. The easiest way a runner can reduce their risk is to gradually increase their training load. 10% per week is the maximum recommended level. Runners can use this information to craft a training schedule that allows them to stay safe while reaching their goals. If athletes want to get more risk reduction from their training, they should also add weight training and cross training to their routine. Athletes can stick to the 10% per week guideline while increasing the strength and flexibility of their muscles. Increased durability and flexibility reduces the stress muscles place on bones, which means a lower fracture risk. It is also important to ease into any new activity, including new terrain. Runners need to give their bodies time to adjust before they go all-in.
Other ways that athletes can reduce their fracture risks are to make sure they wear supportive shoes, eat a nutritionally round diet, and stretch before their workouts. They should also pay attention to any new stress fracture symptoms and get a medical evaluation as soon as possible. If they suffer multiple fractures, whether all at once or over time, athletes should have their bone density checked as well.
And that should basically cover it. For more, check out the video below–and remember, safety first!
- Dr. David Geier, Should a Runner Stop Running With a Stress Fracture?
- Ortho Info, Stress Fractures of the Foot and Ankle