Overcoming Stress Fractures from Running

Bone Stress Injuries
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One common running related injury most athletes have heard about is a bone stress injury (aka stress fractures or stress reactions).

Bone stress injuries (BSI) make up approximately 16-20% of running-related injuries. They are generally due to repetitive and excessive loading of the leg.

Loading is a concept that is key to understand running injuries. Load is added when there is stress to the body = long miles, speed work, difficult terrain, etc.

Of course we need this "stress" and "load" to improve as runners! But too much load can tip the scales into injury.

I explain this concept more in this blog post HERE.

When loading exceeds the athlete's ability to recover from those stressors, injuries occur.

And although I am strong believer of keeping runners active in their sport, this is one injury where it is necessary to stop running for 6 weeks or more.

In this blog post, I'll share some of the risk factors associated with BSI and how important a multi-provider approach - nutrition, physical therapy, and medical professionals - is to help get athletes back on track.

The Signs of BSI
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• Pain during all weight-bearing activities (running, jumping, walking, standing)

• Aching pain at rest

• Pain at night

• Point tenderness (particularly for the shin or foot injuries)

Common locations of these injuries are: pelvis, femur (thigh), tibia (shin), and foot bones.

What Puts Someone at Risk of BSI?
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1. Repetitive Load: Running is a repetitive sport! But when training errors lead athletes to run too fast, too far, for too long, this can increase chance of BSI.

2. Running Form: Poor running form, inadequate footwear, and imbalances in muscle strength and flexibility can result in abnormal stress distribution on the bones.

3. Diet/Nutrition: Nutrition plays a crucial role in bone health and recovery. Inadequate intake of calcium, vitamin D, and iron can compromise bone resiliency.

4. Genetics and Hormones: Genetic factors and hormonal imbalances, such as low estrogen levels in females.

5. Medication Use: Certain medications, such as corticosteroids, can weaken bones and increase the risk of stress fractures.

6. BMI <19 kg/m²: Low body mass index (BMI) values below 19 kg/m².

7. Early Sport Specialization: Engaging in intense and repetitive training from a young age, without appropriate rest and variety in physical activities.

How Bone Stress Injuries are Managed
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When it comes to managing bone stress injuries, it is crucial to consider all the key factors such as:

1. Diagnosis: A proper diagnosis is essential for effective management. Imaging techniques like MRI or bone scans can help determine the grade and location of the bone stress injury.

2. Team Approach: Managing complex bone stress injuries often requires collaboration among professionals, including a nutritionist/dietitian, physical therapist, and sports doctor.

3. Rehabilitation Progression: The severity of the injury and its location will determine the course of treatment in physical therapist. It'll be important to make a customized plan that considers the athlete's goals.

Nutrition is a Key Player in Prevention and Recovery
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Our bones rely on proper nutrition in order to recover from our repetitive sport. Below are several nutritional recommendations to help combat BSI:

1. Calcium: most adults should aim for 1000-1300 mg/day of calcium. Good dietary sources include dairy products, leafy greens, fortified foods, and supplements if necessary.

2. Vitamin D: Adequate vitamin D intake is essential for calcium uptake and bone health. If someone lives in an area of low sun exposure, they should consider asking their doctor if they'll need a supplement.

3. Iron: Iron is essential for red blood cell production and oxygen transport. Sources of iron = lean meats, legumes, dark leafy greens, sardines, etc.

If you or someone you know suspects they may have signs of a BSI, it'll be important to seek out a medical provider who is used to seeing athletes!

Although athletes will be instructed to stop running for a period of time, it is important to remain active with modified activities. I've worked with plenty of runners while they are still on no-run precautions to help them find exercises that are safe for them.

Then once they are cleared for running, it'll be crucial for the athlete to work with a physical therapist who has a solid understanding of managing loading in runners.

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Thanks for reading!
I hope this was helpful and informative! Please reach out at [email protected] for more questions or discussion regarding this or any other topic. 

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Sources

Warden SJ, Davis IS, Fredericson M. "Management and Prevention of Bone Stress Injuries in Recreational Runners." Journal of Orthopaedic and Sports Physical Therapy 2014

Kraus E, Tenforde A, Nattiv A. "Bone stress injuries in male distance runners: higher modified Female Athlete Triad Cumulative Risk Assessment scores predict increased rates of injury." Journal of Orthopaedic and Sports Physical Therapy 2019.