Stress fractures are some of the most common overuse injuries in runners. They can occur in any of the bones of the pelvis, leg, and foot, but most commonly they occur in the weight-bearing bones of the lower extremity: the femur, tibia, talus, and metatarsals. In athletes, stress fractures are usually caused by an increased demand on normal bone due to repetitive stresses and increased muscular pull on that bone. With training, your muscles, tendons, ligaments and bones undergo changes physiologically to become stronger and adapt to the increased load, or stress demanded on that tissue. Bone, however, cannot adapt as quickly as the other tissues in your body, resulting in a bone injury. Abnormal or weakened bone, as in osteopenia or osteoporosis, can handle even less load on them, therefore increasing the risk of injury.
Symptoms: Identifying a stress fracture at its earliest onset is crucial and can decrease the risk of developing a true fracture, or other injuries. Some of the symptoms experienced could be a sudden onset of pain, pain that worsens as you continue to run, tenderness over the involved bone or the area in close proximity, and slight swelling in the area. If you experience any of these symptoms, it is important to seek medical guidance.
Diagnosis: A physical therapist or physician may perform a series of diagnostic tests to try to elicit pain in the bone questioned. The golden diagnostic tool for determining a stress fracture is an MRI or bone scan, which should be performed when a stress fracture is in question.
Treatment: Running should be terminated immediately. Continuing to run on a stress fracture could cause further damage to the bone, and it could increase the risk for developing chronic pain syndromes. Treatment will typically begin by placing the affected extremity in an immobilizing boot for 4-6 weeks, depending on the rate of bone repair in each individual and the integrity of the bone. Some stress injuries may even require ambulating with crutches to completely alleviate any stress on the affected bone.
The doctor may clear you to continue cross training in an environment that decreases stress on the bone involved. Activities typically include swimming, aqua jogging, stationary biking and reduced bodyweight training on an Alter-G anti-gravity treadmill. Be sure to consult with your physician or physical therapist before beginning any activities. It is important to ensure that all activities are pain-free. Pain in this case is your body’s way of telling you that the area has too much stress on it and healing time may be further delayed.
In most instances, ground running will not begin until 6-8 weeks post injury, once your doctor has cleared you. This is to ensure proper healing of the involved bone. An interval program should be implemented at first, where you alternate between bouts of walking and running. This will enable you to safely gauge your body’s response to the activity. You should not progress your distance or time running if you continue to experience pain, or feel as though you are changing your form to compensate.
The good news is that these injuries usually heal 100% and sometimes quicker than tendon or muscle injuries. So, don’t stress over it, get help, and get back to your activity safely.
Sara Whitney, a graduate of Northeastern University, is an orthopedic/sports medicine physical therapist at FOUNDATIONperformance’s Pawtucket location. She can be reached via their website at foundationperformance.com.