Stress Fractures in Runners: what you need to know

The Problem.

We occasionally come across stress fractures in runners and the main focus of treatment is on re-education of their training and increasing awareness of their individual soft tissue capabilities. Listening to your body and knowing when to reduce training or have sufficient rest after a specific event is very important and all too often neglected and this can cause a problem. We commonly observe that many runners are reluctant to modify their training schedules and a reduction in volume is often viewed as detrimental to their running. In fact overtraining is common in runners and ultimately causes injuries due to fatigue and poor structured training. The rule of increasing your running volume by only 10% each week is a good objective marker but at the same time this may be too quick for some people. Again, listen to your body and only increase your running if you feel comfortable and those niggles are not persisting.

Some stress is good for the body.

All soft tissues (muscles and tendons) and bones constantly adapt to stresses and provided the loading doesn’t exceed the tissues capacity to adapt then improvement and strength will occur. Stress fractures arise due to cumulative trauma usually due to overloading and excessive increases in exercise volume. There is a physiological response by the bone and a hair line fracture can appear. This is different to traumatic fractures that be may be unstable sometimes requiring surgery to fixate or manipulation to realign them. Radiological examinations are initially inconclusive and usually a callus (response by bone to lay down new tissue) formation is identified 2-3 weeks later. More often than not runners will have ‘hot spots’ (non-symptomatic stress fractures) that arguably may be normal and only symptomatic when something changes or when they exceed their normal training volume/intensities. Everybody has a different tolerance to tissue stress and an optimal amount of running per week. There are many reasons for this variation for example, age, genetics, overtraining, fatigue, diet and nutrition.


Case Study

I recently had a runner who prior to the diagnosis of a stress fracture had been experiencing some shin pain. They thought that if they ran a 20 mile race easily then that this would be fine as they hadn’t pushed themselves. The problem is that you are still loading your lower limbs thousands of times regardless of the intensity of the exercise.
Initially seek some physiotherapy advice to eliminate any abnormal lower limb loading.
Progressively loading the musculoskeletal system is paramount and therefore having some objectivity in how you train is important to enable you to modify and reduce running volume if you are experiencing pain. This is also important when recovering from a stress fracture as you need to put graded stresses through the bone in order to strengthen it. Only increase these conservative stresses as symptoms allow. Reduce volume if you are experiencing pain and increase slowly if not.

If in doubt consult a physiotherapist at Hallamshire Physiotherapy clinic and lets help you get back to running.

Matt W