Stress Fractures: What you need to know
A stress fracture, put bluntly, can mean you're out for up to 3 months. But a full recovery is possible. But what can we do to prevent such an injury?
What is a stress fracture? Exactly what it says on the tin! A stress fracture is usually suffered by a runner from what seems innocuously running along and their bone suffers an insidious fracture. You don't need to have fallen, or tripped, or kicked anything. This is simply from the impact with the ground! What causes a stress fracture?
1. Sudden changes in frequency, intensity and / or duration
2. Pushing through pain! (See earlier blog!)
Altered biomechanics when we are in pain will modify your foot's impact which leads to an increased risk of a fracture
3. Insufficient recovery time
Rest!
4. Sudden change in running surface
For example: treadmill to road or grass to road
5. Sudden change in shoe type
Typically from supportive to unsupported
6. Running in old shoes
Change your shoes regularly
7. Low bone density
If you are suffering repeated fractures from innocuous injuries then consider liaising with a GP for a DEXA scan. If your bone density is diminishing (osteopenia) then you maybe a candidate for calcium and vitamin D supplements. If this is ignored and other risk considering factors occur, for example; age, gender and diet, osteopenia which is reversible is more likely to become osteoporosis which is irreversible.
What are the metatarsals?
These are the long bones in your feet. We call them 1st - 5th metatarsals. Number one being your big toe, number 5 being your little toe. Stress fractures usually occur in the 2nd & 3rd metatarsals due to the foot's anatomical structure and biomechanics.
What are the signs?
It's not just painful to run! It's painful to walk and worsens the further you walk.
It's painful at rest, even when your foot is non-weight bearing
You may have some signs of redness and swelling.
How can I be sure it's a stress fracture?
An X-ray is used to confirm a stress fracture. I have left this image large, so you can see how hard they are to spot on an x-ray! Sometimes a consultant will use an additional x-ray approximately 6 weeks later to see bony regrowth to confirm their diagnosis.
Irrespective of an x-ray, the treatment for suspected or confirmed x-ray is the same. You will be given a hard, supportive walker shoe to walk in. Typically, you are allowed to weight bear in the shoe but your consultant will confirm this. On occasions, you will be put into an ankle cast.
How long will you be out for?
In short, you will be like this for the first 6 weeks. A consultant may wish to arrange a follow up after this period an organise an additional x-ray to confirm whether bony regrowth has significantly occurred for you to have the cast removed and walk in a hard, supportive shoe still. You may be suggested to walk in a hiking boot.
In extreme cases, you maybe fortunate enough to have a graduated return to running from week 6 - 12, however your consultant may suggest you work with an running injury specialist, like your local, friendly physiotherapist. You will need this to ensure you are performing stretching and strengthening exercises too. How can I reduce my risk of stress fractures?
1. Balanced diet
2. Regular GP health checks
3. Get rid of the old, worn out trainers
4. Allow yourself to have down weeks.
5. Ensure you get >8 hours of sleep per night!
6. Increase your exercise tolerance gradually
7. Build in low impact cardio-vascular training too
8. Include strength training into your program
9. Listen to your body (see earlier blog!) If it hurts, your body is warning you
10. Learn from your mistakes. If it happens once, don't let it happen again!
The warning signs will be there, don't ignore them. Listen to that niggle that you get. It might keep you out for a week or 2, but that niggle may become a stress fracture, which will keep you out for a lot longer! See a highly specialised clinician; get assessed, identify what is at fault, and put necessary corrective actions in place.
