7 Running After Stress Fracture Guidelines

A few weeks ago on Facebook I asked what injury had taken you out of the running game and I was blown away at the number of people who said running stress fracture! Not only that, but how many reported having multiple stress fractures.

Like any good journalist my interest was peaked and the research began!

I quickly realized that this is one of the most common and frustrating injures among runners (right alongside the IT band). Unfortunately the female athlete triad or other nutritional issues are one of the big causes…but not the only.

What is a Stress Fracture?

According to the Mayo Clinic: Stress fractures are tiny cracks in a bone. Stress fractures are caused by the repetitive application of force, often by overuse — such as repeatedly jumping up and down or running long distances.

Stress reaction: Bone is breaking down and becoming weak, but has not broken (usually minimum 3-4 weeks non-running exercise)

Stress fracture: A fissure has occurred in the bone, might need a boot for stabilization (usually 6-8 weeks non-running exercise)

It appears that many doctors will use the two interchangeably, though they are different! I think this is largely to ensure you understand that the bone needs rest and because they can’t say this chronic and repetitive bone stress.

This is not to say that running will always lead to stress fractures. They are indeed preventable in most cases!

The most common running stress fractures are to the tibia, metatarsals (the foot bones), fibula and femur. The second and third metatarsals of the foot, receive the  greatest impact when you push off to walk or run and thus are very common.

Basically the lower leg, which is absorbing so much of the impact from each foot strike. And becomes weakened with underfueling and overtraining.

Most stress fractures are treated non-surgically. Which means the recovery process is largely in your smart hands.

What Does a Stress Fracture Feel Like?

This is something many runners have wondered when they start to experience foot pain. Could it be a tendon, a bruise or is it a stress fracture?

When it comes to a stress fracture, the most notable symptom is localized pain that gets worse with running over time.

Meaning, you might notice a little something at a specific spot in your foot/ankle/shin/hip and think nothing of it, but over the course of a few weeks the pain keeps getting worse and worse every time you run.

When you can pinpoint the pain, and the pain is on a bone, a stress fracture is definitely a possibility.

• Try backing off for a few days.
• If you return without pin pointed pain, it may have been a tight or overworked muscle.
• If not, then go get an x-ray – ASAP. It’s better to catch it as a fracture before you turn it in to a full break.
• A break will require more time to recover and stress fractures don’t magically heal by ignoring them.

Here are other common running foot pains if you still aren’t sure.

After doing my research, I noticed that Diz Runs has actually been doing a ton of amazing content on injury recovery, so I reached out and he has graciously provided us with this massively awesome post on recovery from a stress fracture or preventing one!

7 Keys to Running After a Stress Fracture

Running after a stress fracture is a difficult process for a lot of reasons that go well beyond the physical.

The array of emotions many runners will feel as they get back into the sport can be all over the map:

• Worried about the potential of re-injury
• Discouraged over potentially losing fitness
• Excited to be running again

Whatever emotions you’re dealing with, remember that getting back into running after a stress fracture isn’t as easy as lacing up your shoes and heading out the door.

The first few times out after being cleared to run after a stress fracture can be tough for a few reasons:

#1 Phantom Pains After Stress Fracture

You will feel just about everything going on within your body, and you’ll be worried that each of them is a new injury!

Trust me, you’re fine.

• focus on your breath
• take in the scenery
• enjoy the fact that you’re running
• try not to be paranoid about every little sensation

#2  Go Short, Go Slow

This can be tough, but you really do have to ease back into running slowly. Remember, your stress fracture developed over many miles, and if you try to do too much too soon there’s a good chance that you can cause the stress fracture to come back!

• keep your first runs short (and short is relative, it depends on how long you’ve been out and what your mileage was like before the injury)
• ensure your intensity is low (again, relative)
• allow your body to re-adapt to the demands of running (act like a beginner!) – all of your joints, muscles and tendons need that time
• seriously act like a beginner, use run/walk, follow the Couch to 5K plan if you need guidelines

#3 Work Through Mental Fears of the Loss of Fitness

If your running stress fracture had you out for awhile, you very well may have lost some of the fitness that you worked so hard to build over the past weeks/months/years.

Hopefully you’ve been doing a lot of cross training while you were healing, but we all know that getting out and going for a run is just different, and if you haven’t been able to run for awhile it can be frustrating to feel like you’ve lost ground.

• For the first several runs after coming back from a stress fracture, just enjoy the fact that you are running again and that you can do so without pain.
• Remember that you will regain fitness faster than the first time you tried to get there because your body and mind know what is possible.
• Checkout this full guide on how much fitness you lose with time off

Over the next several weeks you’ll be able to work back to where you were pre-injury, and as hard as it can be to stay patient that’s the best thing you can do to prevent another stress fracture.

#4 Pre-Hab and Re-hab Like It’s Training

I cannot emphasize enough to work with a Sports focused Physical Therapist. A general PT is focused on simply getting you walking pain free, a sports PT wants you to run strong and get back out there 100% as quick as possible.

Once they assign you PT exercises, do them.

Sounds obvious, but I’m serious. If they give you 5 exercises to do 3 times a day, do it! These movements are not just going to help with the recovery process, but will prevent future running injuries.

Don’t be afraid to ask your PT what you can do. Can you bike, can you swim, can you yoga? Find out the limitations and then STICK TO THEM!

Rushing the recovery isn’t worth the setback.

#5 Strength Train Consistently

We know that running is good for our health and our bones, but strength training is the other thing that’s a must for strong bones!

According to multiple studies, strength training places a stress on the bone which tell the bone to build mass even in those with osteoporosis!

While you are waiting to place weight on your injured leg, start weight training with your upper body and core. That’s right, it’s going to help as well! Strength training for runners helps with endurance, improves posture, improves speed and will help prevent other injuries.

Once you are ready to start adding strength to the leg again, work with that PT to get guidelines.

• Start with body weight only movements
• Consistently utilize single leg movements, this will help ensure your stronger leg doesn’t compensate after injury
• Add in mini-bands
• Finally you MUST lift weights – the studies show the bone building occurs from lifting heavy things, not just your body weight.

#6 Focus on Inflammation Reduction

During the recovery process there are going to be aches as the body adapts to getting back to the intensity of running. Our goal is to both help the body adapt and relieve the mental fears from soreness.

Some inflammation is required after a workout to produce results.

BUT chronic inflammation from high stress or pain, we want to control without using NSAID’s.

• Herbs For Muscle Recovery – easy things you can add like tea to feel good
• Anti-inflammatory Meals – Foods that are going to assist in recovery
• CBD Oil for Runners – This was a game changer for me after knee surgery. Maybe largely because it improves sleep.

#7 Return to Running Program After Stress Fracture

This is not a time to wing it, like we might do with some races. You want to follow a truly structured plan to return to running and keeping it pain free.

Phase 1

• Eliminate all weight bearing activities until cleared by your Doctor
• Start doing the strength training for upper body and core immediately
• Ask if you are cleared to do Aqua Jogging or Pool Running  – this is a phenomenal way to keep your fitness and will be really useful during the rebuild

Phase 2

• Begin doing cross training like a stationary bike, rowing or swimming once cleared
• Continue doing strength training, only start adding in any lower body approve by Physical Therapy
• If there is pain, stop, reverse and go back to phase 1.

Phase 3

Now it has probably been 6-8 weeks and you’re ready to officially start running.

• Start with a short 20 minute run/walk session
• After every session evaluate any appearance of pain and go back to phase 2 if it appears
• Continue walking daily and slowly increase the number of runs each week
• Then slowly increase the volume of time running vs walking
• Don’t add speed work back to your plan until you have at least a few months of completely pain free running

After all of this, read on for the must do’s to prevent any future stress fractures from running!!

Pictured here RunTriTam

Speaking of preventing a stress fracture in your foot from running…

How to Prevent Running Stress Fracture?

Assuming that you’re going to keep running, and that the running caused the stress fracture in the first place, is it just a matter of time before you’re dealing with the same problem again?

No!

Not every injury, stress fracture included, can be prevented but there are certainly things you can do to minimize your chances of getting another stress fracture (or getting your first one, if you’ve never had one before).

1. Increase Mileage Slowly

The rule of thumb is to increase total mileage by no more than 10% per week, but coming off of a stress fracture you’d be wise to be even more conservative for the first month or two.

Yeah, it might be frustrating to progress at such a slow rate, but it beats no running at all because of another stress fracture!

2. Mix Up Running Surfaces

Running on asphalt or concrete is harder on your body than running on trails or grassy fields.

A running surface that has a little more give to it will lessen the stress on your body, and can decrease your odds of developing a stress fracture.

3. Get Off the Treadmill

I really hate running on the treadmill, but I know some people like them and that’s fine. {Amanda’s Note: yup love mine!!!}

Believe it or not, there can be a link between treadmill running and stress fractures.

When you’re running on the treadmill, your feet contact the deck of the treadmill pretty much exactly the same every step. If you’re running on any other surface, you’re going to get slight variations with how your feet hit the ground due to changing surfaces, turns, topography, and a whole host of other variations.

Why does this matter?

When your feet are hitting the ground slightly different with every step (and we are talking about differences that are almost impossible to perceive, but bear with me) the point of maximal stress on your bones is different with each step.

But on the treadmill, you’re landing the same way virtually every time your foot hits the deck and focusing the force on the same area over and over. So if you have the option to get outside or run on an indoor track instead of a treadmill, do it!

4. Check Your Shoes

When was the last time you got a new pair of kicks? As your shoes break down, so does their ability to provide cushioning when you’re running.

Typically, a good pair of running shoes will last between 300-500 miles, but the durability varies from runner to runner and shoe to shoe.

Another good idea is to rotate multiple pairs of running shoes, especially if you’re running several days a week. Shoe rotation has several benefits, one of which is that it allows the foam to fully decompress before you wear them again so you get maximal shock absorption.

You may also want to have the running store look at your shoes to see if there are any noticeable wear patterns that would indicate you are rolling your foot, which would lead to extra stress on the body.

5. Focused Sports Nutrition

A stress fracture is a breaking down of your bones, so how can you help improve the strength of your bones so they won’t break down due to the stresses of running?

Making sure you get enough calcium is an obvious answer, and a good one, but it’s not the only ingredient your body needs to strengthen your bones.

Did you know that if you have a Vitamin D deficiency, your body actually can’t absorb the calcium needed to build stronger bones? So make sure you’re getting enough Vitamin D, whether that’s through diet, supplementation, sun exposure, or all of the above.

• Underfueling will weaken bones
• Being low in minerals will weaken bones (not just calcium)

A calcium deficiency (either through inadequate intake or improper absorption), the body will pull calcium from bones in an attempt to maintain balance.

When there’s too much of this borrowing, along with increased stress on the skeletal system from running, the result may be significant bone loss. This can lead to increasingly weak bones and tada you’ve gotten to the stress fracture.

6. Listen To Your Body

Honestly, the best way to prevent a stress fracture is to simply listen to your body. Our bodies are great at telling us that something is wrong, we just tend to be terrible at heeding the warnings and backing off to allow the body the ability to heal itself.

Stress fractures are no fun, that much is obvious. But there are things you can do to dramatically reduce your chances of developing a stress fracture and being forced to take a running break.

So listen to what your body is telling you, increase your training volume intelligently, and give your body the fuel it needs and you’ll be giving yourself the best chance of enjoying pain-free miles for years to come!

Have you ever had a stress fracture?

What other running injuries do you need info on?