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Return to Running Safely After Stress Fracture (and prevent them!)

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 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.

In fact, here’s a handy little graphic to keep you on your toes when it comes to running stress fractures!
running stress fracture 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!

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. – Mayo

How to Return 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.

Expectations Running After a Stress Fracture

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

Phantom Pains

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

getting over stress fracture

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)
  • your intensity low (again, relative)
  • allow your body to re-adapt to the demands of running (act like a beginner!)
What to expect when returning to running from a stress fracture from @dizruns and @runtothefinish #runchat Click To Tweet

Fearing 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.

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.running stress fracturePictured here RunTriTam

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

How to Prevent Another 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.causes of injuries

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.funny running memes

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.

Checkout this whole post on nutrition for preventing stress fractures!

6 tips to prevent one of the most common #running injuries, stress fractures!! from @dizruns and @runtothefinish Click To Tweet

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.

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 XRAY – 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.

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?

Denny Krahe is a Certified Athletic Trainer and Running Coach specializing in helping runners prevent common running injuries and being able to run pain free.
 
He is also the host of the “Diz Runs With…” podcast.
Click here to visit his website.

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Reader Interactions

Comments

  2. SuzLyfe says

    I'm coming back right now, and I'm dealing with the fear! I can coach others through it, but when you stress fracture a bone in your back, and it really sidelines you in such a significant way, you truly are frightened. I'm hoping to start testing the waters again this coming weekend. I've done some mini runs (like a couple hundred feet), and I still feel something–not pain, just not right–so I'm just going to take my time.
    My recent post SoulCycle x Target, Blends, and Blog Inspiration Weekend

  3. My Healthyish Life says

    I had a metatarsal stress fracture in October and it took me until the beginning of this year to start running again. I can completely attest to all of these feelings! Especially the fear over re-injury. It's been a slow and steady return to running, with some steps forward and steps backward.
    My recent post Whole30 Week 4: Let’s Finish This

  4. wendy says

    I've had a few stress fractures in my feet. One was due to arthritis in my big toe. My coach works with me on hip strengthening to help me (among other things) from landing so hard on the inside of my foot. It really is all in the hips, isn't it?
    My recent post Big Sur Marathon Training– Week 1

  5. Megan says

    I had two stress fractures two years ago then after being recovered for 7 months was in a car accident and broken my tibia. The struggle is real! But I've managed to maintain my fitness through swimming, cycling and weight lifting. I'm only now just beginning to test the waters with treadmills and stairclimbers.
    My recent post Healthy Chocolate Berry Bars {GF, Paleo, Vegan}

  6. Laura says

    This is such an important topic! I agree that nutrition is a really key component- I’ve dealt with a few stress fractures and I link it back to my vegetarian years when my protein (and therefore iron, calcium, Vitamin D, magnesium, etc) was much lower than it should have been. That’s not to say that you can’t do it right on a vegetarian diet, but I wasn’t paying as much attention to getting all those nutrients as I was to avoiding meat and my body was thrown off by it. I’ve been healthy and strong since adding in whole food supplements, more meat and training smart.

    • Diz Runs says

      Nutrition and rest are so often overlooked when it comes to a variety of injuries, stress fractures definitely among them. Glad you've find a nutrition strategy that works for you!

  7. mapsley says

    Unfortunately I have. And the worst part is the fear of doing it again. Most common injuries/aggravations for me are tendonitis type things and muscle strains. I have a hamstring that just doesn't like speed work, and it drives me nuts! It seems speed work aggravates any type of injury. I guess a good topic for more info might be: How can I get benefits of speed work without re-injuring or aggravating?
    My recent post Experiencing God….Anywhere

    • Diz Runs says

      Speed work is such a slippery slope because there are SO many benefits to doing it yet if you are really pushing hard you are toeing the line of injury with every workout. One way to get some of the benefit without as much of a risk of injury is to do longer intervals which will require to you run a bit slower but still pushing you outside of your comfort zone. Think 800m/mile repeats instead of 400m repeats. Yes, the longer repeats may not technically qualify as "speed" but you've got to weight the pros and cons.

    • Diz Runs says

      That sucks for your BF! (And for you too, hope you're ITB is feeling better ASAP.) A sesamoid bone stress fracture is tough. Not sure it would require a "no running again ever" diagnosis though. Might want to encourage him to check with a sports med doc/pediatrist that has experience working with runners. There may need to be some serious modifications made, but I'd think he could still do some running if he wanted.

  9. mkadens1 says

    Knock wood, I've avoided stress fractures so far. I'm more of a muscle strain kind of girl. I agree with Mapsley above that speedwork makes my high hamstrings angry.
    My recent post Training Ups and Downs

    • Diz Runs says

      Definitely hope that the suggestions help you stay stress fracture free! I know some people, especially non-runners, think that if you run you're destined to deal with a stress fracture, but that really isn't the case. Happy running!

  11. rosedaughter1427 says

    I've had an actual avulsion fracture, which put me off running for 6 weeks! It was just about agony to be stuck in the pool aqua-jogging or standing on the sidelines while coaching a cross country team! I agree with everything you say above, and in fact recommend that you get a physical therapist to address any biomechanical imbalances and really rein you in from re-injuring yourself. My physical therapist had to put up with 3 weeks of "Can I run yet?", but once I was cleared to run, I was allowed to run 2 miles every other day. Make no mistake about it, I had all sorts of phantom pains in my foot, and I felt so out of shape, but I was just glad to run again. The next week, I progressed to 3 miles; the week after that 4; and then 5 miles. By the 5-mile mark, I was allowed to resume base-building mileage (20-ish mph), gradually ramp the distance up over the next 2 weeks, and heck, even throw in 1 day of "easy" fartleks. I am very grateful that I took things slowly, as now I can run completely injury-free.

  13. Benjamin says

    I have a question, I’m coming back from a tibial stress fracture in my right leg that happened on December 4th during an APFT. Tomorrow I have to take another APFT but when I run, even when it’s just a few hundred meters, I still have the pain that feels like a bad shin splint in both legs. How can I combat this and should I be worried about the pain that I am still feeling?

  14. Amanda Brooks says

    Thanks for the great article, I’m currently waiting to hear back from an MRI to determine whether I have a stress fracture in my foot.

    I just want to go running and have resorted to purchasing loads of new running gear ready for when I’m back on the road :@) Retail therapy and physiotherapy helps lol

  15. Gene says

    Thanks for the great info. I am recovering from a stress fracture in my knee (chondyle). I have a great doc (former doc for the Indianapolis Colts who is know the team doc for Xavier University's basketball team) who diagnosed me through x-rays and MRIs. He said I had no other damage in the area surrounding the stress fracture. I spent 6 weeks on crutches, and moved into physical therapy. I would expect plenty of muscle soreness from the therapy because of the weakness that developed. What I didn't expect (and I am still experiencing) is the significant lingering tenderness in the knee area. My doc says the bone has healed (as of the end of February), but I am still limping in the end of April. My therapist seemed surprised to learn of this. Nobody can answer the question about when the soreness in the knee joint will dissipate, but it keeps me from even trying to run because I end up limping after a two mile walk.

  16. Rachel says

    This was actually a really good article on the subject. Very helpful. Thanks so much!

    Last November I found out I had multiple stress fracture in the pubic ramus area. I started running again in February but it’s been a struggle. I’ve started having pain again so I’m going in to get an X-ray.

    The doctor gave me a 2 month healing time but it was 3 months before I was even able to run. When I look at other people’s experiences with the same injury, it usually takes 5-6 months to heal, sometimes years. It’s really discouraging.

  17. Val says

    I have a stress Fracture on the Third metatarsal bone on my foot. Do you reccommend going to a Physical Therapist?

    • amanda says

      oh gosh, I’m not a doctor so I’d hate to give you the wrong info!! I would say that for me with any major injury, at least one visit to the PT has always helped me learn new exercises which make me a stronger runner and hopefully prevent that injury from happening again.

      • Val says

        Okay thanks! And ive been resting for about 4 weeks already and I just want to get back to running and playing soccer so bad, but i know i have to be patient. Do you know how long it takes for a stress fracture on the Third metatarsal on my foot to heel???

  18. suguna says

    hi. i am recovering from stress fracture neck of femur. i am an ultra trail runner who just ran too much too fast. i just graduated from no weight bearing to partial weight bearing. the pain, physical and psychological is real.
    i look forward to walk again in a couple of weeks.
    …to run again….probably another 6 months.

  19. Janice says

    This is a very thorough article. Resting or night pain can also be associated with a stress fracture. If a stress fracture is present it may not show on xray until 2-4 weeks post injury, and a bone scan may be warranted. Successful management of a stress fracture allows the bone adequate time and rest to heal (4-8 weeks) but maintains strength and conditioning in the individual, and addresses any factors in their training/lifestyle that may predispose them to these injuries.

  20. Deirdre says

    Just seeing this article. I am into my 3rd week of no running. But have been pool running and spinning like crazy to ensure return to competition fitness. I have not had scan, so not sure it is a fracture. But certainly some overuse injury to metatarsal, due in part to too much high intensity. You know that supposed 85/15: easy/hard split… Well, in thinking I was invincible, I did it in reverse. Bad idea! Hoping, to ease back into light running within next 2 weeks, and be back fighting fit for 2018 season.
    I definitely recommend the pool running. There is a great sense of reassurance doing an activity that closely mimics land running.

  21. Emma @ MenstrualCupaholic.com says

    Great post, much needed. I only started running last year and have been on and off with it. Because I don’t do it often enough, I think I sometimes push myself too much and then end up taking a very long break due to injury or fatigue.

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Amanda Brooks : Run Coach
Website written, managed and maintained by Amanda Brooks, a certified running coach and personal trainer. Any advice should be taken as general information and not a personalized plan. All opinions, tips and reviews are based upon her personal life experience and the experiences of those she has coached. View our full privacy and review policy.