Is there a difference between a running stress fracture and a stress reaction?
Yes! One means you’re on your way to a long layoff and the other means you’ve caught the problem now so you can start making some quick changes and smart choices.
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.
Previously we talked about some of the specific tactics you can take to get back to running after a stress fracture diagnosis. Today we’ll dive in to some different thoughts on nutrients, bone health, causes and ways to stay injury free.
But what caused it to start with? Can they be prevented?
Understanding Stress Fractures
Why does it seem that so many runners are prone to stress fractures? A few common mistakes:
- Overtraining/overreaching and focusing on miles rather than “quality” is the culprit of overuse injuries (or chronic injuries that never heal properly).
- Old shoes or wrong shoes are the problem. Many time runners choose shoes for color or for price, but considering that your entire body rests on your itty, bitty ankles, it’s important not to overlook finding quality running shoes.
- Skipping planned rest days because of a weight loss goal or ignoring a balanced training plan in favor of more, more, more miles.
- Under fueling based on weight loss focus, ensuring the body isn’t receiving all the needed nutrients.
Often, taking a day off from running and finding another outlet to move the body, is a fantastic way to recover from an injury. Maybe you are training the right way…so next up, let’s talk nutrition for injury prevention.
Boot from @Happyfitmama
Improving Bone Health
As far as calcium is concerned, it’s an essential mineral in the diet of fitness enthusiasts and athletes. The goal is quality sources to reach the recommended intake of ~1000 mg/day, which is vital to the bone rebuilding process. 
Strong bones not only allow for strong and powerful muscles, but reduces risk for stress fractures and other debilitating injuries.
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.
Non-Dairy Calcium Sources
Although milk, cottage cheese and yogurt are excellent sources of calcium, you needn’t be a dairy lover to get calcium:
- dark leafy greens
- tofu
- tempeh
- blackstrap molasses (2 tbsp will meet almost half of your recommend intake!)
- calcium fortified drinks and foods
- checkout more on vegan calcium >>
- AND A NEW SURPRISE ONE: CBD OIL!! (seriously cool evidence on this increasing bone strength)
It’s also important to know a few foods that inhibit calcium absorption:
- wine
- caffeinated tea/coffee
- wheat bran
- low vitamin D
- low electrolytes (you sweat out minerals!)
Nutrient Timing For Healing
Another thing which might aid in your healing or prevention of stress fractures and other injuries is nutrient timing. Marni a Board Certified Sport Dietitian has some incredible and detailed tips, which are all sciencey and researched and of course right up my alley because I love the deep dive. 
Here are a few of her key notes:
- Plan your day of eating before it happens. Plan out your nutrition before/during/after workouts, 3 meals and a satisfying snack between your meals.
- Dietary protein ingestion immediately post workout can assist in the skeletal muscle adaptive response to training. Aim for 25-30g of protein within 30-45 minutes post workout and additional 15-20g protein every 2-3 hours for the next 6 hours (with carbohydrates) to maximize recovery.
- If you are working out for 1-2.5 hours, it’s best to consume a recovery meal with protein and carbs (and some fat) within 60ish minutes post workout. Aim for 1-1.2 g/kg of carbs, every 90 minutes in the 4-5 hours following a workout.
- If you have an off day or a bad workout, under fueling or overexercising will not make things better. Just move on with the methods that are working for you so that you can stay consistent with training.
- Track your workouts and your food, so you can see what’s working! What digests well, what helps you recover faster.
- Don’t be afraid to focus on (and eat for) your own nutrition needs when eating with family, friends and co-workers.
- Your total amount of fluid consumption to replace post workout should be spread out throughout several hours, not consumed all at once.
Do you think of your nutrition as a way to prevent injuries?
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Sarah
Great tips and information! Is it funny I read thought and when I got to molasses I thought woo who another reason to eat more gingerbread cookies?!
amanda
I LOVE the way your brain works
Susie @ Suzlye
And then there are people like me, who did everything “right” and still get the shaft. Grrrrrr. But I obviously mistepped at some point, literally or figuratively, and I’m sure that the rapid increase in my weight from being preggo + all the time on my feet at work didn’t help. Womp womp
amanda
Girl I hear you!! I did all the pre-hab for knees, but stepping in a hole on trail undoes all that great work. I know you’ll be back at it quickly.
Rachel
Thankfully my doctor does NOT use the two interchangeably! That would set me into major panic mode. When she suspects a stress reaction we go into rehab protocol right away. Reactions and fractures are injuries I will NOT mess around.
Jenn
I definitely think nutrition is a major player in keeping our bodies healthy. Great tips here – and thanks for including all the dairy free options!
Lorie
This info is so good for all athletes. I didn’t realize some of the things that can inhibit calcium absorption. Good to know!
Whitney E. RD
Ugh, stress fractures are the worst! I had two of them in my foot a few years back and it was not fun. Proper nutrition is SO important for exercise performance and preventing injuries – great tips here! I’ll add one more fact about calcium availability, studies have shown that both low and high protein diets can inhibit proper calcium homeostasis, so it’s really important to individualize your intake based on your needs!
Kristina @ Love & Zest
You have some great info in this post! I bet a lot of people are going to find it so helpful!
Helen Stewart
when we talk about stress fracture, does it mean that it is an actual fracture?
Ashley
I’ve never dealt with a stress fracture but love how you outlined some nutrition tips!
Dr. Nate Moller
I was on the verge of stress fractures in both shins when in undergrad when I was forced to stop & recover. I was a sprinter and pushed myself too hard, too fast, and didn’t stop with pain. Wish I had some of this advice back in the day. Now I work daily with sports injury patients and can relate to a lot of their pain. Thanks for some great info on nutrition to help prevent and help with this injury :)