How to Prevent, Identify, and Treat a Stress Fracture

Ankle injury. Female runner with an ankle injury.
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Stress fractures are tiny cracks in the surface of a bone, and most often occur in the lower leg or the foot. They're a serious running overuse injury, but they can be prevented if you're careful with increasing your running distance and intensity.

Symptoms of Stress Fractures:

You'll notice gradual muscle soreness, stiffness, and a pinpoint pain on the affected bone. The pain, tenderness, and sometimes swelling are all in one specific spot and gets worse over time.

Unlike some running aches, the pain stays the same or gets worse, even after you've warmed-up.  Early diagnosis is critical because the injury can spread and eventually become a complete fracture of the bone.

Causes of Stress Fractures:

Stress fractures most frequently happen when runners increase the intensity and volume of their training over several weeks to a few months. A shortage of calcium or a biomechanical flaw -- either in your running style in or your body structure – may also contribute to the injury. Common stress fractures in runners occur in the tibia (the inner and larger bone of the leg below the knee), the femur (thigh bone) and in the sacrum (triangular bone at the base of the spine) and the metatarsal (toe) bones in the foot.

Prevention of Stress Fractures:

Make sure you're wearing the right shoes for your foot and running style. Get a gait analysis at a running shop. Replace your shoes every 300-400 miles to make sure you're not running in worn-out shoes.

Don't increase your weekly mileage by more than 10% each week. If you're training for a long distance race, go down in your overall weekly mileage every 3-4 weeks to give your body a break. Take days off from running and cross train to avoid putting too much stress on certain areas of your body.

Make sure that you're doing a proper warm-up, doing a slow jog or walk for five minutes and warm-up exercises, before you start running.

Finish with an easy cooldown run for five minutes and stretching.

Eat a healthy, balanced diet and make sure you're getting enough calcium and vitamin D (necessary for calcium absorption). Talk to a doctor about whether you should be taking any supplements. Avoiding carbonated beverages, alcohol and tobacco helps to reduce the risk of low bone mineral density.

Strengthening the muscles around your bones can keep them strong enough to avoid stress fractures. Because the tibia (shin bone) is the most common site of stress fractures, make sure you're strengthening your shin muscles and calves doing simple exercises such as toe raises and heel raises.

Treatment of Stress Fractures:

If you have symptoms of a stress fracture, you should stop running immediately and see a doctor. He or she can perform an x-ray which may show a crack. However, stress fractures sometimes don't appear on an x-ray, so a bone scan may be necessary to diagnose it. Keep in mind that you need to get a proper diagnosis for a stress fracture; don't try to self-diagnose.

Your injury will likely keep you off the roads for about six weeks, and depending on the severity of the stress fracture you may need a cast. Don't mess around with a stress fracture -- it's not the type of injury that you can run through. It's serious and could get worse if you continue to keep running. Rest, anti-inflammatories, stretching, and muscle strengthening are recommended treatments. Cross-training and water-running are possible alternatives to running while you're recovering. Make sure you eat a nutritious diet, since improper nutrition, especially a lack of calcium, may slow healing.

Sources:

Bennell, K. L.; et al. "Risk factors for stress fracture in track and field athletes: a twelve-month prospective study." American Journal of Sports Medicine 24 1996, 6 (810-818).

Lappe, J.; et al. "Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits." Journal of Bone and Mineral Research 2008, 23 (5), 741-749.

"Stress Fractures", American Orthopaedic Foot & Ankle Society, accessed 4/15/16

"Stress fractures", MayoClinic.com, accessed 3/22/16

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