Stress Fractures – Understanding and Learning From our Mistakes

Most of us in the running fraternity have heard of this ‘voodoo’ term and many of us will probably know someone who’s suffered from one at some point, but what do we know about these and what does our experiences teach us?

Well, one good lesson is that these bone breaks do happen…and to the fittest of us. Everyone is susceptible to them, some more than others and there are a great many varying factors that finally contribute to the bone finally saying “enough is enough..in fact, too much”!

So these bone breaks tend to be different to ‘impact’ injuries where a blow to the area or perhaps a sudden twist, say on the football pitch or on the ski hill might cause. Impact breaks are typically a ‘cleaner’ break (although not always) and occur almost immediately upon receiving the killer blow.

Stress fractures among athletes and runners are something that usually develop over time. Some of the many factors are such as such as suddenly ramping up their training regime, perhaps occurring 5-6 weeks after starting training for a marathon for example. For many it’s because they will have poor running form or frailties in their running gait, such as pronating too much and not developing sufficient strength in their glutes and core to ‘smooth’ out their form. Running shoes that don’t properly support the individual (this is a whole other discussion regarding types of running style such as heel or midfoot / forefoot strikers and barefoot running) through needing additional arch support, denser sole, shoes being worn out, etc. Eventually, by placing too much pressure too quickly  onto areas where the muscles and tendons are weak or overused, the stress is placed directly upon the bones. Finally the bone can take no more stress and finally begins to fracture – Even by suggesting this typical scenario I am missing out a girth of other factors all relevant in the cause and the problem.

In my case, my recent stress fracture of the cuboid bone in the foot was probably due to all of the following (looking at ourselves honestly is not always the easiest thing to do and admit errors):

A long, long racing season, too many races (is there such a thing?) too much hard tempo training and speed work in the few weeks leading to the fracture (I was building for a half marathon for which I was about to start a week’s taper and then leading into the NYC marathon 4 weeks later), a change in training focus moving largely from long distance training for a couple of ultra marathons to working in more speedwork – this should have been a gradual re-introduction (I still think it was!).

At the time of the now infamous break, I believed I was in the form of my life as my training runs indicated some ‘guaranteed’ PR’s in the next races. I was recovering great and felt great – but perhaps I wasn’t after all!!

Devastated having originally been misdiagnosed, a bone scan eventually suggested a cuboid (foot bone) low risk stress fracture. Minimum 4-5 weeks in an aircast boot. Drove me nuts – frustration like you wouldn’t believe. I even went to New York still as hotel and flights were already booked and so watched the frontrunners come by in Central Park, but I am not good at spectating. It wasn’t long before  had to take off and leave everyone else to it.

Patience is very much the name of the game with stress fractures, especially those of the foot. Depending on the severity of the fracture you may need to spend some time being ‘non-weight bearing’ and then continue without crutches for a further several weeks afterwards without the crutches. During this time, you may be able to cross train by swimming, on a stationary bike or elliptical machine to maintain your cardio levels and overall fitness, but be guided by your doctor or specialist.

When finally given the green light to come out of the boot, DO NOT be tempted to rush back into things. The bone may have began to heal and re-model itself, but it is not anywhere strong enough to resume previous training levels. Not only will the ‘broken’ bone be weak and susceptible at this early stage, but weeks of inactivity will have left the surrounding bones, muscles and tendons also very weak. Everything will have to slowly become accustomed to walking and then re-introduce running – Being mindful that running induces forces some 4-6 times greater than simply standing alone.

I can tell you from experience, that coming back from this injury too soon and ramping up the volume and running distance is only a recipe for disaster. I tried to be gradual, but typically I found out the hard way that it was too much too soon when I re-injured the bone and surrounding bones. Even longer back in a cast!

Runners who’ve suffered this kind of injury should spend some time, perhaps with a good physio, reflecting what went wrong and what can be learned from the original injury. You may recognise the symptoms now and realise that you need to adjust your training slightly, perhaps allowing more recovery time. Perhaps you tried to resume training again too soon after a hard, long race such as a marathon and need to understand the damage truly done to your muscles that, when working correctly, would have otherwise soaked up the stress and prevented them being passed onto the bone.

Perhaps you now need to invest in different running shoes and / or orthotics to provide better support (again, there is a whole other debate about this and the benefit of  correcting and strengthening glute, hip & core muscles and then working to strengthen those old & unused foot muscles to do their job) and have your running gait analysed.

Perhaps it’s even a dietary issue or possibly even a medical issue, but whatever caused the original injury, if your serious about returning to running at the same level or even better, than you should investigate the root cause and cautiously rebuild yourself! Believe me, you do not want to find after a few weeks of slowly re-introducing yourself to low mileage running, that you are overdoing things and suddenly (sometimes without warning) bam! You’ve broken the foot again, possibly other bones and now you’ll be out for even longer – all from experience.

In the meantime, watch this video from a certain Mr Gary Robbins – renown Canadian ultra marathoner, gradually returning after a brief layoff with a stress fracture http://www.youtube.com/watch?feature=player_embedded&v=ENSQI2muSck

Happy Recoveries Everyone!!

As an update to this piece, after following the doc’s orders and slowing beginning and running and keeping all mileage very, very low – I suffered another setback to the original injury, some 8 weeks after the original fracture and also managed to develop the very early stages of another stress fracture to my 2nd metatarsal as well.

Lesson to be learned I cannot emphasise enough the need to take any running very, very slowly when you eventually start to come back. If in any doubt as to how the area of injury is feeling – rest for a ew more days. It’s simply not worth it in the long run. It is quite usual to feel some different foot sensations going on when you begin running again. Only natural after you have been completely encased in the air-cast now that all the muscles, ligaments and even other bones have now become weaker due to the inactivity. Everything takes time to re-develop and if not allowed sufficient time, these weak elements could easily lead to more injury.

 

Understanding the need to taper and recover from races and training

As runners we’ve all heard about the need to taper or recover leading up to important races, but why do we hear so much about it?

Most of us will appreciate the need to ‘back off’ from our rigorous training at times or perhaps tak a day off from running altogether as our muscles and body just feel too fatigued to get out there and run some more, but why? You can often read that there is a benefit to running / training whilst on tired legs to mimic how you will feel in the latter stages of a race for example. This is often a form of raining that those preparing for an ultra marathon might do – say a 25/30 mile run on Saturday followed by another 15/20 on Sunday.

What many don’t fully appreciate is that it is while resting that our body repairs and heals itself. In other words, the adaptions that take place after a hard work out, such as a long run or speedwork, tempo runs, etc, these only take place while resting. When we are pushing ourselves to improve, be it to run longer or faster, we create many microscopic tears to our muscles. It is this damage that when healed and repaired, grows back stronger – allowing us to be stronger, faster or more adept at running further.

Now, if we continue to push ourselves hard every day, running or training on already damaged and fatigued muscles, it becomes very hard to train well. I wouldn’t encourage it, but anyone who’s tried to run hard and / or long every day will tell you that their training performance simply suffers as they struggle to maintain the quality. It is for these reasons, amongst others, that we need to back off and have ‘recovery days’, either cross training (perhaps biking or swimming for example) or possibly even have a day off after a hard session. Think how hard it is to complete your weekly long run in the build up to a marathon or half marathon if the day before you completed a multiple set of speed interval repeats. Your long run suffers, you may not complete it all as planned and such, you won’t get the benefits that you would have otherwise received.

So after weeks of building up to your race goal, doing all the ‘good’ things, such as hill repeats, tempo runs, speedwork, etc, your body will hopefully have made some pretty big adaptions, but chances are, is that there are still a lot of muscle tissue damage that needs to be fully repaired and glycogen stores replenished and topped up. To run at your optimum – often known as ‘peaking’, you’ll need to have all muscles rested, fully repaired and feeling fresh. This means reducing the volume of training you’ve been doing. Too often people will also reduce the number of quality sessions in this ‘tapering’ period, which will typically be somewhere between 2-3 weeks for a marathon and less for shorter distances.

The trouble with reducing the ‘quality’ sessions too much is that your body will begin to lose its leg turnover speed. So, you should reduce the number of speed repeats, or the length of the tempo runs, but keep some fast leg turnover work even into the last week – to a degree. However, as you reduce the mileage over the couple of weeks leading up to your big race, your legs should begin to feel ‘fresher’, even sprightly. Your energy levels should feel good as your start to burn off less glycogen and calories, fat, etc. This said, be mindful not to overeat and consider reducing your fat and calorific intake as your reduce your output. It is natural to put on a couple of pounds in the last week or so, but no point in undoing all that good work, eh? It’s hard dragging extra weight around a course!

Similarly, after your race, in particular a long distance event such as a half or full marathon. Your body will probably have run as hard and as longer as it ever has. No matter how you feel immediately after the race, you will have created some damage, hopefully only microscopic muscle tissue tears, but often bigger problems to tendons and cartilage. Running too much too soon after the race will greatly increase the risk of getting injured. Muscles will be fatigued and further stressing them, particularly in the first few days and week will often result in a breakdown. When fatigued muscles don’t work properly, the force and impact each stride has on your body will need to be soaked up, possibly by tendons or bone. Trust me, this IS how we get injured!

Ease back into running slowly. Nothing too long or too fast for a couple of weeks afterwards. Don’t get me wrong though. This period before and after our race where we’re reducing the amount of running we do is tough. For me it’s the worst and the hardest part of training for a race. I’m a runner, I want to run, but running and training smart will help you all in the long run. Something many of us all learn the hard way!