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.

 

Sick? Injured? – Get flexible with your race goals

So all the hard work has been done. That race, be it a marathon or a half marathon that has had you training religiously for the last 4-5 months will be upon you in a matter of days. There’s just one snag – somehow you’ve managed to pick up a little niggling injury or a bad cold or sickness bug!

Some would say this is ‘sod’s law’, but actually it is all too common. The risks of pushing ourselves into training too hard and long, or perhaps more appropriately – not training wisely, is that we can push ourselves into an ‘overtraining’ scenario and our body gradually begins to breakdown. This is why it is so important to listen to your body. When you are fatigued it is difficult to go out a run a good quality hard training session, be it a tempo run or speed repeats, etc that we will actually benefit from. Just to be clear on this point – our body’s improve from overstressing ourselves and then recovering. It is in the ‘recovery’ stage that we actually improve and why more often that not, the day after a hard workout should be spent resting or perhaps with an easy ‘recovery’ run. If we don’t do this, there is only so much our already overworked and fatigued muscles and tendons, heart, etc can take before something has to give.

The other common problem is that too many runners actually get sick during their taper just before a race. This is usually because as the physical questions we ask of our bodies (ie; gradually less and less), our body may be tempted to think that is suddenly now taking a vacation and stop fighting as hard as it has become accustomed to. Place yourself in a room full of people with germs, colds, etc and your immune system is a little ran down, then there is potential to be more susceptible to get sick.

This doesn’t mean we have to avoid everyone of course. Just continue to rest up, eat healthily and well, try to avoid stressful situations as much as possible (stress can also have great negative effects on our body’s immune systems) and generally look after yourself. Some may choose to take some supplementary vitamins pills for example and this may well help, but eating well is just as important as all the nutrients you’ll need can be obtained naturally.

So race day is here and you now have a nasty cold. Should you still run?

This is very much a personal thing, but the general rule of thumb is if the affected cold area is above the neck, then it’s OK still. If, however, you have a cough and are having some respiratory issues, then you should definitely consider postponing the race and maybe considering a different upcoming race. The same goes for if you actually have flu and are feeling achy, etc. It can actually be very dangerous to place too much stress on your body if you are suffering this way and if you ask too much of yourself, it is possible to inflict far worse damage on yourself that can potentially take weeks and months to fully recover from.

Assuming you feel as if you should still run though, you need to be realistic. The chances of you hitting that PB you were aiming for are probably very slim and in this authors experience, the longer and harder the race (such as a marathon, which is already taxing enough on the body), the higher the chances you will begin to suffer more than usual, probably sooner and harder than usual as well. Therefore you should consider adjusting your target. Perhaps just aim to run round the course and try to enjoy it, forget about the time on this occasion. At the very least, allow yourself to back off from your original timing. You never know, you may actually feel better than you thought later in the race and be able to kick on a bit and you’ll also recover a lot quicker if you don’t tax your body quite so hard – Bear in mind that if racing with a sickness, your body will probably suffer a lot more stress, maybe causing you to sweat more than usual or even dehydrate a lot quicker amongst other concerns- so LISTEN TO YOUR BODY and be prepared to adapt!