The Most Common Stress Fractures in Runners
For runners and track athletes, aches and pain in the lower legs are considered somewhat part and parcel of high-intensity training. However, there’s one type of running injury that should not be ignored or assumed as harmless - the dreaded stress fracture.
Stress fractures are a nightmare for any runner — they are serious (and painful) enough to warrant a stop from all running activity.
What is a stress fracture?
A stress fracture is a type of sports injury that develops due to overuse and repetitive stress. Any time we load our bones and joints a process of bone remodelling occurs. This means old bone is taken away and new bone is laid down. Overtime, if the balance of activity and rest is correct, this is how our bones become stronger and more accustomed to high intensity activity. Intense physical activity like running or jumping features repetitive movement that can the bone cells to gradually break down at a rate faster than the new bone can be formed. Over time, a bone stress reaction can result and if continued tiny cracks will develop on the surface of affected bones, which can lead to a fracture when the bone experiences significant stress.
What causes a stress fracture?
The development of stress fractures can happen regardless of an individual’s level of fitness - whether you’re new to jogging, an amateur sub-elite runner, or an avid ParkRun attendee.
While overuse is one of the most common causes of stress fractures, placing sudden stress on the bone can also increase the likelihood of a stress fracture.
Most common types of stress fractures in runners
Stress fractures in runners are commonly localised in the tibia and metatarsal regions of the body.
Tibia (shin bone) stress fractures are by far the most common — an estimated 50% of all stress fracture injuries occur in the tibia. Tibia stress fractures often develop as a result of shin splints that are left untreated but can also occur suddenly due to impact from a falling accident.
Metatarsal stress fractures occur in the middle bones of the foot and are the second most common type of stress fracture — 10-20% of all stress fractures are metatarsal stress fractures.
Metatarsal stress fractures can be identified by pain in the middle of the foot that triggers when pressure is applied, even in simple actions like walking.
Other types of stress fractures in runners can occur in the hips, thigh bone (femur), pelvis and other small bones of the foot and ankle (tarsal bones).
How to treat a stress fracture
The problem with a stress fracture is that it won’t necessarily present as the most painful injury you’ve acquired from running. It can often present as a dull ache, which can worse during or after running. Unlike a sprain or a tear of a ligament, a stress fracture can creep up on you, rather than make a sudden sharp appearance.
However, if you are noticing a sudden influx of pain caused by running - the immediate solution to reduce pain and inflammation is to apply a pack of ice to the area. This will help reduce the amount of swelling and provide some temporary pain relief..
Stress fractures can often be diagnosed clinically by your physiotherapist or doctor. More formal diagnosis may include radiological imaging including xray, MRI, CT or bone scan. Not all stress fractures can be seen easily on imaging, but a radiologist and doctor will often be able to determine a stress reaction.
From there, the fractured part of the bone will need time to heal and recover. Avoid any actions or activities that trigger pain in the area — this is your body’s way of telling you that the injury is still present. Some stress fractures will require a period of unloading which may include using crutches or a moon boot.
Given enough time, stress fractures will naturally heal on their own. However, this process can be sped up by working with a qualified sports physiotherapist who will apply targeted treatment to the affected area. In addition to treatments like heat and ice therapy, a sports physiotherapist will facilitate strengthening and flexibility exercises to help the rest of your leg provide better support to the fractured area. A sports physiotherapist will also keep you updated on your recovery progress with a timeline for when you can resume your regular running or exercise routine.
How to prevent stress fractures from reoccurring
Stress fractures are more likely to reoccur in those who have previously had a stress fracture. Studies from the National Library of Medicine (NLM) indicate that having a history of one or more stress fractures increases the likelihood of developing a new stress fracture by 5-6 times (for women). In similar studies from the NLM, it was also found that women faced a greater risk of developing stress fractures than compared to men (2.3 times).
To reduce the risk of new stress fractures, runners and athletes are recommended to:
- Gradually increase running mileage — rapid changes to how long and how far you run can place stress on the body that it is not yet conditioned for. Changes in mileage should be kept to increments of 10% per week to allow sufficient time for the body to adapt without a high risk of developing stress fractures.
- Wear orthotics or supportive shoes — the right shoes will provide more cushion for the feet and legs, absorbing the impact and reducing the amount of stress placed on the legs.
- Adjust running form — running on your heels can result in more stress being placed on the tibia bone. Modifying the running stride to land on the middle or ball of the foot can help reduce the impact on the tibia.