Introduction
Most people who know my story know that I endured many stress fractures in high school and college, 7 to be exact (3 in my left foot, 4 in my femurs). I consequently did not have a collegiate running experience, as I became another ”injury-riddled statistic”. Everyone probably knows a young, promising female who was done in by injuries, never to return to the same form. However, I’m an exception to the norm, in that I overcame my injuries and am now having a fulfilling professional running career. I beat the odds! I have gotten numerous inquiries over the years from people wondering how I did it. Being the conscientious, consumer of knowledge, I became extremely motivated, passionate, and persistent to figure out ‘why’ and ended up completing a Master’s degree on the topic (~enhancing bone recovery with whole body vibration). I would say that also characterizes me as a runner and person: extremely motivated, passionate, and persistent. I never gave, or give, up (see my post on The cat with 9 lives ). That is why I am still going! I thought I would share what I learned about bone and how to successfully comeback. This is long, but there’s so much to say!
What does a stress fracture feel like
One very common question I get (or see on message boards) is: what does a stress fracture feel like? Having experienced 7 of these bad boys, 3 in my foot and 4 in my femurs, I think I can answer this question! All of my stress fractures started as sharp pain that wouldn’t go away no matter what (with or without shoes). If you continue to train hard (doing hard workouts/race), the pain gets progressively worse, to the point where you absolutely can’t run and you can’t hop on that injured leg. The “hop test” was always a sure sign. I would have “throbbing” pain just lying in bed. With the stress fractures in my feet (all of which were palpable and in a single spot), I found within a few days/1 week, I absolutely couldn’t run anymore (~foot swollen). With the stress fractures in my femurs (not palpable because of the thick muscle), I trained/raced for 2-4 weeks (underperforming), before running finally became impossible. With my femoral stress fractures (in the mid-shaft), I had pain radiating to the hip and knee.
I also had stress reactions in my pubic bones last year (due to a major hip issue, which I had to get surgery for). Considering these bones are non-weight bearing, I was able to jog easy through these, and this enhanced the healing process– I did not have to take any time off. I’ve heard of others jogging easy through stress fractures in their feet/legs– this seems very plausible (keep reading below, to understand how mechanical stress can heal bone faster).
Another common question is: how do you distinguish between a tibial stress fracture and shin splints? I had shin splints for years– fortunately, never a stress fracture. My experience is that shin splints is something you can continue to run through. The pain tends to be most severe at the beginning of the run and improves as you continue to run. With a stress fracture, you absolutely can’t run. The pain gets worse as you run, to the point where you can’t run anymore. From all the reading I’ve done, both injuries are due to biomechanics, whether naturally or forcibly landing on your forefeet, and/or due to overpronation. Shoes cause overpronation, while barefoot running reduce overpronation. Why is this? Think of shoes as being like an SUV– higher center of gravity, and more likely to “tip over”. They are thick and mushy, despite the “stability” and “motion control” built into them (to overcompensate for their inherent defects!) . While barefoot, you are on the ground and more stable. As I talk about below, this is why I train in racing flats and barefoot– more stable landing for my flat feet that used to overpronate while in trainers. Consequently, I haven’t had shin problems in 8 years.
Anatomical/biomechanical discrepancies
I have some anatomical/biomechanical features that make me more prone to stress fractures in my feet. My first stress fracture (which actually completely fractured) was in my left, 2nd metatarsal. Specifically, I have Morton’s toe, meaning the 2nd toe/metatarsal is longer than the first, causing you to place greater pressure on this smaller/weaker bone. Being told I had “flat, weak feet”, I was advised I needed “motion-control shoes”, so I trained in thick Nike Air Maxes and Nike Pegasus. Then, I would wear [minimalist] spikes while racing. This was a HUGE contrast in shoes– why do runner’s continue to do this to their feet?! My Dad specifically remembers me coming up over a hill in an XC race, stepping off a curb to cross the road, while wearing my new, long XC spikes…. and I had a noticeable “hitch” in my step. By the next day, I had sharp pain in my foot. This is how it all began! Within the following year, I had comeback (twice) and developed a stress fracture in my 3rd metatarsal…. followed by the 4th metatarsal, all in the left foot. Why did this happen?! Keep reading…. you have to understand how bone remodels itself. At the time, they blamed my foot type, saying I needed special orthotics to prevent anymore stress fractures (which I got and had no more foot problems…. but other problems ensued).
I will also add that thin women runners are more prone to stress fractures of the spine, sacrum, and pelvis. Thin women tend to have lower bone mass in the spine because we do not have the added weight to load it and act as a positive mechanical stimulus to enhance it. Also, because it’s not bearing weight, it can’t be mechanically enhanced through the impact of running (like the legs/hips). Thus, stress fractures in the spine are due to a combination of fragility and tensional stress of the muscles pulling on the bone. With the sacrum and pelvis, the shape of a women’s pelvis, being wider, creates more tensional/avulsive muscular stress on the bones. There are numerous muscles that traverse through the pelvis. In particular, the pubic ramus has several adductor and obturator muscles that attach. Given the amount of pronation incurred with running, and also hip flexion, the adductors tend to be overused, and you end up with overly strong adductors and weak hip abductors. These muscles can become fatigued (as I talk about below) and begin to transfer the stress to the bone. Thin women, having less fat around the pelvis, have less “cushion” around the bone as well. Post-pregnancy, due to hormonal changes (and widening of the pelvis), can further create imbalances between muscle-bone and place unusual stress in unusual places.
Understanding Bone
It takes a very long time for a bone to fully remodel itself (8-12 months, depending on severity and size of bone) and be normal again. Thus, that bone will develop a bone callus as the bone heals, and this will not only cause you to slightly change your gait (~placing stress elsewhere), but that bone callus may also irritate the surrounding soft tissue and nerves, causing residual pain when you start running again. You never need to worry about this residual pain or re-injuring the bone in the same spot, as this spot is stronger than ever. My experience is this residual pain should go away within 2 weeks of returning to running. However, the change in the distribution of stress may cause you to develop a stress fracture elsewhere (as what happened to me!), if you attempt to comeback too quickly. Unfortunately, for high school/college runners and athletes, there’s always impending pressure to get back in shape and be ready for the upcoming season….. and the injury cycle continues, over and over again! I didn’t break the injury cycle until I took 6 months completely off (no cross training either)– this allowed my bones to fully remodel and be normal again, and thus run normally too.
As far as how long it will take for the bone to be pain free and you can return to running…. this totally depends on the size of the bone, location, severity, whether you took pain killers (see below), and the ability to enhance recovery (see cross training section). I would say a minimal of 4 weeks off (if you use a bone stimulator). Personally, it took me 7-14 weeks for my metatarsal. Some bones have a poor blood supply (pelvis, heel, navicular, sacrum) and will take a much longer time. However, as I mention, in the grand scheme it will still take 8-12 months for the bone to become normal again.
The tests I would use to know whether I could run again was:
1) No pain hopping on the injured foot/leg; and,
2) No pain palpating the area. I would wait a week of being painfree, until I would start running again.
Understanding Muscle
The greatest stress on a bone is where the muscle inserts. This makes that specific point stronger, but if the stress exceeds the ability of the bone to repair itself, microfractures can accumulate and develop into a stress fracture. This is why the non-weight bearing fibula can develop stress fractures, as it acts as an anchor for several muscles. This is also how you develop a stress fracture in the shaft of the femur (as I did)– lots of very strong muscles insert on this very strong bone. When a muscle gets fatigued, it transfers a greater amount of stress to the bone. Muscle and bone are closely linked, such that if a muscle is weak, a bone will be weak too. Make the muscle stronger, and you make the bone stronger. A stronger muscle is more “fatigue-resistant”. As I will mentioned, this was my whole premise for switching to road flats and barefoot running: strengthen those intrinsic, stabilizing muscles in the feet and lower legs, making them fatigue-resistant and the bones less likely to fracture.
Development
I believe a large reason for my stress fractures was developmental. I had a huge growth spurt when I was 15-16 (shot up from ~5’4″ to 5’9″), creating an imbalance between the longer bones and the tight muscles, which lagged to catch up (thus placing stress on the bones). I was like a gangly, baby calf coming into the world! Combine this growth spurt with increasingly heavier training…. and it’s easy to see how and why so many girls get hurt from ages 16-22. Our body’s and hormones change more significantly than boys AND in such a way that can be detrimental to performance. Personally, I grew “up” more than “out”. I felt I didn’t fully grow into my body until I was ~22– that’s when I noticed I no longer “ached” all the time– it was like I could finally train seriously and consistently!
Training Errors
Personally, overtraining was a huge reason why I developed so many stress fractures, which are caused by exactly that: stress! Bones are constantly in a dynamic, remodeling state, being broken down with stress and then refilling those holes during rest (I’ve seen it with my own eyes!). If you understand this, it makes it easy to understand how you should train: hard days to stress the body, followed by easy days to supercompensate and get stronger. Ok, so here’s my pet peave: everyone thinks it’s the repetitive impact, such as with high mileage, that breaks you down the most. NOPE, this is not it…. it’s intensity-depending.
I suffered stress fractures with only 20-30 mpw (nearly all high intensity running)…. yet I’ve had none with years of 120-130+ mpw of mostly slow mileage! Folks, you won’t get hurt running easy mileage or easy high mileage…. but I can guarantee you may get hurt if you do too much high intensity running, day after day! It’s the high intensity running that breaks you down, and if you don’t allow for proper recovery in training (whether running easy or taking time off), you’re going to accumulate fatigue and be more prone to injury. I cringe when I hear high school (and even college) coaches say they are afraid of high mileage cause they think their runners will get injured…. nope, not if you understand HOW to run high mileage. You slow down the pace, and you can run further with ease. Pitter patter, relaxed, good form, quick and light turnover. A high frequency, low magnitude mechanical stimulus is anabolic to bone– this is exactly what easy, long running is.
Surface/Terrain
My opinion (and anecdotal experience) is that surface doesn’t matter for preventing stress fractures. Following the “textbook wisdom” espoused by running and medical experts, I tried to do most of my running on “soft surfaces” when I endured all my stress fractures. Did it help? Heck no…. 7 stress fractures later! I’ve found over the years that my muscles and body actually feel most comfortable on hard surfaces. Even the research says there’s no difference in impact force going from one surface to another (see here). This is due to leg stiffness, what could be called “muscle tuning” (read previous paragraph about the significance of muscles insertion on bone)– your muscles “tune” to the surface and you change your gait, so that impact force remains the same going from surface to surface. However, my theory is that there’s less muscle tuning on a smooth, harder surface than a mushy or uneven surface, so the smooth surface is overall less stressful. This may also be why flats, being harder/closer to the ground (lower center of gravity), are better than thick, mushy trainers. I’ve probably put in 80-90% of my mileage the past 7 years on hard surfaces. My legs actually feel more beat up when I do too much off-road running– dead legs, no bounce. I generally try to mix up the surfaces I run on to change the stress (and same goes for wearing a variety of road flats), but my legs are definitely most comfortable on the roads and bike paths, which have more energy return. I prefer hard dirt/cinder (Colorado,New Mexico,Arizona) over soft dirt/wood chip (Oregon).
You have to be careful with hill running, if you haven’t done a lot of it recently. Overzealous hill running, particularly the more stressful downhill running, can hurt the body. Technical trail running with lots of rocks is definitely far more stressful than smooth roads…. an “injury waiting to happen” (as what happened with Olympic Champ, Takahashi, while training in Boulder, CObefore the ’04 Olympics). I will stick to predictable, smooth roads for now, and leave the technical trail running/racing for later in the career when I can take more risks!
Cross Training
The problem with most cross-training regimens (during a layoff) is you end up with an imbalance between your strong/maintained heart, and your weak legs that need to readjust to the impact of running. You could end up doing “too much, too soon” for your legs. For this reason, I’m not a big believer in cross training, or at least hard/cardiovascular cross training. I believe weight bearing activity is of far greater importance for a successful comeback than maintaining fitness of the heart.
The most natural, weight-bearing, and closest activity to running is walking. Walking is far better and natural to the body than any machine! During a break (and also the comeback), I believe the focus should be on light, natural weight bearing activity and muscle strengthening (~weak areas), whether walking or activities of daily living. If you can focus on both, that’s great. It depends on the person and how much you can handle, but I’d say a minimal of 30 min. of leisurely walking.
There’s a trade of thought in the bone world that bone is most responsive to “unique” muscle stresses (Pilates? Yoga? Tai chi?) and that high-intensity jumping (box jumping) is the most anabolic stimulus (obviously wouldn’t want to do that with a stress fracture). However, based on my Master’s thesis, we now know that bone is just as responsive to the low-magnitude, high frequency, weight-bearing forces, like standing, walking, or standing on a vibration platform (as used in gyms and PT clinics). This is also why bone stimulators (~made by Exogen) enhance bone recovery, relying on a high frequency/low magnitude mechanical stimulus to enhance blood flow and growth factors to the area. Remove the weight bearing (such as with cycling, swimming…. think of what happens with astronauts in space), and you also remove the strongest stimulus to bone and muscle: gravity!
Orthotics
My experience with orthotics is that, indeed, they may be a decent temporary solution, by taking the stress off one part of the body to allow it to fully heal. They most definitely helped me get over the stress fractures in my foot. However, they may cause you to maldaptively change the distribution of stress, causing you to place stress elsewhere and longterm developing a completely new set of injuries. Sooooo I learned…. 4 femoral stress fractures later (plus hip problems, IT problem, years of shin pain….). I wore orthotics for 4 years and never felt right, and I tried a gazillion different types of orthotics and various shoes. That’s not to say that they haven’t helped a lot of people, shortterm and longtterm (my hubby being an example).
The Boot
My experience with the boot: they did not put me in a boot for my first 2 metatarsal stress fractures, and it took 10-14 weeks to be painfree. They gave me a boot for my 3rd metatatarsal stress fracture, and I was painfree in 7 weeks. I wore the boot for the first 2 weeks. I believe the boot is a good temporarily, initial solution for resting the bone and reducing inflammation. However, I wouldn’t recommend wearing it the whole time, which can cause an atrophy of the muscles/bones due to disuse. You need to ween yourself off it, and as I mentioned get into weight-bearing activity…. which will also enhance recovery.
Shoes/Barefoot Running
Like most everyone, I read the shoe reviews in running magazines, running books, and followed the advice of the shoe store guys, all of whom told me what I “needed” for my supposed flat, weak, overpronating feet. While my Nike Air Maxes and Nike Pegasus with orthotics were comfy…. they obviously did not do a very good job of keeping me healthy! In December 2003, I ditched the orthotics and Nike Pegasus, cold turkey, and began training in racing flats and eventually barefoot. As I had learned through my Exercise and Sport Science studies, if you strengthen a muscle, you also strengthen the bone, making it more resistant to fatigue, stress, and injury. I felt my my orthotics and shoes were acting as a crutch and “cast” to my supposed flat, “weak” feet (as I had been told), and if I wanted to be healthy longterm, I needed to strengthen those intrinsic foot and lower leg muscles ( many of which attach to the foot). As with any running or strength training, I knew it would take time, that I would be sore, and I would have to be patient.
I hobbled out of bed every morning for the first 3 months. It was like re-learning how to run and run correctly! I had started from scratch on my mileage, building up to 10 miles per week the first month (running a few miles every other day), then 20 mpw on the second month…. until I was up to 70 miles per week by 7 months, the most I’d ever run. I also began running barefoot around March, starting with 5 min. the first time and getting up to 20-30 min. at a time by June. Most importantly, I was healthy and running consistently!
When I first started, my feet would slap the ground hard, on my heels, running with a long, gaping stride. My body learned it needed to change, and over time I developed the short, efficient, midfoot, shuffling, quick-turnover, light-stepping stride that I run with today. I could tell from the first week it felt right, despite the soreness (never pain), which eventually went away. I had collected numerous research articles over the years, confirming what I had discovered on my own.
Flash forward to 2009-2010: it took a popular book, a funky/faddish “shoe”, and a Harvard research study to finally get people to buy in to what I’d done the past 6-7 years! Specifically, barefoot running/minimalist/low-heeled shoes causes you to shorten your stride and more likely land midfoot/forefoot, under your center of mass (not overstriding and landing on your heels). This adaptation lessens the stress on your legs and joints (see studies here and here and here), making the ankle/foot the main shock absorber, as it’s naturally intended to be. I believe a shoe will never do as good of a job at supporting the feet/body as strong/strengthened muscles in the feet/lower legs. A shoe is really only needed to protect the skin from abrasion/puncture wounds (as I found out last year, when I endured my first puncture wound and had to go get an updated tetanus shot). However, the skin will thicken, like leather, to protect the soles on any surface, but this takes time and patience (and is a risk I can’t take as a professional runner).
I also believe it doesn’t matter what age or ability you are, if you decide to try what I did– the body is very adaptable and capable of getting stronger, just as it is with any training program! You have to think of it as becoming a runner for the first time…. you have to get over that “hump” and be careful not to do too much/too soon.
The bottom line with shoes: find what works for you, and stick to it! You should know within the first month whether a shoe works for you. It just happens to be that flats work for me– that doesn’t mean they’d work for everyone. No shoe is going to be perfect…. only your bare feet are perfect! Every shoe has it’s own “idiosyncrasies” and will stress the body differently. Shoes could even have a slight defect. That is why I think it helps to alternate a variety of ~similar shoes. Too much of a shoe contrast (going from trainers to spikes) is asking for trouble! I believe a secret to my ability to bounce back from marathons is the fact that I train and race in the same shoes. It is nothing new on race day when I go 26.2 miles in my road flats.
Sleep/recovery
Sleep counter-balances the stress of running. It is during your sleep that you get the greatest surge of growth hormone, which counters the stress hormone, cortisol. Growth hormone repairs and rebuilds the body and bones. If you’re not getting enough sleep, or if you have too much stress (not just running) in your life, you start to burn the candle at both ends and break down.
There’s a phrase I like to use for the high-achieving woman who does a gazillion things every day: like a chicken running around with it’s head cut off! You know who you are! I was once “one of those women”…. thank goodness for having a laidback hubby who taught me how to take a chill pill! If this characterizes you, realize that all those things are added stress and energy being channeled away from running, and over time this will take a toll on the body (or bones!). You should strike a balance between everything in your life, and only run as much as you mentally and physicially can handle– it’s not worth it to put in 100+ miles per week if it causes you to break down.
Short-changing yourself on sleep means less growth hormone. If you run more, you need to sleep more, and eat more (which I’ll talk about). You get a surge of growth hormone when you sleep at night…. and you get a surge when you take a nap in the afternoon. This is one reason that separates elites from non-elites– elites are able to better recover, thanks to more “rest”.
Diet/Hormones/Bone Mass
My diet and hormones were definitely not a factor for me developing stress fractures. I have never had an eating disorder (or disordered eating), nor did I have menstrual irregularities. My whole body and hip bone mass is also very good, although it’s a bit lower in the spine (likely because of being thin and not having the weight to load the spine). Unfortunately, diet and menstrual irregularities can be a huge risk factor, esp. for young women, often referred to as the Female Athlete Triad. It boils down to getting enough calories to match the energy demands– your energy balance. If you aren’t getting enough calories to fuel yourself, you certainly aren’t getting enough calories to provide for a fetus– the first thing to shut down is your reproductive system. Your estrogen level goes down, which also protects bone. Over time, you can lose bone mass, and your bones become more fragile and fracture-prone. Ladies, it is not normal to miss your period, month-after-month. If you haven’t had a consistent menstrual cycle, that is a direct correlation to your energy balance, whether you need to eat more and/or cut back your training load to get your period again. It has nothing to do with your percent body fat– you can be a woman with 10% body fat, and as long as you’re in energy balance, you should get your period.
Additionally, while an oral contraceptive may help to increase/maintain your estrogen level and better regulate your menstrual cycle, I don’t believe there’s definitive research that it helps prevent stress fractures or enhance recovery. Taking a calcium supplement (I take Calcium Citrate– greatest absorption) and Vitamin D3 also won’t prevent or enhance, but it is important to overall bone and body health. As far as nutrients that are good for bone, potassium citrate, as found in fruit and vegetables, meat (essential amino acids increase endogenous IGF-1, precursor to growth hormone), and beer (silicon) are all good.
Drugs
I am very much against taking NSAIDs or prescription pain killers (I probably will do a single blog post about this!). Inflammation/swelling is a very important aspect of healing, with immune cells helping to get rid of the damaged tissue and biochemically (IGF-1) signalling replacement with new tissue. There is increased blood flow to the area, which includes growth factors and micronutrients that enhance tissue recovery. NSAIDs are COX-2 inhibitors and block production of prostaglandin, which stimulates tissue repair. You will heal much slower if you take NSAIDs. There is research confirming that you end up with slower and less bone callus formation when NSAIDs are taken– the bone isn’t as strong. Longterm, and with chronic consumption of NSAIDs, you are essentially blunting the anabolic recovery and rebuilding of musculoskeletal tissue, and you end up with more “fragile”, gapped tissue, prone to injury. Performance may not be impacted short-term, but longterm the more fragile muscles-bone are more sensitive to serious injury.
Having unintentionally (and unknowingly at the time) been a human guinea pig…. I took prescription pain killers with my first 2 stress fractures– took 10-14 weeks to heal. I decided not to take anything with my 3rd stress fracture, and I was completely pain free in 7 weeks. Also, they put me on Fosamax (~bisphosphonate) after my 5th stress fracture, hoping it would help to prevent more stress fractures. Did it help? Nope…. I suffered 2 more stress fractures in my femurs in the spring. Why did this happen? Overtraining…. stress…. not enough recovery. Bisphosphonates increase bone mass by slowing down the bone resorption (bone removal). This may be good shortterm, but longterm your bones can accumulate microfractures and actually be more prone to fracturing.
Ice
Ice does absolutely nothing to enhance tissue recovery, including bone. This is an unsupported theory and something I will have to do a blog post about. It definitely helps to reduce pain and thus trick the brain into thinking you’re “getting better”, but it does nothing to enhance tissue recovery. If there’s a mechanical component to icing, such as ice cupping (or physical therapy along with icing-ice bath), that mechanical action may enhance tissue recovery by increasing blood flow and growth factors to the area. However, the coolness of the ice or ice bath (~cryotherapy) does absolutely nothing for tissue recovery. Heat does nothing either.
Conclusion
I hope this post is helpful for understanding bone, how stress fractures may develop, and how to overcome them. If anyone has questions, feel free to message me or post a comment.
**Disclaimer** I am not a physician, so it’s best to seek out medical advice from a professional first. What I’ve shared above is purely my own experience and what I’ve learned through my studies.
I can not begin to explain how very much I enjoyed this post! As someone who incurred two back to back stress fractures not too long ago it was interesting to read what you have found in concerns to why/how this happens and how to help prevent in the future. I’ve been SF free since my last SF (August 2010) and I credit that to making recovery and time off a priority and easing up, big time. I’m still dealing with a bit of scar tissue from the 2nd SF but with the help of active release therapy and regular chiropractic visits that is diminishing over time.
I have a very different foot type then you (extremely high foot arch) and supinate – thus I am typically told to steer clear of minimal shoes because I make up that small percent of population who really should not wear them. In fact switching to minimal shoes (Newtons) prior to my SF is what my doctors think caused the SF’s but I don’t blame the shoes – I blame the fact that I ditched my usual staple Asics and Brooks shoes and only wore my Newtons. I didn’t gradually work myself up to them – I jumped right in them and took off. Big mistake. I’m hesitant to try minimal shoes again and have been sticking with my Asics and Brooks. So far so good.
Great! Glad my post is helpful! I’ve gotten a lot of positive feedback so far. There’s too much textbook-type information out there, so I wanted to give greater insight into what I believe to be true/not true (based on my personal experience and own research). I believe knowledge is power, and if you simply understand the interaction of bone-muscle-mechanics, it gives you confidence to know what to do.
Definitely, stick with what shoe you’ve found to work for you! I wouldn’t call Newton shoes “minimalist”– they try to forcibly change your gait, but they are still a thick shoe, not really allowing for ‘natural mechanics’. There’s a lot of pseudo-science behind shoes/what’s recommended, and really it comes down to the individual and what feels most comfortable to you. Good luck and stay healthy!
Thanks for the response and well wishes! I do have a quick question concerning slow/recovery runs which as I read above you seem to be a strong advocate of. How much slower should a run be from your average high intensity/near race pace run? I’ve been looking into this for some time and have seen varying percentages. I am wondering what your experience denotes?
Thanks!
Well, I can run a 5K around 5:20-30 pace, marathon at 6:03 pace, and my easy runs the past few years have generally averaged around 8-9 min. mile pace (and about ~7-7:30 pace for long runs). I’ll be around 8:30-9:30 pace when I’m getting back in shape.
I’m trying to follow Bill Squires training plan right now, and he says on most days to run, “Relaxed: 2 min. slower than 5K pace”. Being on my 7th week now with the program, I’m finding that I personally like to go about 15-30 sec. slower than this on my easy runs (and I calculate my easy run mileage based on 8 min. miles). You know, you have to go at what feels right to you. I’ve emailed the author of Bill Squires’s book “Speed with Endurance”, and that’s exactly his thoughts– run at different paces and see how you feel and respond. If I’m really tired, I’ll go a lot slower (8:30-9:00 pace), and if I feel good I might be around 7:30-8:00 pace. The only time I really “crank it” is on my long runs– I averaged 6:47 per mile on a 20 miler a few weeks ago (vs. 7:29 per mile on my long run this week).
I should add though that I’m putting in 120-140 miles per week, so I really have to emphasize the recovery. If you’re putting in a lot less than this, it’s probably easier to run at that “Relaxed: 2 min. slower than 5K pace”. The key word here is relaxed…. that’s probably more important than the actual pace!
Thank you for writing this blog! I stumbled upon it while searching for information about metatarsal stress fractures. Your information was very helpful and encouraging to me.
I have morton’s toe and very high arches and I’ve just encountered my first stress fracture. I first noticed pain after running a 5k in my minimalist shoes a few weeks ago. I made the mistake of not laying off the way I should have. I thought I could run through whatever the problem was. For while, I thought that it was getting better. I decided to switch to my old regular thick shoes to see if it helped… after a week of wearing them and standing at work, it’s like my foot blew up over night. I can’t blame either type of shoe for the issue just the fact that I over trained and haddn’t been getting enough sleep at night :/
Again, thank you so much for your thoughtful an through information!
Great blog I came across this while googling stress fractures of the knee.I am 40 and until March this year was a sub 3hr marathoner. I developed sudden knee pain which was treated as ITB until I could no longer walk . MRI revealed I have a rather unique stress # in my lateral femoral condyle. I had review MRI this week at 3months with latest MRI showing spontaneous osteonecrosis.Bone density is good so no osteoporosis . Do you know anything about this and what are my chance of running again? I have had 3 months of swimming and bike not sure what else I can should be doing and hope the bike and swim arent making it worse. If anyone has had this type of # or knows anything I would love to hear about it. Cheers Sam
Whoa, hmm…. Do you take any drugs or NSAIDs? Bones that have a tendency to develop osteonecrosis have a poor blood supply. Out of curiosity (cause I haven’t heard of this happening with the knee), I Googled it and found info about fluid buildup putting pressure on the blood vessels and leading to osteonecrosis. Surely it’s reversible cause bone is a dynamic tissue (and you’re still young!).
I talked about in my post the importance of weight bearing activity– when you use your weight-bearing muscles, it helps increase fluid flow (hence blood circulation/growth factors) and thus enhances recovery. Cycling and swimming are non-weight bearing, so they won’t help as much as ~walking or other weight bearing activities. Here’s my theory: you developed swelling in the IT band near the knee, and it’s lingered cause you haven’t been doing weight-bearing activity that uses your ‘stabilizers’ (which would help get rid of the swelling). It’s consequently put pressure on the blood vessels and prevented bone healing.
3 months is a long time to layoff for any stress fracture (most taking 5-10 weeks). Have you layed off this long cause of still being in pain? Considering what’s happened you probably need to get into weight bearing activity. A bone stimulator would probably help too. However, I’m not your doctor, so you need to follow the advice of him/her, and maybe get into PT to work the IT band issue (even massage therapy).
Good luck!!!
Thank you for this post, I run cross country and this year will be my senior year. About six weeks ago I got a stress reaction in my lower legs, which basically means we caught it before it turned into a full fracture. Five weeks after resting I started running again even though my doctor told me to wait for six. Ive been starting out slow with the running, 20 minutes, 30 minutes, etc but i’m still finding some pain when i press on the spot. This worries me because I can not have another injury, I want this year to be my year and to be honest an injury scares me greatly. I ice my legs after my runs but after reading from you that ice doesnt help I dont know what else to do. I also drink milk after my runs, my coach thought that was a good idea. If you have any advice on what I can do to make the pain go away that would be great. Keep in mind that I do need to get back in shape, if I want to be one of the best on my team I have to get greater milage, although right now i’m just worrying about overcoming this injury.
Hi Erica! Sorry to hear about your leg! If it’s any reassurance…. going into my senior year, I had a stress fracture in my foot in May (missed May-June training), and then got another in August (missed Aug.-Sept.). I cross trained my heart out, ran ~20 mpw for 5 weeks (plus pool running), won Regionals, and made All-State for a 6th time! It really doesn’t take much to get back in shape. The most important factor right now is getting healthy, cause if you rush it…. there’s a greater probability of getting injured again (as what happened with me and my foot).
Have you ever heard if it hurts to press something, don’t keep pressing it?! I’m thinking you should leave your leg alone and try not to mess with it too much. Is it ice cupping you’re doing? Have you tried different shoes? It’s important to pinpoint how you got the stress reaction in the first place. As I mention, there’s two tests you have to pass with flying color before you can even run: 1) No pain palpating/pushing the area (which you said still hurts), and 2) No pain hopping on the injured leg. 20-30 min. sounds like too much to start with– 5 min., 10 min., etc. (plus walking and days off in between), would probably ease the transition back into the impact of running. Also, from my personal experience, there is ‘always’ residual pain when you start running again, but this should go away after 2 weeks. I’d be curious if there’s some factor, like your shoes, that continues to irritate your shin. Milk is good for bone health, but it won’t enhance the recovery. Extra Calcium and Vit. D is good for you too (Calcium citrate + Vit. D). Yeah, so give yourself time! Making a successful, healthy comeback is priority #1. Reassure yourself– it doesn’t take much to get back in shape. Good luck and enjoy the summer!
Camille
Very interesting story and I’m glad to hear you could successfully make it back past all the challenges along the way. I’m at the point of wondering if I do have a stress fracture. Sharp pain on the top of the 4th metatarsal behind the met head towards the ankle after a fast, hilly 10 miles one week ago today, which hasn’t gone away. Chiro yesterday said he thought it was a SF, but I wouldn’t be able to tell for weeks without a bone scan. He did the tuning fork test, which did NOT increase the pain, but my Web research indicates that does NOT mean I don’t have one. I have been able to run without it getting worse and have a race in 3 days. I don’t want to damage myself if I do have one, but on the other hand, if I don’t, I wouldn’t want to miss the race, which is part of a Grand Prix. It does hurt to the touch and walking around and if my shoe is laced tightly. I’m guessing I overdid the hills that week with a hilly 8K the weekend before. Any thoughts/suggestions? Thanks!
Steve
If it hurts to hop on that foot barefoot, that’s a good sign it probably is a stress fracture (or stress reaction). It’s better to be safe that sorry– I tried to run and race (for a week) with my first metatarsal stress fracture, and it ended up completely fracturing. I missed 14 weeks– foot swelled up like a small football. If it’s a stress reaction, you skip the race, and just pitter patter for a few days/1-3 weeks, the bone may heal itself and you won’t miss any time. I know, it may be hard to hold back like this, but it would be awful to completely hurt it and have to miss the rest of the summer training. If it starts to get worse, that’s not a good sign and you may need to completely rest it. Good luck!
Great post – I’m so thankful to have come across this – and happy you are back to running!
Your post makes me feel so much more hopeful – AND I think I finally have an explanation for WHY I am injured.
I was diagnosed with a femoral stress reaction just a few days ago (lower part – just above the patella). I was heartbroken and cried – no running?! My Dr recommended crutches for the next two weeks to help speed healing as I am hoping to still be able to run my first marathon this October (which will probably now be a run/walk).
I wish I had known more about stress fractures earlier, as I have been dealing with this “mystery” injury since May 1 – which was initially diagnosed as an MCL sprain. After four weeks off (2 weeks were spent pool running), I came back one mile at a time for three weeks until the pain was suddenly back and I was limping around. I have to note that I had mostly run in Asics prior to injury and for a few runs during my initial comeback, but I turned to my Vibrams after those first few runs caused pain. It was a huge improvement! I will probably stick with them once I am cleared to run again.
Initially, I blamed a combo of a race (5k) and bike ride for the “MCL” injury – then transferred that belief to the stress reaction diagnosis. However, after reading your post, I now know it had nothing to do with that – rather, my overzealous approach to training this year. I didn’t increase my mileage by more than 10%/wk, but I DID NOT vary the intensity of workouts. I gained speed over the winter and pushed every run for all I was worth. As great as the log numbers look, I know to never do that again. :S
For now, I am running in the deep end of the pool 4x/week for 30 minutes, along with some laps. I am also focusing on non-weight bearing leg strengthening. Your philosophy of mixing in some light weight bearing exercises does have appeal (and makes sense) so I might slowly add some in this week. I begin PT Thursday and am hopeful for a quick (and permanent) recovery.
Good luck to everyone who is dealing with an SF!
Hi Stacy! Glad my post has enlightened you! Sorry to hear about your femoral stress reaction. Fortunately, a stress reaction doesn’t take as long to heal. As I mention, mechanical stress actually helps it to heal. If you can tolerate it, definitely try some walking. It sounds like you know now that you “pushed” your body too hard on a daily basis. The key is learning to run “relaxed” on your easy days, head to toe– you don’t have to push it hard every day. I like to think of how a boxer feels, doing their “shake-out”…. they only “fire”/punch when they have to. From what you describe, your femoral stress reaction is near the medial part of your knee, correct? There’s a lot of muscles that insert around there, exerting different actions (even your hamstrings wrap around the medial part of the knee and insert on the tibia). I’d be curious to know exactly where the stress reaction is– that can you a lot about what mechanical action you’re doing too much of and how you need to balance out your body (~different shoes, PT, strengthening). Just a hunch, but I’m guessing you overpronate in your Asics (stresses medial aspect of leg), while you’re more stable/neutral in the Vibrams. The Vibrams may be ‘too little’ shoe for a marathon, but a thinner/firmer shoe (~Adidas Adios for example) might work better for you. I’m also guessing you’re weak on your lateral hips/abductors– your PT will help you with this. Good luck!!!! You’ll be Ok.
Camille
So glad I found your post…I just found out today what my hosrrible pain is…Doctor could feel the stress fracture it is that bad. Top of my right foot – middle tow had been hurting a litle for a while but never thought anything of it. But my last run on Saturday I was at 6miles and my foot started to hurt…no big pain so I slowed my pace and keep going…mile 7 I stopped and was a walk and by mile 8 I was in so much pain I had to stop. I could still walk on it Saturday and no swelling until I stopped walking on it and after three hours I got up to walk and I couldn’t put any pressure on it. And then on Sunday I couldn’t put any pressure on it, found out that crutches are no fun but I used them until seeing the doctor today. He didn’t do an xray becasue he said that wasn’t needed, put my in a boot for a month and then I go back.
I am in lots of pain and the sweeling is getting worse I think. Is this normal? I have had a few people tell me that usually you don’t have this much pain with a stress fracture but I am having lots and that means a lot becasue I have a high tollerance for pain and this foot is killing me. Is this normal?
I have completed two half marathons, one in May and the next in June. I have been running in 5 finger Vibram’s and that solved my shin splint problem but the Dr today told me in wasn’t normal for our bodies to run in them and that I need to try arch supports. So I have a pair of those along with I have been back in my asics for walking. I was triaing for my first Marathon and feel horrible that the Doctor told me that I can not do it as its coming in October and he says no running for 6 weeks atleast. I am super sad but reading your article has given me hope. But finding the right shoe is my hardest thing. I don’t blame the shoe for my injury but what else would have happened or went wrong?
I just want to know how long I will be in pain for and my Doctor told me no more advil as that was not good as you also said. And to take minimal Tylenol as that isn’t good for your liver either. My foot is sweeling up and hurts real bad. Walking in the boot is ok but still painful but I am done with the crutches becasue those were no fun and the Doctor said I didn’t need to use them if I was ok walking in the boot.
Please let me know your input on the pain and shoes.
Thanks.
Bummer, sorry to hear about your foot! With my first metatarsal stress fracture, it was so bad my foot swelled up like a small football! I couldn’t put on my shoe! Considering how you bear weight on your feet and the force with each running step…. it’s gonna hurt. Having had 7 stress fractures, I think the ones in my foot were the most painful. So yes, consider this normal, and do the best you can to tolerate the pain, without taking anti-inflammatories.
As far as shoes, I’m not a big fan of the original Vibrams. The hard rubber doesn’t feel comfortable on hard concrete. Even having tried to wear them often, I found there to be too much vibrational force up the feet/legs…. my legs would feel beat up. Personally, I’d prefer a flat sole that has greater surface area contact with the ground. I’m not of the opinion that everyone needs “arch support”, considering that the arch needs to depress during midstance to help with shock absorption (see here: http://www.sportsci.org/jour/0103/mw.htm). For now, shoe support, but also bearing weight, will help to reduce the swelling and inflammation. I found that getting in the pool and water jogging or putting a buoy between your knees and kicking is helpful. Definitely try to get some supported/shod loading on the foot, ~walking, to help increase blood flow and the healing process. Walk with the boot. I know, it hurts really bad right now, but if you can tough it out, it will heal much quicker. A bone stimulator will especially help if you can get your hands on one. Good luck healing and making a successful comeback!
What shoes do you run in? Or do you not? I was thining about Nike Free’s or something similar…I want to start thinking about this now because I want to find something to try and that I will not have my shin splint issue again when I am healed from the fracture. What do you think a bone stimulator will do and where can you get one?
So walking is a good thing? It is painful but if it helps the healing I will do it. Also did you do the pool running at the begining of the fracture? and the kicking? I am going to find someone that has a pool if this is something that I can do now! I am going crazy on the days that I would be running…its killing me not being able to do so.
Thanks!!!
Hi Danielle, I’ve trained in road flats since Dec. 2003 (I believe I mentioned this in the stress fracture post?). Right now I’m sponsored by Inov-8, who makes some excellent “minimalist” shoes– Inov-8 Road X 155s and 233s are great. I like the 195s, 220s, and 230s for off-road running. Really, it comes down to what feels most comfortable to you. Another previous favorite was the Brooks Green Silence. Nikes are a little too soft for me, but I liked the Lunaracers. Frees have a surprising amount of heel-to-toe drop, but I like walking in them.
For the bone stimulator, ask your doctor about it. I’m not sure if insurance will cover it, but the research strongly supports it for enhancing recovery. It’s a mechanical stress, like a vibrational force…. increases blood flow to the area.
Yes, read my post about the walking. Absolutely, walk…. next closest thing to running! It’s natural for the body. I did do pool running at the beginning with my 2nd and 3rd metatarsal stress fractures. It felt therapeutic. Knowing what I know now…. I would have progressed to walking, and then the running.
Good luck!
Camille
Very interesting post, I’m glad to come across it.
I was diagnosed with a stress fx in my rt tibia 4.5 months ago. Everytime I think I’m ready to return to running, the pain will return after a week or so. I start off with a very gradual rehab process of 5 min walk 1 min jog type of runs.
The residual pain you talk about going away in 2 weeks or so, is it normal to feel the pain while walking? or palpating? Or are those 2 signs that I’m not ready to start up again?
Thanks so much!
Hi Randall! 4.5 months should be plenty sufficient for the bone to heal. If you’re going to develop another stress fracture, it will be in another location, possibly on the same bone. It may be that the bone callus is irritating the surrounding nerves and soft tissue (nerves take longer to heal too). As I mentioned, it takes a really long time for the bone to fully remodel itself and be normal again. Also, if your shoes are too soft and thick, that makes you more unstable on your feet and will irritate your shins– you may feel pain/crunchy scar tissue palpating along the whole tibia (possibly both legs). If this is what you feel, I’d recommend trying a shoe a bit firmer, but still flexible (Adidas, Brooks, New Balance, and Puma tend to have a firmer/stable feel).
But yes, 2 weeks of a consistent return to running is usually sufficient for the residual pain to go away. I’m thinking the pain you feel with walking/palpating is because of the irritated nerves/soft tissue and/or shoes that are too soft and irritating your shins. You can also help to relieve shin pain with barefoot walking/running. The bone should be healed– no worries there! Good luck!
Hi Camille!
Thanks for your post. In 2008, I had a full break in my 3rd metatarsal a month before the Boston Marathon – I actually broke it so badly that I displaced it and it healed shorter and raised (so the 2nd and 4th metatarsal heads were dropped). I did a bit of research to learn what would make it heal faster and what to do to avoid in the future. I cut out all caffeine, alcohol, nsaids (though didn’t have them much typically anyway) and got a bone stimulator. I gained 12 lbs (that took forever to get rid of) despite lots of cross training. But I did come back – I actually began running after 10 weeks (6 weeks earlier than projected, mostly thanks to Exogen in my opinion) and did so slowly with no issue to the bone (although i did have lots of soft tissue “issues” along the way) and have run 7 marathons and an ultra and several shorter races since then.
For 3+ years I’ve had no issues. I took to heart my changes about doing things *gradually* (mileage, intensity, shoe changes) and getting rest. I also completely agree with you on the point about lots of easy miles (verrry easy) and over the past few years have gradually gotten up to 70s/80s mpw very comfortably. But low and behold, 2.5 weeks ago, I got another stress fracture in my 2nd metatarsal. I admittedly am a bit perplexed since I was running easy, it was a down week and wasn’t actually in training mode… but in retrospect the biggest culprit was a big lack of sleep that week after an evening long run that I crammed in before a weekend trip away. And perhaps running that 50min run on a concrete beach boardwalk when i’ve gotten very used to trails. That honestly is all I can think.
Anyhow, sorry for the long ramble but wanted to give some context before my questions for you. And I would LOVE to hear your input…
- For recovery, have you had any experience with the AlterG and if so, do you have any recommendations on when/how to incorporate that into the comeback? I am lucky enough to have access to one but do know it is still relatively “new” so there is not a ton of info out there yet on how to best use it. I plan to start early next week but don’t know yet if i will run or walk etc.. (In the meantime, I have been cycling, swimming and pool-running without a belt).
- My bone density (DEXA), calcium and vitamin D tests all came back with flying colors (but yet I still got a fracture??). Ive started looking into taking Strontium – do you have experience with that? Or are there other supplements/foods you’ve seen provide extra value?
- My doc last time gave me the green light to run at 10 weeks. There was definitely no feeling of the fx well before that. This time, my (running specialist podiatrist) doc is kind of letting me go on my own… how on earth do I tell what is the bone vs the soft tissue when I transition to running so that I know i am ready? I’ve been going on/off with the boot and when i go without it there is not *pain* but i do feel stuff in the general vicinity so it’s kind of scared me back into the boot, but then my ankle gets stiff and sore and I wonder if it’s that “phantom” pain. Any thoughts on distinction are much appreciated.
Sorry for the long post. I have been fascinated (and terrified) by this whole thing for the last several years but I am determined (again) not to let this happen to me again so all the extra input is all the better. Thanks so much for your post… and for reading my long response!! Keep up the great running!!!
Pam
Hi Pam! Sorry to hear about your foot problems– bummer, sounds like what happened with my first metatarsal stress fracture (healed improperly and now deformed). To answer your questions:
– I’ve never run on an Alter-G. Any amount of weight bearing, as tolerated, is good for coming back. You need to get your muscles and body used to the impact again, slowly but surely. Personally I like to walk cause it’s most natural to me. I would do the walk-jog plan, until you’re back to full running. The treadmill is a bit awkward for my gait, but if it suits you fine…. go for it!
–Foods/beverages/supplements won’t hasten the healing time, but longterm they will definitely help to strengthen and maintain bone mass. I don’t know anything about Strontium (have to research that one…. didn’t even discuss it in Bone Phys. in grad school!). Good bone foods/beverages: meat, beer, fruits/veggies (for the potassium citrate), and supplementing with Calcium Citrate + Vit. D (I get the Walmart brand, Spring Valley). Try to get around ~2000 IUs of Vit. D each day, and 600-1000 mg of Calcium.
–As I mentioned in my post, the two tests to coming back are: 1) No pain hopping on the foot, and 2) No pain palpating the bone. THEN, you wait a week before you run. There is no set amount of time until you’re ready to come back…. every bone and every person is different. I guarantee you will have some residual pain when you start running again– this is normal! The bone, itself, is healed and strong.
– I should also add that our bones are constantly in a remodeling state– being broken down and built back up. I can actually feel it when my bones are a bit more “broken down” (that sharp pain). I’m guessing this is what happened with your foot…. obviously you’re going to think “Ohhh, that’s not right!”. Many, many times…. I’ve trained through this, run easy for a few days, and the bone has built itself back up. I can tell you that when you ever feel that sharp pain, if you just pitter patter for a few days, the bone will remodel itself and be Ok.
Good luck!!! Sorry for the late reply…. I was at a race all last weekend!
Thanks so much Camille
Right now (3.5 weeks), it doesn’t hurt to touch it, but does feel awkward when walking still (and hop test barefoot is a no go), so I’m holding off on running (and the alter g) for now. I’m discouraged since my doc had originally projected 4 weeks until I could run. I’m using the Exogen 2-3x a day – in your studies, did you see any upper limit of it making things worse by using it more often?
Regarding nutrition, you say that vitamins won’t help the healing but I’ve read that things like alcohol/caffeine/nsaids can hinder the actual healing process. If that is the case, would the alcohol in beer outweigh the benefits of its silicon? I do like beer (and wine) but have cut them out solely for healing purposes.
Thanks again and great job in your race!
Hi Pam! You can’t really put a timeline on when you’ll be 100%. With my 3 metatarsal stress fractures, it took 7-14 weeks to be pain free. Because we have to bear weight directly on our feet, it is very likely it takes longer to heal because it’s more “inflammed”. Have you ever heard if it hurts to press something…. don’t do that?! You probably just need to leave it alone and let it rest. As for the Exogen stimulator, with our study (using whole body vibration training) we only applied 10 min. per day, which was enough of a stimulus. From what I remember, mechanical stimulation is more anabolic when applied with 4-6 hours between the “bouts”– multiple bouts are good. 3 bouts might be overkill! You should follow the recommended use for the bone stimulator, as far as the duration of use.
As for nutrients, the alcohol itself (not just silicon), in moderation, is absolutely beneficial to bone– it acts as a phytoestrogen, making it especially good for women! Overconsumption of alcohol is NOT good for bone. I drank unfiltered beer (yeast at the bottom has nutrients!) when I fractured my rib…. we started homebrewing in 2009, so I get a daily dose of unfiltered beer. I haven’t heard of caffeine being bad (but maybe when overconsumed?)…. for what it’s worth, our head Bone Biologist at Oregon State would come to Bone Lab meetings every week with a 64 ounce Pepsi! NSAIDs….. Do NOT TAKE…. yes, they most definitely hinder the healing process.
I think that’s it! Let me know if you have anymore questions! I enjoy applying what I learned!
Hi Camille,
Thanks again for your replies
. I’m 12 weeks out and doing much better! I’ve been able to get a lot of time on the alter-g at a lower weight and it’s helped a ton with the transition to running as I bumped up the weight gradually every few runs. I’m actually tapering off it and getting back on the trails (and some roads) really well.
For a while there I thought things weren’t healing and then one day I went out and did stand- up paddle boarding and all the muscles in my feet woke up and I stopped feeling any pain in the foot immediately. I suddenly realized that the soreness must have been soft tissue and the bone was strong. Since then, I’ve been walking around in Nike Frees (but still running with my orthotics) and the feel feel stronger already. But that realization not only helped me see the light at the end of the tunnel (and start testing the waters running on land), it also made me realize that maybe I should get myself off the orthotics at some point. Do you have any recommendations on HOW to ween yourself off the orthotics? Obviously, like many adaptations with the body, I wouldn’t want to do it too quickly, but I’ve not run a single step without them in 3.5+ years so I’m a bit unsure on how to even begin. They have been a crutch, for better or for worse so it’s hard to let them go, especially with my fear of another stress fracture coming on again.
Thanks for any input. And than you again SO MUCH for your post and your responses. You’re an inspiration!
Pam
Hi Pam! Great to hear you’re making steady progress back! That’s interesting on the paddle boarding– sounds like what I experienced doing one-leg balancing exercises last year to get the strength back in my right leg. See, if you use your ‘stabilizing’ muscles and overstimulate the nerves, that’s also an anabolic stimulus to the bone and surrounding tissue. This is why barefoot running works so effectively! As far as weening yourself off the orthotics…. well, I did it cold turkey and was starting from scratch on mileage at the time. I’d worn orthotics for 4 years, including in regular shoes. My ankles were very sore and stiff for about 3 months, and then one day I remember waking up/getting out of bed and it was all gone! It was amazing! Like everything else, it’s a gradual process. You have to get over that “hump” (kinda like when you start training again), where things are sore (but hopefully never painful). The ligaments, tendons, and muscles have to readapt and get strong. Try to do a little at a time, being mindful if anything ever feels painful. I think the barefoot running helps, but if you do this…. try to do only a few minutes at first, soft/smooth natural grass. Cool, keep it going! Glad to be an inspiration!
Camille
Hi Camille,
I’ve been a lurker for a while now. I was wondering if you think digestion can have anything to do with stress fractures. My diet is good…red meat 2-3x a week, lots of veggies, beans, lentils, cheese, and beer too. I was recently diagnosed with my fourth stress fracture/reaction (all on the fibula). In the months leading up to it, I was having serious issues digesting my food. I would get 15 minutes into a run and have to go, now! I don’t want to be too graphic, but it wasn’t normal and I was usually able to identify food in it. I was wondering if the not absorbing nutrients from the food could cause injuries. Interestingly, the only running injury I have ever had is a stress fracture on the fibula.
Thanks,
Lynn
Hi Lynn! That’s interesting! First off, it’s very important to chew your food well, so it’s broken open and can be digested/nutrients absorbed in the gut. Mastication is the very first part of digestion– very important…. your gut can’t do it all alone! Otherwise your food passes right through you (which my eyes have unfortunately seen, from working in a Foods and Nutrition Dept.!). You definitely need to make sure you’re getting enough Vit. D to help absorb Calcium…. especially in the winter when you get less sunlight exposure.
As far a link…. I’m not really sure! Hmm, maybe a hormonal imbalance, linking gut hormones to ~estrogen (which protects bone)? I have runner friends with Celiac’s disease, which makes it difficult to absorb certain nutrients. You could read up more on this…. I think you have to go Gluten free.
As for the fibula, it is a non-weight bearing bone and acts as an anchor for muscles– stress fractures to the fibula are directly caused fatigue and stress of the muscles on the bone. It could be caused by something as simple as slipping off a curb, or due to repetitive stress of improper fitting shoes. Maybe a problem in one leg is causing you to compensate and use your other leg more…. placing greater stress on the outside of your lower leg.
Interesting questions! Hope you’re not having gut problems anymore and are healthy! Good luck!
Camille, Thanks for the response. My gut has been better since the second day I was forced to take off from this injury, hence my question. I was tested for Celiac about 10 years ago, before it was commonly diagnosed. At that time I was diagnosed with IBS. It was probably flaring up from work stress over the last six months and the stress of running probably made it even worse.
At this point, I’ve been out 3.5 weeks and can walk with no pain, even without the air cast. I’m looking forward to starting to run again in my favorite season!
Hi Camille,
Thanks for the great post! I’m in a boot cast with my 2nd fibula fracture, and I’ve been lamenting that maybe I’m “just not cut out for running.” The problem is, I really love running, and I’m actually kind of good at it. (I completed my very first half marathon this year, and finished 3rd in my age group!) Your post has given me some hope that maybe I’ll make it through this.
Do you have any advice for people with low bone density? I’ve been diagnosed with “lower than average” bone density (T-score of -1.4, if you’re into statistics), and I’ve been told that I’ll just have to accept a high risk of stress fractures if I want to continue being physically active. Being physically active is just who I am…my husband and I spend our weekends backpacking, cycling, snowboarding, training for triathlons, etc. I’m having a hard time coming to grips with needing to accept 1-2 fractures/year to have what I consider to be a normal and healthy active life.
Also, do you have any perspecive on minimalist running shoes for people with low bone density? I have a pair of Vibrams I use for kayaking, and I was hoping to try them for running to improve my technique and ankle strength, and reduce this cycle of broken fibulas. However, I’ve been warned by my orthopedic doctors that people with low bone density should stick with a supportive shoe with plenty of cushion to avoid stress fractures.
Brief bio in case it’s helpful: 27 year old female, 110 pounds, high arches, currently running in Sauconys with custom orthotics, very cautious training schedules (3 runs/week max, increase mileage by less than 10%/week, plenty of stretching & strengthening).
Thanks!!
I’ve been diagnosed with “lower than average” bone density (T-score of -1.4, if you’re into statistics),
Is this for your spine, whole body, and/or hip? They usually look at these 3 things, and each of them tells you something differently. If it’s your spine, that’s actually pretty normal, if you’re thin (~spine isn’t being loaded as much as someone who’s heavier). Hormones and diet can also impact the “preservation” of your spine. If you have “osteopenia” in the hip and/or whole body…. then I would be concerned! As a runner, you shouldn’t have low bone mass in your hips– the exercise loads your hips and should make your bone mass strong. Exercise, getting enough calcium and vitamin D in your diet/supplement, sleep, AND most importantly GETTING YOUR PERIOD will all have a significant impact on maintaining your bone mass.
As for your fibula, I’m thinking it’s a gait and/or shoe issue. Or overtraining– too much physical activity? There’s a lot of lateral-stabilization going on when you get off-roads, on trails, so maybe too much? Maybe you’re supinating too much? You could meet with a PT and figure out ways to strengthen your lower legs. I’m a big proponent of barefoot running for helping to strengthen the lower legs. But it’s all a balance between rest vs. stress.
I disagree with your doctor– if you strengthen the muscles, you strengthen the bone too. But it’s a process of adaptation…. you don’t want to jump into too much/too soon. Maybe try a lightweight trainer or racing flat first? The VFFs are pretty minimal. It took me a good year to fully adapt to training in racing flats. So it’s a lengthy process…. like you’re becoming a runner all over again!
This may sound odd, but maybe you should try running more and more consistently? Only 3 times a week, wow…. I bet you’re hauling too! If you get into a consistent/daily training routine (5-6x/week), your body will figure out that you need to slow down to stay healthy and feeling good. The focus would be on low-intensity…. relax and shake out any tension! That’s the premise of my Master’s thesis– low-intensity stimulus is highly anabolic to bones. It’s the high intensity, “running out of your skin” that overstresses the body and leads to breakdown.
Good luck and keep me updated!
Camille
Hi Camille, I just loved reading your blog. I am currently a XC runner in high school, the top in our girls team, and I’ve been diagnosed with tibial stress fractures year after year after year. I’m a junior now and continue to get them ever since 7th grade! I’m just so sick of it.. the past 2 years I’ve taken 1-2 week breaks during XC season, but it’s no use. I just get the same pain in the same spots everytime. I love running with a passion, I love getting better, and setting a good example for my team.. but it’s difficult to pursue my dream when I’m constantly in pain. This year I decided to run through the pain and I’ve broken many PR’s but I had to stop last week because of shooting pain in my shin during my workout.. I couldn’t even finish..
The worst part is that I have no idea what I’m doing wrong that leads to these stress fractures. I’ve tried absolutely everything in the book to prevent and treat them, but it’s no use. Pretty much I’m doomed for the rest of my running career. I have normal arches, not too flat, not too high, I’ve tried every shoe out there and there’s been no difference. This year I made sure to not overtrain (less than 10% each week) and it helped from June to August surprisingly, but after I ran my first XC race of the season, I got shin problems.. again. The only thing I have not tried are molded orthotics, but I really don’t want to pay $50-100 on something that may or may not help.
I’m considering barefoot running/running in trainers my senior year. I’ve noticed that whenever I run on treadmill my shins don’t hurt as bad, but you can’t race and do hill workouts/actual speed workouts on treadmills! It’s so frustrating, and actually, my coach’s main goal was to save me for my senior year and go full out then. However, I’ve been doing exceptionally good this year and I haven’t been able to make myself stop running even when I experience the worst pain. I’ve just put up with the pain for so many years, and I wish atleast my senior year I could run injury free for once. The worst part is that as soon as I get to the peak of my running in the season, I hurt so bad that I’m forced to take a week off, and then I’m back to ground zero re-training and everything. I would love to run college XC like my sister, but it’s almost physically impossible for me due to my shin problems. I’ve been to many Physical Therapists, Doctors, Sports Medicine Professionals, but nobody’s solved the problem. If you know any way I could run a pain-free senior XC season, I would love some help. Thank you so much for your time.
Thanks so much for this post. I am a competitive runner and marathoner and just completed my first half-Ironman Sunday, after which I had severe pain in my foot. Turns out it was an sfx in my 2nd metatarsal on my left foot. This is my fourth sfx since 2007. First two were tibial, and last year was the left navicular, for which I was put in a hard, non-weightbearing cast and crutches for 6.5 weeks and then a boot for 2.5 weeks. After that I was advised by the orthopedic surgeon and physical therapist to stop running marathons and to cut my mileage back to under 40 miles per week. It took me a long time to work back to running after the navicular sfx, but I did it and was doing well. The most I ran over the summer was 30 mpw, and during the half-Iron training, I never ran more than 20 mpw. My bone density is double the average for a woman my age. I eat well — I’m vegan but take great pains to get enough protein, vitamins and minerals in my diet. I am severely lactose intolerant so cannot eat any dairy, and I can’t bear eating meat, so that’s why I’m vegan. Anyway, I am looking for answers, like you did, as to why this keeps happening. I run in neutral shoes with custom orthotics that were made after my 2nd tibial sfx. I just don’t know where to go from here — bloodwork? Even more physical therapy, even though I already know what to do? I’m just very frustrated.
Thanks for your insight.
Hi. I have one specific question that I can’t seem to find the answer for no matter how many resources I search so I was hoping you might have some advice. It seems there is so much information on the diagnosis of a stress fracture but very vague info on the training after the healing. So here is the situation: I had this dull ache back in May after training for the Warrior Dash on the bleachers of a high school, anyway-I thought it was a muscle strain and I was just being a baby. The nagging on and off discomfort wouldn’t leave completely so I went to doctor in August and found out by MRI I had a femoral shaft stress fracture (I had done several races including a half marathon and was currently training for a full). My sports med doctor said I did not need crutches and I was able to walk, which includes being a nurse that walks a lot at work (so I have been actively walking this entire time). As far as activity, I was only able to swim and bike. It had been 6 weeks and I was able to start the elliptical for 30″ and now (9 weeks post MRI) I am doing 2-3 mile runs and able to progess effort but not time.
So after all this information, my question is if I am not feeling pain or discomfort and I run slow could I run an extremely slow marathon in 2 weeks? I know when I type this it sounds stupid but my thought is that if it is healed and I am running on it, why would it matter how long I am on it if I run “gently”? I am not a fast runner to begin with (2:15 half, 4:45 full), so if I did a walk run routine would I be putting myself at risk of injury again?
I read your story and I agree that it is not the distance but the force. I have run 15 half marathons and 5 marathons and several smaller races in 5 years. I have never had a fracture until I started training for these new obtstacle races and I was doing more stressful training on my body.
I appreciate any advice, like I said I don’t want to be stupid but I signed up for this in the spring and want to do it so badly,…but only if it’s not a completly dumb idea.
Do you think surgery will help a stress fracture to go away?
Hi Shaydon, most stress fractures do not require surgery. There are situations where a bone could develop a “non-union”, because of poor blood supply to the bone, and you need surgery. These stress fractures may take a longer time to heal, or not heal at all/properly, on their own.
Thank you for the post. I’m a 43 year old mother of four who, in the past two years, have developed a passion for running. After many years of very slow “running” I decided to try picking up the pace–shorter strides, faster turnover– and also had an iron deficiency diagnosed and treated. It changed my entire outlook on running. I began to place in my age group and enjoyed running like never before. I did, however, develop a calcaneal stress fracture in my left foot and took four months off (on crutches for 6 weeks), keeping sanity by pool running and maintaining my core work. I returned to running slowly in August. I’ve had a couple of great races and training is going very well. Three runs per week–one easy, one tempo/speed, and one longer tempo. Last week, I did a 14 mile run (training for a half in December) and the old injured site is bothering me. Not pain, and I can hop, but it is uncomfortable and now has shaken my confidence. Any words of advice for me? I have a bone stimulator and I’m again using it just in case. I’m running in Saucony Kinvara shoe, which I really like.
Hi Diana! Good for you on upping your training, but sorry to hear about the stress fracture! Funny enough, this sounds similar to someone else I corresponded with. This may sound odd, but maybe you need to run more frequently, ~easy jogging/walking on the days in between your hard days? It’s a greater stress to your body when you’re only running 3 times per week, and those runs are hard! It’s the high intensity/stressful running that hurts you…. not the easy running! It’s going to be even more stressful to go for 14 miles, when you’re only running 3 times per week. If your body is in a routine, and used to running…. it’s not going to be so overwhelming to the body to go for 14 miles (let alone, race 13.1). When I was coming back from my hip surgery last year, I was walking twice a day during my recovery, 3-6 miles per walk. My body was used to moving and having the impact. It wasn’t such a drastic change when I started running. My body actually felt better, the higher the mileage and more frequent the running. You can equate walking and easy running to the low-level mechanical stress of the device we used for my Master’s thesis– this type of stress is anabolic to bone. If you don’t want to run on the other days, walking is an excellent substitute.
My other concern would be your shoes. Stress fractures in the feet are almost always due to your shoes. Maybe it’s a mismatch between the shoes and your gait? Do you land heavy on your heels? It may be that you need to find a different shoe until your foot gets to feeling 100%. It’s up to you to figure out what feels the best. You don’t need to worry about reinjuring the bone– it is stronger than it’s ever been because of the bone callus. However, it’s going to hurt because as I mentioned in my post it takes a long time for the bone to fully remodel itself. The bone callus itself can irritate surrounding nerves and soft tissue and cause inflammation. It’s really a matter of getting over “the hump”, and hopefully not changing your gait and injuring a totally different part of your foot/body!
Anyways, hope my advice helps! My thoughts in summary are 1)Move more, lightly… walking?! Get the blood flowing. 2) Try a different shoe– go to the store and try on different shoes. Isn’t the Kinvara kinda soft/squishy/flexible? Maybe try something firmer, ~Adidas or New Balance?
Camille
Camille:
This article is great! 100x more informative than anything my doctor has told me!
I’m coming back from a stress fracture in my third metatarsal (happened September 13), and I’m in my second week of running. I’ve worked my way up to running once every 3 days for 3 miles at a time. Next week I’m hoping to take it up to 3 miles every other day.
My question for you is did you ever experience weird cracking in the joints of your surrounding toes when your metatarsal stress fractures were healing? Specifically, in my case, my second and fourth toes crack like crazy now. I already had the bad habit of cracking my knuckles before this injury, but I never cracked my toes before. Now, however, my second and fourth toes perpetually have that “pent up pressure” feeling that you get when you want to crack your knuckles, and they crack if you so much as blow on them….it’s really weird! And to make things even stranger, my third metatarsal joint (the one I injured) never feels like I should crack it nor has it yet to join its neighbors in cracking 24/7. Any insight on this?
Again, great post and thanks to all the other commenters too for asking such good questions!
-Grace
Great! Glad my article is helpful to you Grace. I speak from both a science-research perspective and from practical experience.
As I mentioned, it takes much longer than the typical 6-8 weeks for the bone to fully remodel itself and be “normal” again. Expect it to take several months (it depends on the bone size, health, age, severity of the stress fracture). Your 3rd metatarsal currently has a huge bone callus where you had the stress fracture. That’s going to cause the other bones in the feet to shift, and you will likely end up slightly changing your gait. This is what I’m guessing is happening– you are placing greater stress/compensating with the other toes/metatarsals. I would suggest making sure you’re in the right shoe size– your toes need to spread. If they’re cramped (shoes are too narrow or too short), this could definitely cause problems.
These are my thoughts! Good luck!
Camille
Hi Camille,
after training for and running a half marathon went to doctor with upper thigh pain (that had me near tears after the half). Diagnosed with hip stress reaction. Am searching for the difference between stress reaction and stress fraction AND how does healing and recovery differ. Any help, advice would be greatly appreciated
Thanks so much for your information. I am new (2 year), “older (49) runner (slow
Hi Jill! Glad what I posted is helpful to you. Sorry to hear about your stress reaction! The good news is, a stress reaction isn’t as severe– you caught it just in time! With the femur, it’s basically caused by the muscular tension stressing the bone. You basically have an inflammation of the periosteum (~sheath of the bone, where the muscle attaches)– a stress fracture is where the bone accumulates microfractures and it cracks. Since you only have a stress reaction, it should heal faster, but I couldn’t give you an exact time frame (few weeks, month?). You’ll know when you don’t have any pain hopping on that leg– 100% pain free. Until then, take it easy, and then start with walking before running.
Good luck! You’ll be fine!
Wow Camille! Thanks for the quick response and a clear description! Just what I wanted to hear!
Thanks and bless you for the gift of your knowledge that you freely give….you helped me feel so much better. AND, yes, you gave me more information than my doctor!
You’re welcome! I’ve seen what all of this looks like under a microscope…. I know what it feels like…. I’ve lived it! It’s definitely reassuring/comforting having the knowledge and knowing what’s going on in your body. You’ve just got to rest your muscles right now (and thus your bones!). Walking is good though cause it’s low stress.
Camille
hi! I stumbled upon your post researching stress fractures. I went to the dr. they saw nothing on the x ray but he put me in a boot for 3 weeks. went back, and he said I could get out of the boot but no running and I go back in 2 weeks. I had gotten to where I had NO PAIN and when the dr. pushed on my foot to check it, he must have been pushing HARD, bc it hurt me for several days after! Do you think its possible he bruised or reinjured my foot doing that? I am getting discouraged as I thought I was better (no pain 3 weeks) then after he mashed on it…pain for 6 days! I have now not been running for 5 weeks! any advice would be appreciated!
Hi Heather! Sorry to hear about your foot! Have you ever heard if it hurts to push on something, don’t do that? I highly doubt he reinjured the bone, but since there’s surrounding nerves they’re likely inflammed because of the pressure. However, overall as I mentioned there’s 2 tests you have to pass: 1) No pain hopping on the injured foot, and 2) No pain palpating the area. Then, once you are painfree with these two tests, you wait a week before you start running again. Since you still have pain with palpation, you’re not ready to run yet. You could start back with walking though, which will ease the transition to running.
Good luck! You’ll be fine!
Camille
thanks for the encouragement about my foot. One more question, how hard should I press on my foot? B/c I can press on my un-injured foot hard enough to make it hurt, haha. When I push on my injured foot it doesn’t hurt, but when the dr. pushed on it it really hurt, so I have no idea how hard he was pushing/when I will really know. Hope that makes sense!
Push as hard as you can! You should have absolutely no pain palpating it, and most importantly no pain hopping on that foot.
Thx. I just started getting back into fitness after a year or so of being a couch potatoe. I live to LA and did a 5-6 mile off road hike in my VFF flats. I felt like a kid again as I started increasing speed and getting the barefoot strike down. I was so into this experience that I did it 5-6 days a week with little recovery.
After my 10th week, I experienced a 2nd metatarsal stress fracture in my left foot. I have been hobbling around for 7 weeks now and still experience some pain. There is visible swelling still and I feel that I may have reinjured a few times by just steeping too hard up the stairs or on the hills around the neighborhood. I consistently read 8-13 weeks recovery, but have been scared that I won’t get to get back to my routine.
I agree with your comments regarding ice and heat. Both pretty useless as well as drugs and crazy supplements. Time and rest is about the only thing that heals bone.
Thx
Hi Brent! Sorry to hear about your metatarsal stress fracture! Sounds like you got a bit overzealous and did too much all at once. Walking on rocks/roots with minimal shoes is a strenuous workout for your feet! That’s definitely something you’d have to build your feet up to.
Did the doctor give you a boot or recommend a stiffer, cushioned shoe? I think this route is beneficial the first few weeks so you get less pressure and bending forces on the metatarsals. This allows the bone and muscles to rest, but if you continue to do some walking, you can still get blood flow to the area to enhance recovery. It’s a matter of balance between rest and getting some “protected stress” to enhance healing. As far as recovery time, it totally depends on the person, the bone, and the severity of the stress fracture. You have to pass the two tests I mentioned: no pain palpating the area and no pain hopping on the foot.
Anyways, when you finally are pain free, hopefully you’ll progress more gradually back into your routine. Rotate different shoes– each stresses the feet and body slightly differently. Good luck!
Interesting post on stress fractures! I am a PT who ran competitively in hs and college. I have run cross country (used regular running shoes and racing flats which are now basically minimalist shoes) and was a heptathlete in college. Used spikes also. Supposedly developed a stress fx in my back from a triple jump injury but bone scan revealed it was not active (so I know now injury was probably more S.I. joint related). I’ve taken courses in running for PT and do gait analysis and hands on evals. You would be interesting to eval and analyze. Im sure you have had it done at some point? If not or you are interested in a free video-analysis, I would love to do a post, discuss and link to your post.
Well written and agree with most of your post but here are some of my thoughts:
-The pelvis is a weight bearing joint (see here for a description: http://www.coreconcepts.com.sg/mcr/posterior-pelvic-pain-sacroiliac-joint-pain-in-pregnant-women/) though not direct, as with the leg. Forces through the leg during ie. the long jump will be more than the forces from the muscles pulling from contraction. With one legged jumping, if the muscle pull was that great, you would have an avulsion fracture during the activity.
-You list some good examples of guidelines for returning to running after a stress fracture. Ultrasound also provides a test to “dx” a stress fracture in shins or at least alert for a problem, although its not 100% reliable.
Barefoot running does change the PLACE the forces are distributed. So it helped you but not in the way you think. Dr. Irene Davis, PT, gives a great presentation of the research on this so far: http://www.youtube.com/watch?v=4eTugVVo86g
If 15-16 is when you had your growth spurt, that is a bit later than the avg. girl and 16-22 is late for most. This is the typical range for men however. But growth from bones do stretch tendons and can cause things like Sever’s Disease. Problems at your age are usually from female athlete triad (typing my thoughts as I read so I see you covered this later).
Overtraining (and the triad definitely) cause stress fractures. High intensity, yes, can damage but I would argue so can low stress high mileage at some point for the “right” person who doesn’t intake enough and has a poor osteoblasts/osteoclasts balance. Research has shown the two biggest indicators of future injury are *mileage* and *previous injury.* My experience is what matters with intensity, is how quickly you increase and if you add rest in. I would love to see your thesis though.
Agree-type of surface doesn’t matter when you run. Your body adjusts and there is a lot of research demonstrating this. But chamber or tilt of the road or surface does somewhat. I agree-different States have different dirt =) Colorado is much harder than CA but not sure how much it affects me.
Yes vibration therapy helps!
I’m not big on orthotics unless you have major issues where your body can’t safely adjust ie hip replacement on one side with leg differences. This would cause problems up the chain and would not be equal on each side. I was a fitter for the now defunct. Somnio shoes and the shoes were beneficial for those people who had major injuries problems. They usually had problems on one side and would be forced to compensate on the other. But I did not recommend them for everyone. The shoes allowed a separate fit to even out each side and balance them. But overall, I’ve been taught to go with strengthening and flexibility first and that very few people need orthotics. Yes they definitely can cause stress in other areas! Sorry you found out after the fact!
Yes you need a PT rehab program with the boot. A good Dr. will refer to a PT who is knowledgeable about running analysis and runners.
I can say, I started in Nikes way back when (after beginning running in my Cheap Kinney ‘running shoes’ which are now probably considered minimalist. Nike tends to have the highest drop I have used.
Form: I midfoot strike and always have but it is because my calves are tight, so know WHY you use the form you do. Everyone is different. Don’t follow a fad. Consult with someone who can analyze videos AND also does hands-on joint mechanics ideally (or has done hands on and knows what the joints are likely doing) and can explain to you why your form is one way or why you might need to change it. Most shoe store advisers are limited in their knowledge to a point and cannot do hands on analysis of muscles and joints.
Agree over-training does not = not enough calories. They are two separate problems. You can push body too hard with enough food intake, although they usually reside in combination. For example, I can go out and run 8 400′s today and eat enough to sustain it but if i haven’t been running, I’ll likely get injured. So I would classify over-training as not enough rest and also probably doing too much too soon.
Disagree about ice being ineffective: Studies aren’t the best but do show it does increase blood flow after and reduces inflammation probably even micro inflammation in tissue which you may not see- which indirectly might help. An example of this is macro inflammation (a bruise) is helped with application and disperses the blood and extra fluid more quickly. Any build up of fluid inhibits the nerves which inhibits the muscles from working.
Congrats on your accomplishments and Good luck!
Thank you for your input Andrea! I love hearing experiences like yours, coming from a health professional. I esp. like how you pointed out the caloric deficit association with higher mileage– that’s very true. That would impact the whole hormonal milieu and go hand-in-hand with the female athlete triad. This wasn’t my issue though, so I wanted to point out from a personal standpoint that not everyone fits into this stereotype. I run 120-140 miles per week now (and eat like a horse!), compared to 20-30 miles per week when I had most of my stress fractures in high school/college (and regular periods too, without oral contraceptives). This is why I believe intensity/tension in the body, with a lack of proper recovery (hence overtraining), is likely more significant. From a personal standpoint, seeing it with myself and teammates (and I know this probably holds true with most D1 female distance runners)– they hammer it every day! There is no concept of recovery. It’s not the mileage, although certainly an unprogressive jump from 30 to 60 mpw in a short time span could cause the “levee to break”. Funny enough, even now as a professional athlete…. a lot (or even a majority) of the marathoners I compete against were D2/D3/NAIA runners or didn’t compete at all in college. They survived/enjoyed college…. maybe a lower stress level…. not the “meat grinder” attitude and pressure of D1 schools. So I strongly believe intensity is more causative.
Ohhh, you would have fun analyzing me! I run like I’m sitting in a chair– very upright, little forward lean, not much hip extension. I actually. Yes, I was analyzed last year (2010) by the PT (~a runner) who designed my program pre- and post-hernia surgery. I did the program for 4 months and it helped tremendously. I’ve consulted with him since then about my “lack of hip extension”, and he thinks I should let my gait “just be”. I’m working on a blog post about what I experience in 2010 (hernias and labral tear)– part of my lack of hip extension may be due to an anatomical defect with my right leg/hip. Funny enough, a few months ago we were watching videos of me running in high school– I ran completely differently, with much better hip range of motion and forward momentum. However, I can complain now…. cause I’m much faster than I was in high school!
As for ice– I did a blog post about this, including citing a meta-analysis that reviewed all the research on this topic: http://camilleherron.com/2011/07/21/do-ice-bathsicing-really-work/
There was actually a recent article (few days ago) in the NY Times about this as well (http://well.blogs.nytimes.com/2012/01/04/why-ice-may-be-bad-for-sore-muscles/?src=me&ref=general). If there’s any benefit to ice or icing, it’s if there’s a mechanical component involved. The coolness of the ice acts as a pain reliever but has no impact on enhancing tissue recovery. Pressure or even the hydrostatic pressure of cold water immersion is thought to be a positive stimulus to the immune system and thus tissue recovery (there was an article in Nov. about this). This goes along with my Master’s thesis about the impact of low-level mechanical stress on fluid flow and stimulating growth factors and immune cells to the area.
I did a separate page about my grad school research, with a link to my thesis: http://camilleherron.com/other-talent/
Anyways, thank you again for your input! I love brainstorming with other great brains.
I’ll have to read over my post to see where I can make some changes. 
Camille
Hey Camille! Really glad I came across your website and your experiences of stress fractures! I was wondering if I could ask some advice? I broke my third metatarsal just below the head six weeks ago. It was actually a trauma – I was running XC and I heard/felt a snap as I put my foot to the floor and I had to drop out of the race. It was so cold that my foot didn’t swell up until I got home ( I have Raynaud’s Syndrome so have very bad circulation to the extremities!) and it took my two days get x-rayed and get a fracture boot. At four weeks I was discharged from the hospital and told to start wearing trainers by the consultant, even though he’d originally told me it was 6-8 weeks to heal. I’ve only just started wearing trainers in the past few days and am struggling to weight bare on the broken foot. I can still “feel” the fracture site. It’s not downright painful, but I’m worried it’s not healing properly. I just wondered if you had a similar experience with any of your foot fractures and how long until you could walk pain free? I want to run but am worried that I can barely walk atm. Thanks for your help. Lizzy.
Hi Lizzy! Glad you found my website! Sorry to hear about stress fracture! Considering you were in a boot for 4 weeks, it’s definitely going to take time getting used to normal weight bearing again. This is definitely the hardest, and most overlooked, part to coming back. Start with walking, before you start running again. You won’t be ready to run again until you have no pain palpating the area and no pain hopping on the foot. Then, ideally you should wait a week beyond being pain-free, until you start running again. I can guarantee you will have pain when you start running again. This seems to be normal– no worries about the bone because it will be stronger than ever. This pain is because of irritation to the surrounding nerves/soft tissue, likely because of the bone callus. Good luck getting healthy and coming back! Give it time.
Thanks for the advice Camille! I guess the discomfort I’m feeling is normal. I need to have more patience
Yes, definitely normal! Be patient, indeed.
Hello! I also stumbled across your site and am finally encouraged!!. I’m not a runner, but finally found a passion in flat track derby. Which in turn, had inspired me to cross train and really and finally enjoyed exercising!! Lo and behold, not understanding to take it slow and build up my training, I was diagnosed with a stress fracture on my 4th metatarsal.
My knee actually stopped me from doing all my work outs just around the same time before I had any significant foot pain, because after research, I realized that I had to build up my muscles before I could do all that skating and jumping (I forget what the power jumping is called)! Then, the pain in my foot became more pronounced wearing heels one day. So, after a month of taking it easy, I finally went to the doctor at the end of October, he said to see how it felt in another 3-4 weeks. Then, the podiatrist (finally diagnosed), and the boot. I did wear the boot when I was out and about and running around the house, but not diligently for a couple of weeks. I was still in pain, so, I finally wore it for three weeks straight.
Now, it’s just been on and off again (wondering if I didn’t wear it long enough), I tried not wearing the boot for a weekend, and boy, did my foot ache (though, I think it has more to do with building up stamina) and kind of floundering around on the internet trying to figure things out. I’ve been discouraged and have stopped any kind of exercise. But, I want to thank you for this encouragement!! I’ll try the hop test today, but, I do know that palpating still really hurts (even though it’s now been five months) I’m going to start walking and trying pilates slowly with my strength training for my legs and core, and then, from there, there’s a hot yoga class I’ve been interested in. I’m thinking of checking my bone mass… Maybe, I can start skating again – I so miss it!!! Thank you! Thank you!
Hi Lisa! Glad you found my blog post helpful! Sorry to hear about your foot! It sounds like you just need to be patient and realize it’s going to take time for the bone to heal and comfortably bear weight again. Don’t do nothing…. do something, and gradually do more (~walking). The weight bearing through walking first will definitely ease the transition back. Pain through both palpation and the hop test is your indication of whether you’re ready to progress back to your sport. You mentioned wearing heels– don’t do that! Wear normal, comfortable shoes as much as you can, and refrain from ~heels or awkward dress shoes. Good luck and hope I’ve eased your mind!
Hello again!
I’ve been rereading through your article and the comments, but I am not able to clarify something for my processing of the information presented. I’m actually able to palpitate my metatarsal with no pain, but I did get achy somewhat later in the day. I palpitated the area last night and was up reading for awhile and felt no achiness. Then, I palpitated again this afternoon, and probably within the hour (maybe), it got achy and has continued to be achy. So, is it no pain = no achiness after, or no pain just while palpitating? Once the achiness goes away, I’ll check the hop test again, but the last time, it kind of did the same thing. No pain, until achiness later, but palpitating had still hurt back then. I’ve had no issues with walking and hope to build up to 5x a week this next week! Yay!
Thank you! Thank you! for your passion in this!
Hi Lisa! You shouldn’t have pain, period. The two tests I mentioned are simply ways of testing whether you still have pain. Since you do, that indicates you’re not ready to run yet. The trick is waiting until you’re 100%…. then you wait a week, before you start running. Good for you with the walking– that will help ease the transition back to running! Good luck with a successful comeback!
Camille
Hi Camille!
Great information in this post; thank you so much for all the research you have done and for summarizing it all so clearly for us.
Of course I do have a question….but first, a quick history. This fall I had my orthotics “taken down” a bunch…meaning I had them made much less supportive to reflect my improved biomechanics from years of running. (I have, unfortunately, worn orthotics for over 20 years…and I am only 38!) This was an overall good change at first: my gait was more comfortable and my speed increased a bit (I set a PR for the half marathon in the new orthotics on an incredibly difficult course with less than optimal training, for example.) Unfortunately, I
developed a stress fracture in my right fibula in late November. No sharp pain, just a little ache…but after a few days it was incredibly tender in one spot when I palpated the bone. I knew enough to stop running. After a week the pain was completely gone and I raced an 8k. Again, no pain when running but then extreme tenderness later in the day and for almost a week afterwards; just brushing my hand over the area created tenderness! So 2 weeks off. Then no pain and an xray that showed significant bone remodeling. 2 runs, tenderness, 2 more weeks off, 4 runs, tenderness, more time off and another xray once again showing that the bone looked good. I last ran almost 3 weeks ago. All in all I have put in 41 miles since the pain first appeared in November. I have used an exogen for the past 5 weeks one to two times a day and have had no restriction in my daily activity (chasing a 6 year old) aquajogged, done the elliptical, done core work, MYRTL and crossfit. I am incredibly fit and have great core strength and hip stability now, which is a nice bonus. And I have had no pain at all for the past 2 weeks.
So, now for the obvious question: do I run again? Or do I take more time off? I have a marathon in just over 5 weeks so I would like to get my legs used to running a bit again, but I don’t want to start too early and shoot myself in the foot (so to speak). I certainly do not intend to ramp up to full on training in those 5 weeks, but some miles would be good. I have just never, ever experienced this level of sensitivity post-stress fracture (I have had a few others in other areas, much more cut and dry and with no post-fracture pain) and it has me very nervous. Any advice is very, very welcome! Thanks!
Hi Allie! I wrote a long reply last night, and something malfunctioned when I replied! So here we go again….
Sorry to hear about your fibula stress fracture! That’s interesting what you’ve done…. running here and there, but mostly resting. That’s also not surprising you could run, considering the fibula isn’t really a weight bearing bone, and just acts as an anchor for muscles. It’s the “pulling” of the muscles on the bone that lead to the stress fracture.
Based on what you told me, it sounds like the change in your orthotics ever-so-slightly changed your mechanics so that you’re overusing the muscles that attach to your fibula. It sounds like you did “too much too soon”– the body/bones/muscles needed more of a gradual adaptation.
Personally, I can tell you I believe I trained through a fibula stress fracture so I could run the ’08 Olympic Marathon Trials. However, my stress fractured was incurred from slipping off a curb, so it wasn’t “overused induced” like yours. I jogged easy for 5 weeks, so the bone could heal and I could at least start and finish the marathon. It took another 6 weeks after that to be painfree. So I ran easy through the pain, until the bone was 100%.
Unfortunately, you’re basically wanting to go from not running, to running a marathon in 5 weeks. That’s a HUGE jump and stress to the body! If it was me, I wouldn’t do it– that sounds like you’re asking for trouble, and your body will likely pay a price for it. There’s lots of other marathons out there, and you could allow for a healthy, gradual comeback and run another marathon later on. Plus it sounds like you need a longer adaptation period to adjust to your “new” orthotics– which hopefully you do. If you don’t…. I don’t know what to tell ya, unless there’s a way to go back to your “old orthotics mold”, or maybe you need to try a different shoe to balance out the orthotics.
As far as knowing you’re ready to run again, the hop test and no pain with palpation are important. I’m willing to bet you will have pain coming back, because of the muscles pulling. The bone should be healed and stronger by now. It would be a matter of adaptation to the new orthotics.
Good luck with everything! Don’t stress yourself out too much cross training like a mad woman! Getting used to the impact is far more important than the conditioning of the heart…. esp. if you want to run 26.2 miles.
Camille
hi Camille
great Forum!!
I need your advice..I was diagnosed 4 months ago with a stress fracture of the foot- 5th metatarsal. Im not a runner…i do walk alot ..no other real explanation.. I had been walking around for 3 weeks or so before going to the doctor…and he did a few things before finally ordering an MRI and making the diagnosis..so it was a good month or more walking on the fractured foot before a diagnosis. Then I was placed in a boot. I have had a long history of chronic pain and issues with my knees and other areas..In fact there has been a long discussion of the possibilty of some sort of muscle disease/myopathy with me though it has never been definitively diagnosed…I do have elevated CPK (muscle enzymes) but muscle biopsy was negative. Considering my struggle with physical issues and pain, I was a bit paranoid about my foot injury so followed my podiatrists suggestions to move and weight bear as LITTLE AS POSSIBLE.. I wore the boot for 11 weeks…i was still experiencing alot of pain and swelling on the top and outside of my foot when I had a followup MRI after 11 weeks with the boot and the MRI showed my fracture as totally healed…no swelling or adema..(the MRI did show 2 small neuromas as well–which were inflamed on the first MRI–not inflamed on the 2nd). The thing is..Im still experiencing alot of pain…and strangely–my other foot hurts as well now!! After reading your posts..Im wondering if i wore the boot too long..do you think there was muscle atrophy from not walking all that time?
I raised this concern with my podiatrist..because I feel as though i have lost some sort of padding.
i have this sensation as if Im walking on the bones of my feet now..both left and right.
He says my feet look normal to him..and that i am thin and we ll lose padding with age (im 53)
but this is definely something that has occurred since the fracture..and my feeling is that either it happened as a RESULT of the fracture and boot…or maybe its some change in body which RESULTED in the fracture…He ordered me custom orthotics..Im very flat footed (id been wearing over the counter ones for year and years) and says i should see how I do with those..
I have an appt with a sports orthepedist next week, but am very concerned with all the pain Im having..How do you feel about Physical therapy..The podiatrist thinks its overkill..
I welcome any thoughts
thanks!!
Hi Eugene! Sorry to hear about your ailments! A stress fracture in the 5th metatarsal is a bit rare. You say you’re flat footed, but based on your 5th metatarsal stress fracture– do you supinate a lot (~feet or legs roll outwards)? Yes you absolutely need to progress back to normal weight bearing and “ween” yourself off the boot. You can definitely get atrophy from basically “casting” the feet (same thing happens with shoe wear…. take a look at the feet of barefoot habitants vs. shoe wearers!). I think you need to be patient, and try to get back to normal weight bearing and walking. It’s going to take time. Are you taking any NSAIDs or other pain-relief medicine? That can definitely slow your healing rate.
Good idea to get a second opinion on your health. Let them be your guide on what’s going on with your mechanics/health. Hopefully you can also find some comfortable shoes to wear that alleviate the stress on your 5 metatatarsal and work with your whole body. Don’t let pain deter you from bearing weight– the bone should be healed by now, and you just have to re-adapt to normal weight bearing again. It’s like taking on a strength training or any type of exercise program…. you start out weak and in pain, and over time the muscles get bigger and stronger (and no more pain). You have to get over that “hump”.
Good luck getting healthy!
Camille
thanks camille..for the insight…
yes–i find that because the part of my foot where the fracture occurred still hurts..i avoid putting weight on it when walking..in fact, even though the followup MRI showed it to be completely healed…it hurts so much that I have been doubting the MRI..It makes sense what you say (my podiatrist never explained it to me this way)–that the bone iS healed but that the callusing has aggravated neighboring soft tissue…Ive read so many things online where people stress caution…and say that not adequately resting or using the boot can cause re-fracturing of the same site–or displacement–that i have been very skittish about putting weight on it…of course by doing so..im throwing my gait off and stressing other parts of my body/feet..so–do you suggest that i try to walk as normally as possible, putting weight on the 5th metatrsal..even thugh its sore and still hurts?
is that the best way to resume??
thanks again..
Hi Eugene, yes, definitely you need to try and bear weight as normal as possible. You don’t want to end up with compensatory injuries elsewhere because you’re changing your gait (which is actually common). The bone should be healed and stronger than ever, so you have no worries. It sounds like you were away from bearing weight for so long– plus the surrounding nerves and soft tissue are irritated. As I said, you need to be patient and progressive with getting back to normal weight bearing. Because our feet bear so much direct force, it’s understandable you’re feeling a lot of pain. Tough it out– you’ll be fine!
Hi Chamille!
Thanks for the great information! I recently got a calcaneous stress fracture in my right heel deep against the achilles. I ran to hill runs (constant ups and downs) one on a Wednesday and then ran 2 miles further on Friday, Dec 30. less than halfway i could barely pick up my feet. I was running in Vibrams which I have been running in them since late November..so not long but was doing fine with 2-3 5k’s a week in them…no pain other than the initial break in the first week (calves killing) and had run in Nike Frees all year. I had done two Triathlons in 2011 and was contiuning my multisport training so not all running all the time! I didn’t get diagnosed for about 2/12 weeks I just limped around but didn’t run again..just bike, swim and Jillian high impact DVD’s but modified if it hurt which couldn’t walk without hurting!
I am currently in a boot for 4 weeks had to do crutches for the first 2 because the boot hurt my heel. I am currently beginning the 3rd week and finally using the boot with a little pain in the area.
My PT (just a friend treating me on the side) said no bike for 2 weeks so all I am doing is swimming, pilates (boring).
How do I know its getting better. All the Ortho doc said was …no running, no training, and do you need some pain pills…see ya on 2/28 for an xray….I didn’t need pain pills…and duh no running i would like to walk first , thank you.
I leave in 10 weeks for Haiti and I am worried that I won’t have my right foot strong enough …my good heel is starting to hurt now from the stress I have been putting on it. I am 5’4 125 so I am not a heavy person….I sneak and take a few steps without the boot on just to see if it still hurts!
Any advise will help!!!
Hi Lisa! Sorry to hear about your calcaneal stress fracture! Sounds like you did too much too soon– you overused your Achilles and it pulled on the calcaneal bone, creating the stress fracture. I can only imagine how much that hurts! It’s going to take time and rest right now, although at some point (as tolerated) you need to progress back to walking/weight bearing. Some mechanical stress will help it heal faster. The location of it makes it tricky, considering how sensitive the Achilles is (naturally) and how much it’s used. Maybe you need to go back to a shoe (both street shoes and running shoes) with some heel lift, to alleviate the stress on the Achilles. Definitely, progress back to walking, and then as it calms down and you can walk comfortably, try the 2 main tests to determine whether you can run again: 1) No pain palpating the area 2) No pain hopping on that foot.
I can’t give you a timeframe of how you’ll progress and be painfree. It should feel Ok in 10 weeks, but the location of it might make it trickier than most stress fractures. Just be patient! Good luck getting healthy and ready for your trip!
not sure where my post went, probably on another subject! Thanks so much for your advise and response.
I can walk with little pain but was told to where the boot 24/7 after it didn’t bother me (did crutches for 2 weeks) So you don’t think it would “hurt” it to put a little weight on it and try walking without boot around the house? I was told non-weight bearing until 2/28! I can pull myself up on both tippy toes but cannot hold myself up with just the hurt foot. Was even told to stay off bike( on trainer)..my bike didn’t hurt it when i was in severe pain.
I am fine with waiting on running(sort of)..but I just want to walk
Again, thanks for your help!!
You should definitely test it out with some walking– do as tolerated, and over time it should get better. From what the research says, and I’ve said a gazillion times over…. mechanical stress heals. Being “non-weight bearing” causes muscle atrophy and bone loss. It perplexes me when doctors tell their patients to ~walk on crutches or be non-weight bearing this long. You need some amount of mechanical stress, to help it heal faster.
Your post was really helpful! I am a beginner runner and I jumped right into 20+ miles a week with one day of hill work outs and one day of speed. With only one day off a week. At the end of two and a half months I got my first stress fracture in my foot and am still recovering. I’m on week 5 of recovery… I’m waiting it out just really anxious but nervous to get back out there. I’m not training for a marathon (yet) but just for health and enjoyment. Any suggestions as to a healthy schedule to get started on once I’m ready to run again?
Hi Marissa! Sorry you’re off to a rough start as a runner! There’s always a “hump” you have to get over when you start something new. Sounds like you maybe ramped it up too much too soon for the body. I’m willing to bet it was the intensity that hurt your foot, and not the mileage. You know, I’m a big proponent of walking…. the next closest thing to running! Start with walking, as tolerated. When you can 100% pass the 2 major tests (~no pain palpating the bone, no pain hopping on the foot), then progress back to doing the walk-run thing. I couldn’t tell you how long it will take to get back to full running– considering you’re a newbie, you probably need to build an aerobic base, before you do progress to high intensity. Definitely though, walk…. before you run, to get your feet/legs used to the impact. No shame in that (even for myself being an elite– see my post about coming back from hernia surgery). Good luck!
Camille
Hi Camille
I appreciate your all round comments about bone healing….like the pelvis having a poor blood supply.
And… a bone stimulator reducing healing time to around 4 weeks……are you talking about a vibration machine?
I have a fractured rami from being rolled by a fast moving mountain bike cyclist on the footpath!
Hi Ray! You’re welcome! Wow, that sounds like a rough injury! I don’t know if a bone stimulator can directly target the pubic ramus (too deep?). A whole body vibration (WBV) platform is actually what I did my bone recovery research with– we looked at this for helping to heal hip fractures (since the femur is weight bearing). I haven’t read the research lately to see if they’re using WBV platforms for other types of fractures/stress fractures. I would talk it over with your doctor and a PT. Since the pubic ramus is an “anchor” for several muscles in the groin (~adduction), I’d imagine just walking would be beneficial for lightly stressing these muscles, to enhance bone healing. Always, start with walking…. before you start running. Maybe a PT program would be beneficial when you’re healed well enough? Best wishes healing and getting back out there!
Camille
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Hi Camille! I just found your blog, and I feel like I learned more here than I have anywhere else about stress fractures. Thanks!
I was just diagnosed with a stress reaction in the talus bone in my ankle. I have had one other stress fracture (2nd metatarsal when I was 16). I’m 29 now and have had many years of 80-100 mpw with no bone injuries and few injuries at all. I had my first baby 5 months ago, ran clear through my pregnancy (60+ mpw most of the way and 50 mpw the last month), took two weeks off, and then slowly built back to 70 mpw. I did add faster workouts a couple of months ago, and I hadn’t done that kind of thing at all when I was pregnant, so maybe that was a factor.
I have a few questions:
- Do you know anything about talus stress fractures? From what I understand they are fairly rare, and I can’t find much information on them. Right now I am in a boot until I can walk without it pain-free, but I don’t have any idea when that will be.
- I am breastfeeding my baby, and from what research I’ve done this usually causes a temporary decrease in bone density. Some of the studies I’ve read suggest that even supplementation with Calcium/Vitamin D can’t prevent or help this decrease. Have you studied anything about post-partum bone density? My fear is that it will take a lot longer to heal since the baby is taking everything.
- I was really intrigued by your advice to walk a decent amount before starting to run again. Do you have any advice for when to start walking? I like the hop test as a pre-cursor to running, but when do you decide to start going for longer walks? Do you keep the boot on until you can’t feel the stress fracture site when you walk around without the boot? I would love to build back with progressively longer walks, but I don’t know if walking too much too soon could set me back.
Thanks so much!
Hi Camille!
I echo the comments of all the others in that this was an extremely helpful blog! I initially developed a tibial fracture (lower 1/3 near the ankle) about 6 weeks ago but thought it was a pulled muscle and only took off a couple of weeks. I started running again way too soon and worsened it, went to the orthopedic surgeon who diagnosed it and now I have 3 more weeks of rest before I can get back out there. I’m going out of my mind not being able to run but time off has given me the ability to read up on ways to prevent future fractures and just in general take better care of myself. I really enjoyed the information you have here and will employ the things you talked about to see if it will help. I was supposed to be running my first full marathon next month but it’s looking like I won’t get to do that until the fall. Here’s hoping all of us stay injury free! Thanks again…you’re an inspiration!
You’re welcome Jennifer! Glad you find it helpful! Definitely have to rest and be able to pass the two main tests (no pain with palpation, no pain hopping on that leg). I would recommend starting with walking before running– there is some impact with walking, and that will help ease the transition for the muscles/bones back to running.
Glad to be an inspiration and best wishes getting healthy and making a successful comeback!
Camille
It is crazy how we can come across articles on the internet that are so pertinent to our own story. My stress fracture is in my femoral neck and was diagnosed about 8 weeks ago while I was gearing up for a tune -up half for the Boston Marathon. While I ruled it as a hip flexor issues, something deep inside knew I should not run the half as their was something more serious going on. I claimed it to be deep down muscle, oh what us runners can convince ourselves of. I am glad I made the decision not to run and bummed I am not going to Boston, but this injury has definitely shed light on my amenorrhea connected with some disordered eating. I have been to some sports medicine doctors in Boston and now in touch with nutritionists to help get these systems all in balance before I get back on the road. It is so hard to be injured and I have definitely been trying to over compensate in the pool and such, trying to reproduce any endorphin that I can. Trying not to let my Type-A take over too much, I finally been more in tune with health v. over-doing it and trying to name which is what. Thank you so much for this article as it helps reiterate that we aren’t alone in this running world and that it is not always necessarily something we did wrong, but more a combination of things and the more we know, the better we can be when we get back on the road.
I get to go out on Brisk walks next week and I can’t wait. Assuming there is no pain ( thanks for the part about the resonating pain, but feeling slight lower than the injury was scary at first) but have since dissipated.
Thanks
Hi Pearson! Glad you found my article, and hope it’s reassuring! Sorry to hear about your stress fracture and having to miss Boston– That’s good though you recognize the things you can improve upon. The human body is highly complex! You really have to be in-tune with it to know what it needs…. in order to stay “in balance”! The biggest thing my husband and I have seen with female runners IS…. the Type A personality…. always rushing around “like a chicken with it’s head cut off”. Women, esp., are very bad about this, and often due to stress and other life commitments…. forget to focus on relaxing and giving their body what it needs (food, rest, relaxation). The biggest thing 99% of women need to learn how to do is to RELAX and simplify. This is what it takes to be at the level I’m at and most importantly to stay healthy and training consistently. Definitely, start back with walking before running…. it doesn’t have to be “brisk”. I would focus more on relaxing the body from head to toe and enjoying the scenery. It’s the impact that’s most important, not the intensity. Good luck with a successful comeback!!!
Camille
Camille
Thank you so much for that. It never hurts to be told over and over to relax and you obviously know the drill, I am totally a “chicken with my head cut off.” I have been cleared by the doctor to walk 3 x a week and have my MRI in three weeks. One question I have is, I am feel like a paranoid little baby constantly wondering if I am feeling pain, does it hurt? Don’t know soreness from pain and want to baby the leg as much as possible. I walk just fine with no pain, but do you have any experiences with being super cautious and nervous to put pressure on the injured leg. Nice to have folks who have been in similar situations. Thanks for the kind words
Hi Pearson! You’re welcome!
As I tell everyone else in my post and throughout the comments, there’s two tests to know you’re ready to run again, 1) No pain with palpation and 2) No pain hopping on the injured leg…. basically, you should be 100% pain free, and then wait a week before you start running again. There is no time frame and no “rules”, but your own intuition, on when you’re ready to run again. I guarantee you will have pain coming back (usually subsides after 2 weeks). Don’t be afraid…. if you’ve taken a reasonable amount of time off, the bone is healed and should be stronger than ever because of the bone callus. The biggest thing you have to worry about is compensating and changing your gait, which could cause injury elsewhere. Try to walk/run as normally and symmetrical as possible.
Good luck and glad to be of help!
Camille
Super Helpful. Instinctually, I think I can trust some aches, which isn’t the sharp pain, but none the less after 9 weeks of no weight bearing, a little bit scary
Thanks
Pearson
Hi Camille,
This posting is so encouraging to me! Thank you for writing it! I am experiencing a two stress fractures, one in each foot, both of the 4th metatarsal. The first stress fracture was from getting back into running slowly and pushing myself a bit on some stairs. Then the other foot was injured after wearing the boot on the right foot for a week and causing too much weight to be put on it. I lightly rolled my foot one day, and now I have two stress fractures! My podiatrist told me that since I couldn’t wear two boots, and he wasn’t sure about the left foot being a stress fracture, that I should put a boot on the right foot and just wrap the left for two weeks, and then we would x-ray and see if there is a stress fracture for sure. Since I’ve been wearing the wrap on the left foot, I have been walking really carefully and just on my heel to give it some rest, but the pain is not better, and I am worried that this treatment might be causing more issues in my left foot. Do you have any experience with only walking at home and to the car, etc. being beneficial to a stress fracture or will it not heal without a boot? I just wondering what damage walking can do to it. Thank you so much for your help! Just hoping to not delay my healing of both feet.
Hi Adrienne! Glad you like my post! Sorry about your bad luck! A lot of getting and staying healthy is about intuition– doing what feels right and best to you. If you’re wearing a boot…. you want to be in a shoe on the other foot with a similar thickness. Otherwise, you’ll be compensating and adjusting your mechanics, possibly maladaptively. Definitely, the boot should only be worn temporarily to allow for some amount of rest. However, longterm you are better off progressing back to normal weight bearing and walking– this WILL enhance recovery.
I don’t see why you couldn’t just wear two stiff shoes…. and then progress back to wearing more flexible shoes that promote greater foot activity. Walking is definitely beneficial…. but with a funky boot and a wrapped foot right now, I’m thinking your mechanics will be off! Symmetry would be good.
Hope for better luck for you! Let your body (and intuition!) be the guide of what’s right!
Camille
Camillle,
Thanks so much for the reply! I totally agree with you that my mechanics are off. The left foot just feels awful! Good suggestion about the stiff soled shoes. Are you talking about Dansko or a orthopedic shoe? I would love to not wear the boot for too long as it does feel awkward. My podiatrist seems to think two weeks on one foot and then switching the boot to the other foot for two weeks would be helpful, but now I’m not so sure. My booted foot is feeling pretty good after two weeks, but do you think it would be beneficial to put the boot on the other foot for two weeks and maybe balance out the right foot with a Stiff soled shoe or will putting the boot on the foot just cause more problems? Thanks again for your suggestions! My instincts are not agreeing with my doc and it’s frustrating
. Really appreciate the help!
Hi Adrienne, you’ve got a unique situation, and I think you just need to do what feels most comfortable to you…. go with your instinct and own intuition! There are no “rules” on wearing this or that shoe or boot. If you have a pair of stiff-soled, low-heeled shoes in your closet (maybe even something like a motion control running shoe), that would be great. If you want to get an orthopedic-type slip-on shoe, those are great because there’s usually no heel-lift on them, and you could get one for each foot. I say low-heeled because you don’t want to be ‘raised’ and placing greater stress on the forefeet, and then making sure it’s stiff is good because there’s less bending forces. You can likely walk more easily (and less compensation) this way, which is good in general for enhancing blood flow to your feet to enhance healing. Then, as you start to feel better…. you can progress to more normal, flexible shoes.
Good luck and hope my replies are reassuring! You’ll be Ok– through trial and error, you’ll figure out what works best!
Camille
I’m very glad to have come across this post. If you don’t mind, though, I’d like your opinion on something, since you seem to have a lot of experience with this.
I ran for years in regular old shoes, and always was kept from getting higher weekly mileages by knee pain from an old gymnastics injury. In hindsight, I’ve figured out that this was because I was heel-striking in those shoes, which put a lot of stress on my knees. So, about a year ago, I switched to Five Fingers (I haven’t gotten bold enough to try complete barefoot running).
The VFFs worked wonders – even though it took a month or two to get used to my calves being sore all the time, when that phase was over, I felt absolutely wonderful running, and gradually increased both my speed and my weekly distances – but never by much. If I could run 4 miles 5x a week, or 4 miles 4x a week plus one 6-7-miler once a week, I was happy. I think I probably go between 6.5 – 7 mph.
I no longer heel-strike, and I think I have been running comfortably since I got used to the shoes. I haven’t had any major soreness or injuries, other than some minor foot pains at the beginnings of my runs (I figured minor fascitis or something) that always went away after the first few minutes of running.
Then suddenly I got a very strange pain in my heel. The pain just wouldn’t go away – every step was painful. It just suddenly started one day, at the beginning of my run, and kept getting worse the more days I ran on it. The pain was worst when just stepping off the foot. I don’t have good health insurance so I went to an urgent care center, and they gave me the Boot and said to stay off of it for a couple weeks, figuring it was a stress fracture.
I guess my main question is: How the heck would I get a stress fracture NOW, in my HEEL, when I don’t heel-strike anymore??? It just doesn’t make any sense to me. Running has been so comfortable for so long, with no problems, and this just came out of left field, has completely sidelined me from running, and is extremely frustrating – not to mention getting to me emotionally. I guess I’m maybe hoping for some idea about if this maybe ISN’T a stress fracture, e.g. how would I know if it’s a fracture vs. something else?
I should say that I got rid of the Boot after five days because it didn’t seem to be doing anything, and in fact was making things worse. Walking usually wasn’t very painful, if at all, from the very beginning, but the boot was making walking hurt. I started padding up my heel, wearing higher-heeled shoes during the day (I have to walk a lot for my job), and it completely fixed the residual pain from walking. So walking doesn’t hurt anymore – it’s just when I try to jog. I’ve rested for 2 weeks from jogging now, and things SEEM to be getting better, but I just don’t know how seriously I should take this or how likely it is that it is, in fact, a stress fracture. If it was, I’d probably stop trying to push my healing process so much, by taking little test jogging steps every day (which still hurt, albeit not as badly).
Hope that made sense. Sorry so long. Any help/advice would be much appreciated.
Hi Rebecca! Glad you like my post! Sorry to hear about your recent heel pain! You probably need to see a doctor to get it imaged to figure out if you have a soft tissue or hard tissue problem, so you know how to treat it. Even though it doesn’t feel like you land on your heels, when you push off…. the plantar fascia pulls on the heel bone. Whether this sudden onset of pain is due to your street shoes and/or your VFFs, no matter what…. there is stress on the heel bone, and maybe you did something that further exacerbated the problem.
Definitely don’t wear the boot if it bothers you. Getting healthy is all about intuition, and through trial and error, figuring out what feels best. However, you definitely need to know if your problem is bone or soft tissue because that impacts whether you truly need to rest for a few weeks (to let the bone heal), or if you can comeback sooner by proactively treating the soft tissue.
Good luck!
Camille
This is a wonderful post! I took 6 weeks off for a metatarsal stress reaction (not fracture) then started running again. I’ve been running for 5 weeks and still have aches when I run and when I’m not running. It’s not sharp pain, but I still get scared that I’m reinjuring myself. It’s my first bone injury after 15 years of running. Any thoughts on recognizing residual pain vs. reinjury?
Hi Jessica! Thank you and hope you find my post helpful! You definitely don’t need to worry about re-injuring the same spot– the bone is stronger than it’s ever been because of the bone callus. However, since it takes the bone much longer to be “normal” again, the bone callus can inflame surrounding tissue, nerves, and cause inflammation. This could cause you to compensate and place stress elsewhere (leading to an injury). It sounds like this is what you’re going through. I would ask yourself– why did you get injured in the first place? Is it something about your ~shoes that keeps placing stress on this area, or is it simply a matter of time and waiting for the bone to be “normal” again? This takes months– much longer than the time off. Rest assured though, you’ll make a successful comeback and this pain should go away if you train consistently and intelligently (not doing “too much too soon”).
Good luck with the comeback! You’ll be fine!
Camille
Thank you so much for your answer! I just started running again about 6 weeks ago and I’m “training” for Boston…but of course with much lower mileage and no speedwork. I got through 16 miles this morning and my foot was fine, so I’m hoping I’m in the clear.
By the way, I’ve googled stress fractures an embarrassing amount of times and your post is some of the best information I’ve found.
Hi Camille!
Thanks so much for posting this, your information is very helpful. I am a Zumba instructor, and have been for about 6 months now. Not as strenuous as running, but it is a cardio/high impact work out. I believe that I got my first possible SF the middle of last month, luckily the podiatrist could not see the fracture on the xray so he put me in a boot for 2 weeks. He allowed me to teach my class in the boot, but I am not the best patient so I taught most of my classes out of the boot the 2nd week. It did end up feeling a lot better and he allowed me to wear an athletic shoe for the next 2 weeks. The first week went really well, but I am coming into the 2nd week now and after teaching 2 classes yesterday I feel like the pain is coming back. Although, it does not feel as bad as the first time. I start to feel close to 100% better over each weekend, then I teach my first week day class and I start to feel more pain. I feel like I am blabbing on
So to get to the point, I may have re injured myself and I could possibly be getting a second SF in the opposite foot 
I have never had this issue before, and I have been athletic all of my life. Do you think it is a result of trying something new (dancing on toes a lot) even though it’s been about 6 months? I really love what I do and would hate to take a break, but do you think I need to take some time off, I only teach 4 classes a week? Also, I really think the problem may be when I do heel lifts during routines, so I have completely taken that out of my routine. Do you think that is wise or should I leave the heel lifts in hopes of strengthening the bones? Thanks so much for your time!
Hi Whitney! Glad my post is helpful to you! Wow, you have a tough situation, since teaching Zumba is your job. Is it possible for you to teach/demonstrate, without having to get too physical yourself? Could you get an orthopedic shoe, or wear stiff athletic shoes?
It sounds like you need to go back to the doctor to get re-x-rayed (or bone scanned)– you need to know for sure that you have a stress fracture, which should show up by now. This will guide you on what to do. You definitely do need to have some rest time, or less physical activity than usual, to allow the bone to heal (if you truly have a stress fracture.
Definitely, any weight bearing activity…. and doing so more than usual…. can lead to a stress fracture. It’s a matter of having too much stress and not enough rest.
I’m confused on what you mean by heel lifts– are you referring to a shoe insert, or lifting up on your toes? Don’t be raising up on your toes, if it hurts! You need to rest, but more importantly…. you need to know whether you truly have a stress fracture. That will determine your course of action (~rest vs. soft tissue treatment).
Best wishes getting to 100%!
Camille
Hi Camille!
Thanks for the quick response! I have been wearing a really light weight shoe for my class, I guess I tried to get back to normal too quickly. I will start wearing a stiff athletic shoe for now own, and even resort back to the boot if needed. I will also demonstrate with less physical activity. As much as I hate to do it, I will also schedule another appointment to see if it is a SF for sure. I didn’t think about how my schedule changed so drastically, but I went from teaching 2 – 5 classes a week to teaching 7 – 9 classes a week. The second week with that schedule was when I got the fracture, I never thought of that until your comment:
“Definitely, any weight bearing activity…. and doing so more than usual…. can lead to a stress fracture.”
I am back down to only 4 classes a week, with one being a really low impact class. Hopefully I will be back to normal soon and will keep away from the crazy schedules. Thanks again for your response!
Whitney, I just wanted to let you know that you are not alone. Your story is IDENTICAL to mine. Seriously, every detail! My podiatrist told me it is plantar faciitis, but I feel it is a stress fracture that has not shown up on xray yet. I’ve heard that Reebok Zigs are great shoes for Zumba instructors like us. It’s SO HARD to rest when you know you have a class full of people counting on you!
Camille, this blog is full of great information! Thanks for sharing your story to help so many!
Wow, amazing! Sorry to hear Lisa! I don’t know how y’all do it, but hope you can find a solution that allows you to still teach, but also rest your foot! Be careful and use common sense. Good luck getting healthy!
Thank you for your information regarding stress fractures and all it encompasses. It has been a little over a week of no running due to four stress fractures – femur, pelvis and both tibias. I’m devastated. My first Boston is in four weeks and not only was I at the top of my training, I was elated to have finally qualified. I even purchased the official jacket. : (
My doctor has told me to use crutches (both legs ache though) and try to stay off my feet as much as possible. I have a DEXA scan and an appt. with a endicrinologist and a nutritionist next week. I now know what I have been doing wrong -especially after reading your posts. I have not been eating. Not feeling hungry after an 18 miler made me think that I could save those calories for dinner. Once dinner came, I felt I needed to watch my calories in order to lose those few pounds to get a better marathon time. Thus, you see my pattern. As for breakfast after a hill wo or fartleck, forget it… I was too busy. Stress from a recent divorce and pressure to do well in Boston broke me – literally. My heart feels just as broken.
As I lay in my bed with all four areas throbbing (NO NSAIDS!), my hope in writing this post is to help others in seeing the importance of nutrition. I missed out on a very big dream of mine due to not taking care of my body. Eating a healthy diet is a must for ALL runners.
Hi Aimee! Wow, thanks for sharing your story openly! I’m going to do another post about women’s health/female athlete triad/menstrual cycle. It sounds like you fit the profile for someone with the female athlete triad. I hope this is a wakeup call to take your health very seriously. The impact of not eating enough means that your body must “break itself down”, including your bones, to provide fuel for cells where it’s most needed. Your reproductive system shuts down– if you’re not providing enough fuel for yourself, you’re certainly not providing fuel for a fetus! Estrogen is suppressed, which normally “protects” your bones. A lot of this is psychological too (as you allude to on wanting to lose weight to get faster)– I hope you will seek out the right people to help you, which it sounds like you’re doing (~RD, psychologist, etc.). While I’m not your doctor, I disagree with him about “trying to stay off your feet as much as possible”. Simply by not running, you are resting your body, but you need some normal weight bearing (as tolerated) to enhance the recovery process. If you can eventually progress to walking when you start to feeling better, this will help. But for now…. you need to get your dietary issues sorted. Best wishes getting healthy and changing your perspective! There’s a quote on my homepage, “Semper Salveo”, which means Always in Good Health. Your healthy means everything!
I have been a physical therapist over 20 years now and have a significant interest in biomechanics, healing processes etc. Your writing and insight are brilliant. Most MD’s are just repeating what they’ve read/learned and not actually thinking analytically. I agree with you on most if not all issues, but love that you are actually “thinking”. I believe I have a stress fx now in my 3rd metatarsal, but was just given a laser, steroid injection and an rx for Mobic.
Hi Kelly! Wow, thank you for the kind words! From my experience having interned with a doctor as an undergrad, I totally agree with you– doctor’s only understand the “textbook knowledge”. Understanding stress fractures is much deeper than this…. as you point out, thinking more analytically. What I shared is my personal experience and what I learned from my work as a researcher. As a PT, I would love to hear your perspective on what you agree/disagree on. Another PT messaged me a few months ago about how she believes the problem with higher mileage is that many don’t get enough calories to match their energy expenditure. The body must then break itself down to provide fuel for cells where it’s most needed (hence, the female athlete triad). High intensity running is definitely far more stressful than low intensity running…. but it’s a matter of understanding details like the above, that doctors/researchers often miss.
Interesting on your foot…. did they do an x-ray or bone scan? Could it be a neuroma, since they’re treating it with steroid/Mobic? What do you mean by laser? I did another post about the detrimental effects of NSAIDs/Cox-2 inhibitors/corticosteroids: http://camilleherron.com/2011/12/05/the-little-things-nsaids-cox-2-inhibitors-and-corticosteroids-hinder-bone-and-soft-tissue-healing-and-recovery/
Would love to hear more of your thoughts! Hope you figure out your foot issue!
Hi Camille,
Thank you so much for your amazing insights! Could I please get your input regarding an upcoming race I have? I’ve been running on my own ( no cross country or track, not very fast) for over twenty years. No stress fractures. Then on December 4th, 2011, I was in an accident and sustained two pelvic stress fractures. (bone density scans showed my pelvis to be normal) I am entered in my 32nd 100 mile race on March 31st. It is all run on fine crushed gravel, and I’ve finished it 7 other times, my fastest time in 21 hours and 51 minutes, so I am not very fast. I’ve been able to build up to 70 miles of easy running for the past two weeks. There is discomfort, but not what I would call pain afterwards. The second MRI I had on the 21st of February showed the stress fractured had healed, although there was still some edema in the area. I have taken very few NSAIDS, and when I have, it hasn’t been for running related pain. Do you think I would be OK “running” this event, if I walk/ran it?
Hi Anita! Wow, way to go on your long distance running exploits! That’s amazing! Sorry to hear though about your recent stress fractures. When did you start back running? You know, this is your call on whether your body is prepared for 100 miles– that’s a whole other beast, even though it’s at a slower pace! Plus, if it’s trail (inclines and descents), that can really mess with the muscular stresses on bones. As I point out in my article, it’s normal to have residual pain when you comeback– there’s lots of muscles attached to the pelvis, ~stressing the bones. It also takes much longer than a few months for the bone to fully remodel itself.
It’s really up to you on this! Better to be safe than sorry! Nothing more frustrating than “taking a risk” on 1 race…. only to find yourself in a world of hurt (and emotionally frustrated) for several months thereafter. It’s tough when you set goals like this so far in advance, but the body has a way of telling us to “back off” and take it easy.
So these are my thoughts! Best wishes on whatever you decide!
Thanks Camille. I tried running on it two days after i sustained it, not knowing I had them. I was hoping I just pulled a adductor muscle or my SI joint was out of place. But when it took me over 20 minutes to “run” a mile, no matter how I adjusted my gait, I knew something was very wrong. The fist doctor told me it was just a muscle tear, but by then my gut told me it was something else. Even walking, waddling, and scuffling hurt like crazy. After much nagging (to put it nicely) he referred me to an orthopedic surgeon, who did a useless X-Ray, which showed nothing, whereupon I commenced with the “nagging” for an MRI (almost three weeks later) which clearly showed the stress fractures.
My body is ready as far as endurance goes. I ran a 50 mile race on smooth trail the end of October in 7 hours, 39 minutes. Naturally, after taking so much time off, I am pulling at the bit because I feel rested. But all those muscles you mentioned that are attached to the pelvis let me know they are still aggravated within an hour. Is it possible they could tear during the event given all they’ve been through?
I agree with you, that it is better to be safe than sorry. I have another 100 lined up the end of August in South Dakota, all on smooth “rails to trails” surface. But ultras are a whole other animal, in many ways. Some of these runs have become a yearly “tradition,” and the people an extended family, and the thought of missing this race in North Carolina is difficult.
Thanks again for your input!
Hi Anita, when you get a stress fracture in the pelvis, until it fully heals the pelvis is somewhat unbalanced. The bone itself, where the stress fracture is, is stronger than ever, but you can compensate, stress other muscles, and cause injury elsewhere. I remember when I had my hip issues in 2010, what started as just a problem on the front of my right hip, eventually led to pain on the left side and even in my back and IT band. It’s like if one thing “goes”…. it causes everything around the pelvis to “unravel”. It’s because of all the muscles and how they work together to stabilize the pelvis.
Could you still go to North Carolina to volunteer or just to vacation?? I totally understand the “camaraderie” of running!
Thanks Camille. I “ran” a half marathon on the 18th of Feb., and felt the pain exactly where you mentioned, (the ITB, the hip, it just seemed to radiate all from the right side of my pelvis). Although MRI results show the bone itself healed, I think I have a ways to go. Looks like I am going to put the run in NC on hold, but I am looking at a marathon in mid April in Kansas. I may go run a 50 in Nevada the following weekend, (all on dirt road) depending on how the marathon goes. I also found your insights into body fat and menstrual cycle VERY interesting. Even when my weight drops below 115 and my BMI is around 18, ( I am 5″5 1/2 “) everything is normal. When life is extremely stressful (husband gets deployed with less than a months notice), it becomes disrupted, or stops all together for months at a time. ( I have told this to my doctor in the past, but have come up against a lot of resistance from him) Can you recommend some recent articles or books on the latest information on this topic. I have always “felt” this about low body fat levels and stress, but when I have voiced my thoughts, I usually get dissed. I have also found that my pain tolerance is nill during the days right before my period starts.
Thanks you!
Anita Fromm
Hi Anita! Be careful with all the long running! I can’t imagine the toll that must take on the body…. and to do a marathon+50 miler, yikes!
Regarding the menstrual cycle, I’d suggest meeting with a dietician and/or an endocrinologist. I’d recommend my RD friend, Jackie Dikos, with “Nutrition Success” if you’d like to do a phone consultation. I’ve been wanting to do a blog post about the menstrual cycle/female athlete triad, but it’s something that’s very complex (and not my forte). You can Google “Energy availability” or “energy balance” and the menstrual cycle. Not only does your diet/getting enough calories impact your menstrual cycle, but also your stress level (and how that impacts the whole hormonal milieu). I found a few links that are somewhat helpful:
http://speedendurance.com/2008/01/07/the-female-athlete-triad-iaaf-nutrition-for-athletics/
http://emedicine.medscape.com/article/312312-overview#a1
My professor in grad school, Dr. Melinda Manore at Oregon State, is one of the leaders on the topic of the female athlete triad. You could likely find her contact info online. Best wishes with everything!
Hey Camille, it really seems like you have a lot of insight to offer so I figured I would ask for your help. I suffered a stress fracture in left femur about 4 years ago while I was running cross country in college. Originally it was misdiagnosed as a tear, so I returned to running to soon and reinjured myself (wasting a whole summer and fall in the process). They got the diagnosis right this time around and I initially had crutches, took time off, and let the fracture heal properly. I did PT with the school at the time and attempted to make a comeback, but I was never able to get more then a month or 2 back into training as I would gradually build up milage (starting with a walk/jogging program for several weeks), and eventually feel the same pain in my femur resurfacing. My next attempt was during the summer where I received PT from a clinic back near my hometown, that involved even more stretching and weight strengthening then my previous PT experience. When I tried starting things back up with light running on grass mostly, after two months of gradual build up my left leg was feeling the same kind of pain in my femur once again, and I felt it was too much to continue trying to run against.
At this point I stopped pursuing competitive running in college, and took time of. Over the next couple of years I saw doctors once again who after running scans told me my bone had healed and showed the standard type of extra bone from the healing process you’d expect to find over the original injury. They basically told me I could run through the pain as best I can and not worry about hurting the muscle again. They also said the pain may never go away either, and is just something I have to deal with. I have run on and off throughout these past couple of years, but the femur pain in my usual spot will pop up if I find myself overdoing it by running on a semi-regular basis.
My most recent effort back in the Fall and Winter saw me running for about 3 months (peaking at about 40 miles per week), taking 2 or 3 weeks of very easy running right before, and racing a half marathon for the first time. This was the most training I had done since before the injury, and while my body held up well enough to get through the race, I have tried to continue running some sort of milage after the race a challenge. I have found the pain intensifying of late despite cutting my milage down to around 20 miles a week. Some history on myself, I’m very inflexible, I do take the time to stretch before and usually after I run for about 15 minutes both times, but I still find my flexibility lacking. Also, I run very heavy, I’m a stomper, not exactly the healthiest running style. I had a left ankle sprain (the same leg my femur pain is on) about 4 or 5 months before the original stress fracture in my femur. I was told since its the same leg, it is unlikely that the stress fracture came from over compensating due to my original ankle sprain which led to me wearing orthotics. Any thoughts you have on solving my left femur pain problems would be great, it seems to be a recurring issue that rest on its own can not solve at least.
Hi Ira! Thank you for getting in touch and sorry to hear about your longtime frustration with your femur pain. You know, ironically… my femoral stress fractures started after getting orthotics as well. I went for 4 years with orthotics…. femoral stress fractures and lots of other pains…. before I ditched them, went to a basic shoe, and finally got my body back to normal.
Did you ever take a break completely from running, ~6+ months off?
It sounds like your issue is mechanics. You’re continuing to stress your femur, whether because of your ~orthotics, shoes, and possibly how they make you run.
Running is also largely about relaxation. You have to learn how to run relaxed and stress-free…. let running be a stress reliever.
Have you thought about cutting out the stretching (particularly before)…. leave your leg alone? Maybe try something like ~foam rolling instead. There’s a phrase: if it hurts to push/pull something, don’t do it! Leave it alone.
So these are my thoughts! Seeing that it’s hurt this long, I wouldn’t expect it to get better over night, but if you are willing to ditch your orthotics or try different shoes, that could be the key. Of course, this wouldn’t come easy either…. see my post about my transition to minimalism. Good luck figuring it out!
Thanks for the advice Camille, I’ll keep it in mind. I have read that stretching especially before running does not really do anything for the body. I have taken about 6 months off in the past, that was after the original injury though, a few years ago. I did read your post about minimalism, and that is something I am definitely considering, can never hurt to try, thanks again!
Just got done with doctor regarding my injury to my right leg. I am sooooo darn thankful it is NOT a stress fracture. I am a new runner (returning after 10 years off) and I went from 6 miles to 8 miles in ONE DAY. And then, I was an idiot and I REPEATED it the very next day – despite my body telling me to walk or go home. I made myself very, very sore as a result. I am just beginning to be able to hop on one leg again – barely.
And being a runner, I didn’t ease much on the running after I was aware of an undiagnosed injury, but continued running 5-6 miles a day, 5 days a week. The final straw that got me to doctors yesterday and today is I read about stress fractures and blood clots – scared the hell out of me! I count my lucky stars it wasn’t either – in fact, this past week where I haven’t run but been using the eliptical….I’m already feeling better.
I am also doing the run / walk / run and I am LOVING it – I started it 2 weeks ago but it was too little to late – shall I say as it pertained to my old injury of running 8 miles. The good news, I have no NEW injuries.
I agree it is not mileage but intensity. And run / walk / run works for me because it keeps my muscles from cramping up and being overused. Not trying to be a marathoner – just a recreational runner who takes her running seriously. Your time to write this for us – I read the entire thing. Really, really appreciated. Keri / Tampa
Hi Keri! Thank you for commenting and glad you don’t have a stress fracture! Sounds like you did too much too soon. Definitely, stick with the run-walk routine…. it works for everyone at all levels! Be patient, and enjoy being outdoors and “moving”. You body will adapt, be healthy, and before you know it…. be fit! Keep it going!
Hi Camille,
I have been reading your inspirational and very informative post and really enjoy it! I consider myself a very positive and go with the flow person but I am really having trouble wrapping my head around my healing time for my “stress reaction” in the right Pubic symphysis bone. I did not know for an entire full year while training in Colorado that I have had this issue. I thought because i am from sea level that I just had trouble adjusting to the new climate/alt. I am now back in Boston (my home) and have been diagnosed with a “stress reaction”. I am going on week 6 of my recovery from no running or stressfull physical impact, ei, no eliptical, or anything else similar. I have no clue if “pool running”is helping or setting me back in my healing. I really desire to finally break the 2:30 barrier in the marathon in the next few years but dont know how to get back to a “completely healed” runner again. So, should I stick with pool running? Should I just give my injury more time to heal without any pool running. I really dont know what I should be doing to best heal my “stress reaction” in the Pubic symphis. Just recently had an MR( 4weeks after intial MRI I and it said “some healing” has occured. We just rulled out a possible sports hernia as well.
Thank you for any feed back and wish the absolute best for you. ~ Marc
Hi Marc! Sorry to hear about your stress reaction to your pubic bone. Injuries to this area are caused by the stress of the muscles pulling on the bone. Unfortunately, there’s not much you can do, to not stress this area because of the muscle attachment– it’s always being stressed to some degree, which makes it difficult to do any sort of cross training without enduring some level of pain. So don’t see pain as a bad thing. A moderate level of “mechanical stimulus” is good for enhancing healing. I recommend walking instead of pooling running– the weight bearing of walking is more natural and eases the transition back to running.
You could have a hernia, whether inguinal or sports hernia. It takes a specialist on this area to know (I had to see someone who could “feel” my inguinal hernias). Definitely try and cover all your bases– hernias, labral tear, osteitis pubis, etc.. The pubic/hip area is very complex! If you go months with this problem, definitely…. it could be a hernia or labral tear.
Best wishes getting healthy!
Hey, Thank you very much!
yes, in the works of rulling out the sports hernia. The doctors lableled my condition to be “osteitis pubis with a muscle bulge on the surface of my groin, What do you think of the “muscle bulge” that came up negative for a hernia in the MRI? Also, what if i walked and did a little pool running, as long as it doesnt hurt to much? Thank you again, Marc
Hi Mark! I believe hernias don’t normally show up on an MRI? What could the “bulge” be?! I would say walking is better than pool running because it’s a natural, weight bearing activity. That’s the closest thing you get to running. Hope you figure out what the bulge is!
Thank you Camille! Best of luck with your training, and thanks a lot for taking the time out to talk to me!
Hi
Great post thanks a million. My 13 year old son plays hurling (indigenous to Ireland) a very fast sport using a hurley (think hockey sort of). He wears boots like soccer boots with “blades” on the soles for grip during a match or training on the field. However he feels he cant run properly lately (has had a huge growth spurt lately) and complains of his feet throbbing and being very painful during the session and after too? any thoughts on what could cause this. I was going to see about inserts for his boots but not so sure now. There is no shock absorption in his boots but didnt think he needed it as his sport is always on the field. Thanks again for the post x
Hi Mary! Gosh, just thinking of how soccer boots fit, I can’t imagine how uncomfortable hurling boots are! They probably fit tight, right? I don’t know what to tell ‘ya, other than maybe his feet have grown or he needs to loosen his shoes. Is he more comfortable barefoot or in other shoes? Sounds like the shoes, themself, are the problem– too small, tight, not soft enough.
I am a 41yr old woman who has been running on the heel since age 13. I developed what they told me was a fallen metatarsal when I was around 34. I wore orthodics in my running and work shoes ever since. I started developing hip and knee pain a little over a year ago. I started researching a way to keep running and getting rid of the pain. About 6 months ago, I slowly started on the path to a forefoot strike with vairous running shoes, getting a lower and lower heel each time. On my first run, even in traditional high heel running shoes, I could feel the immediate difference in the feel of the non-existent impact to my knees and hips. I was sold on the first day even thougth my feet hurt. As time went on, around the 3 month mark, I noticed my fallen metatarsal disappearing. I don’t wear orthodics in any of my shoes any more. My feet are stong now and my times are increasing. I don’t feel as winded even with my increasing times. I am starting to wonder how fast I can really run, because I have never been able to maintain the speed consistency like this before. Amazing. I will be testing my first barefoot shoes very shortly. I am currently running in new balance 690′s for my runs. I concur with everything you are saying becuase I have lived though my own pain first hand. They should ban traditional high-heeled cushy runner shoes….just a bad idea that causes alot of medical issues over time.
Wow, thanks for sharing your story! I believe too a good majority of injuries can be traced to shoes/inserts. One shoe/insert solves one problem…. while creating another. Ultimately, we’re better off getting as close to our “natural state” as possible.
hi camille, i have been having pretty tough time with a stress fracture and few other complications and wondered if you had any advise. in April 2011 i did a half marathon coming second in a time of 1 hour 20 which was a bp for me. never raced so hard in my life. the next day im in agony and cant walk. i go to see my physio who says i may have a lateral miscues tear or lateral ligament strain. he said to continue on with physio and if it doesnt get better he will send me to an orthopedic surgeon to get an mri. durig this time i had to go on my honneymoon to thailand for a month so was unable to get the mri before i went so wore a knee brace and just got on with it, i managed ok, pain was stil there when i got back so got the mri and it was all clear, but i still had the pain. at this satge i was still able to continue walking without too much trouble (wearing the brace) and daily activities werent a problem. the surgeon said ill just give you a cortsojne shot and you should be back on your feet. i wasnt told of the side effects, so i agreed as i longed to be up and running again. after the shot i was in trememdous pain and rang the surgeon and went into him several times. i could barealy walk. the cortsione also casued fat necrosis and disclouration adound my knee (lateral knee) where the cortiosne was inserted. i went back to him about this and he said it was cosmentic and shouldnt cause pain. i went to another dr who also said the cortisone has caused some damage but it sholdnt cause you pain and explained it would cause pain if this happended on the bottom of your foot where you need the fat pads, but not on the side of your knee. so the 2nd dr sent me for a bone scan which suggested a stress fracturre of the lateral lip of the lateral tibial plateau. got sent for another mri after that which still showed up clear apart form a small line where the pain was. (possibly the stress fracture) so 6 months after the injury i get put on crutchers for 8 weeks. have been off the crutchers for 2 months and still no better. the fact that my ‘stress fracture’ is now worse after the cortisone is what is worrying me, before it i was able to walk and do day to day activities. now i cant stand for long periods of time, have trouble working, pain at night, my social life and relationship with my husband is going down hill and just my overall quaility of life has been impaired, i come home in tears almost daily, am im quite depressed about it all. i would just love to be pain free on a day to day basis and be able to do things with my husband like tramping and fishing. i dont care if i never run again to be honest i would love to but now i would just like my life back. also i should add i had a bone density test done 2 weeks ago, which shows i have osteopina im 28 years old and i would probably contribute this to 15 years of gymnastics and dance with periods of distorted eating and ammenoheria. im unsure if this would be realted to the long healing time of my stress fracture, i dont know. so if you have any adivse or input that would be great. i have gone form running 120 kms a week to nothing, and im having a real hard time with . have done some cross training like biking but it just aggrivates it. i dont know if it is just going to be more time, does the tibial plateau get much blood flow? or if the cortisone has delyed the healing and will take longer, or if the cortisone has done permant damage. thanks for your time.
Hi Camille,
Wow! Thank you for your generosity in answering so many comments.
I was just diagnosed with a stress fracture on my 4th metatarsal. I’m a beginning runner who perhaps went minimalist too fast (Merrell Barefoot Trail Gloves). I’ve worn the boot this week, which helped somewhat, but this weekend the pain has been pretty intense, even while resting.
Am I reading your info right when I infer that perhaps it’s okay to walk a bit on it, even if it hurts? That it might even help the healing process? (You mention the hopping test; I can’t imagine doing that right now!)
Thanks again for your dedication,
Anne
Hi Anne! You’re welcome on putting the info out there and replying to people! It’s been quite fun actually, hearing others experiences and giving my two cents.
Your experience sounds pretty typical. The throbbing pain while at rest is normal. Think of it as the blood flowing to the area to heal the bone and swelling. That’s going to put pressure on the surrounding nerves.
Definitely, some weight bear is good, in spite of the pain, to enhance blood flow to the area and thus the healing process. Do what you can…. obviously don’t force yourself to do more than tolerated.
The hop test is definitely a great measure of how you’re coming along. Give yourself a few weeks, to the point where mentally you think you can, and test it out.
Good luck with the healing process! Be careful not to do “too much, too soon” with the shoes and your training. The body has to adapt to any new stress, gradually.
Camille
Camille, thanks for the info and advice! I’m feeling better already for putting some weight on the foot. For others out there who come home and just want to take that boot off, I found some awesome Skechers that allow me to walk around without stressing the foot too much. Skecher Go Runs.
Good luck to you Camille in your races and good luck to everyone out there who is recovering from an injury.
Anne
Great to hear! Wow, that’s interesting about the Skechers! I talked to Meb about them in NYC, and I know they’re a bit more “supportive” in the midfoot– is this why they feel good? When I had the stress fractures in my left foot, I had some custom-orthotics made that had extra padding in the midfoot under the metatarsals. Maybe the Skechers have a similar effect! That’s good to know– thanks for sharing!
Camille,
This is great information!
I have recently gotten a stress fracture in both of my femurs. I ran my first half-marathon in February. I’m still a beginner in running but I trained for a long time for the half. I was told by the doctor to not do any exercise for at least 4 weeks, and obviously no running for a long time. I haven’t exercised in 2 weeks now and I’m going crazy! Do you suggest any exercises, besides swimming because I don’t have access to a pool, while I’m healing? I really enjoy running and hope to return back to it one day, so I don’t want to overdo anything and have another injury.
I really appreciate your post and willing to help others!
Emily
Hi Emily! Wow, sorry to hear about your femoral stress fractures! Hopefully this is just due to the stress of training or a mechanical factor (~shoes), and not something like ~low bone density. I recommend getting into walking, as tolerated. The weight bearing is good for enhancing the recovery process. That’s my best advice! Walking is the next closest thing to running…. just a slower version (take in the scenery… breath the fresh air!). Good luck getting healthy and back out there running!
Camille,
Thanks so much for being there!! Would it be possible for you to share your insight about Inferior pubic ramus stress fracture? I have one on the right side. I have been on crutches mostly resting in bed and with limited sitting for 4 weeks and have been prescribed 6 weeks of rest. I am worried about moving too much trying not to sugar coat the situation. But hoping to get off crutches in 2 weeks after all this rest period. Do you think it is realistic?
Thank you so much!!!!
Hi Olivia! Sorry to hear about your stress fracture! There’s several adductor muscles that insert on the inferior pubic ramus– this type of stress fracture is purely muscle induced, ~overuse of the adductors (~overpronation). What often happens is running leads to strong adductor and weak hip abductors, since we are always ‘pronating’ but never moving laterally and using our hip abductors. A good PT could work with you on stretching your adductors and strengthening your abductors.
You definitely need to progress back to normal weight bearing and walking. While the pulling of muscle on bone induced your stress fracture, it’s use in moderation will also help you recover faster. Don’t think that pain is a bad thing– you need to get back to normal activities of daily living. Definitely, give it a shot on getting back to moving normally. Only you know if you’re ready to! Best wishes!
Camille,
Thank you for sharing and for the wishes!!
The hardest part has been not knowing how much movement in day to day is ok.
Thank you again for being there!!
Hi Camille!
I talked to you in february regarding a calcaneous stress fracture. I listened to your advise and eased in to walking and a couple of days later running . I have been runnin 3-5 milesseveral days a week in top of biking and swimming(training for Aug tri) i still have stre feeling patwinging arou injury sight but my follow up xx rays showim healing well. Do you thnk it is ok to run my first 10k on may 5th? I did u mileage a bjt too soo but i feel ok. Im not twinge , weird feeling free. But seem to be feeling good othr than that. Is kt too soon to try te race?
Again, thanzjs for al your wisdome!
Lisa
Supposd to say thanks for sharing all your wisdom!
Hi Lisa! That’s great you’ve been able to get back into walking and then running! It’s up to you on how you’re progressing and whether you’ll feel good enough to run the May race (which is still quite a ways away). Getting in gradually more time on your feet, and more frequently, is the key. If you start pushing the intensity, that’s when problems start to flare up. You simply need to progress to doing more mileage and keep the intensity low. You’ll make a successful comeback if you continue with this approach!
Best wishes and good luck long term preparing for your August Tri!
Camille
Hi Camille,
Most of this was during high school and college, and now, 3 kids later, I started training again. I plan on running my first marathon (I was a sprinter) in June. During my first 17 mile training run I developed a pain (thought it was muscle) in my right leg by my tibia. Days later the pain became more localized and hurt to the touch. I did not see a Dr. but assumed it was the beginning of a small fracture. I have taken 2 1/2 weeks off and I feel very little pain when I touch the area. I can jump on the leg with no pain and run with no pain. Do I go by feel at this point? If it was a small fracture could it possibly be healed already? I thought about biking for the next 3 weeks but after reading your blog I am excited because I would much rather walk or jog slowly to get back into training again. What would you recommend? I really appreciate your insight and your blog!!
Thank you for this awesome blog! I have had 3 stress fractures, anterior compartment syndrome, and shin splints through out my running life
Thanks! Katie
Hi Katie! Definitely, go by what feels right. Obviously, if you start back running/walking and the problem gets worse, you need to go see a doctor. Maybe you caught the problem in time (~stress reaction). Our bones are really good about remodeling and healing themself. Weight bearing activity can enhance the process, which is why I’m a proponent of ~walking.
You should read my latest post regarding Boston. A lot of people freak out at the first sign of pain. A lot of times you can continue running through these aches and pains, if you run easier or modify your training in some way. I hurt every day. As one of my friends pointed out, what’s your “Pain of the week?”. Knowing what I know, I can actually tell when my bones are being stressed more…. that sharp pain. I’ll jog easy, pitter patter for a while (rather than resting)…. and the problem resolves itself. This is what you learn being a longtime athlete.
Hopefully you resolved the problem quickly! Be mindful of the intensity when you get back to running. It’s the time on your feet…. and moving frequently…. that matters most. It’s amazing how many people have messaged me about training 3-5x/week (~every other day)…. usually at a high intensity…. and then they go do a massive long run on the weekend…. and wonder why they get hurt! The body likes to move, and move frequently– people would be better off doing something every day, rather than every other day. I can’t imagine the stress on the body running infrequently, and then expecting the body to hold up by doing a monster run on the weekend! Just thought I would point this out cause I hear it commonly. Best wishes and stay positive!
Hi Camille! Thanks for the quick response! I would love to run everyday, but I have to balance out life with kids (we are homeschooling right now) and in the process of adopting and my husband works in full time ministry and is also training for the marathon we are going to attempt to run together
. I am thankful for your advice on running more frequently as opposed to long/challenging workouts less often. Sometimes I feel like if I actually have an opportunity to workout I need to go really hard and fast to make it worth it. As it warms up outside this spring I may try to run a little early in the morning and then later I may not have to run so many miles so fast to get them in. For some reason I have had the mentality – go hard or go home 
As a stress fracture prone person I may need to develop a new modo! I hope to go for a slow run today and I hope all goes well! I look forward to keeping up with your latest posts and will read the one you recommended! Thanks again! Katie
Hi Katie! Don’t be afraid to at least walk on the days you don’t run (if you can fit it in!). The body likes to move… it likes the impact… no matter how slow. There’s no such thing as too slow! Slow it down, relax, breath the fresh air… and enjoy the moving. When I had my hip surgery in 2010, I was walking twice a day (30 min.-1hr. at a time) during my rehab. Then when I started back running, I was doing the run-walk twice a day thing. Within a 6 week period I went from doing the run-walk thing…. to running Dallas White Rock, and winning!
So I tell people…. never underestimate the benefit of walking/moving frequently. Intensity doesn’t as much.
Hi Camille – wow, I’m so happy I found this site and your articles! I’ve been VERY frustrated with a stress fracture in my right hip socket (actually more of a stress reaction) since October (though it was a long time building I suppose) and now I’m struggling with achilles pain which I don’t understand since I haven’t been running! My doc prescribe PT and I did all those PT exercises to strenghen my hips etc.. and I honestly think they do nothing. I have made a conscious effort to work on my core and I think I’ve done some good work there and definitely feel stronger. My doc was very stern that I should stay away from anything weight bearing and only swim. I didn’t feel great about that but I listened and have been doing lots and lots of swimming which has actually been kind of nice but not nearly the same benefit. I, of course, have been taking tons of Advil which after reading your blog I feel terrible about and am stopping this minute. I’m 50 years old, carrying a few extra lbs. I have run 6 marathons in my lifetime when I was younger and before kids, but really up until my running was halted, I was running maybe 20 miles a week and thoroughly enjoying myself. I miss it SO much. I miss being outside. I thought that by now I would be running again and certainly not suffering from achilles pain! I would LOVE your take on my situation. What other information can I give you? I realize you’re not a doctor but other than being able to read an MRI, they can misguide you a bit. Plus he made me so nervous to do anything……
Please let me know your thoughts.
Thanks very much.
Hi Barbara! Sorry for the delayed reply– if you see my latest post, I was in Boston. Trying to recuperate!
Sorry to hear about your frustrating hip and Achilles issues. You know, by now, you should be getting back to normal weight bearing, even walking. The bone should be healed sufficient. Maybe you compensated for the hip pain and somehow stressed your Achilles. This could also be shoe related (which I did another post about if you look for my post about Achilles/plantar pain). It takes bone a very long time to fully remodel itself, but don’t let pain stop you from proceeding to become more physically active. It sounds like the NSAIDs hindered your recovery, but cutting them out allows for normal healing to resume. So definitely– don’t be a afraid to get moving! As an elite athlete, I endure pain on a constant basis, even knowing what “bone pain” feels like, backing off slightly (but continuing to run), and the pain goes away. If I took a day off every time something hurt…. I’d never run! The body likes to move and get the blood flowing. Move twice a day…. even getting outside twice a day to walk.
Best wishes and enjoy the beautiful outdoors (whereever you are)!
Camille
Hi Camille – I forgot to mention that I still have pain at the top of my thigh, and pain when transitioning from sitting to standing occassionally. Also, I read your article on achilles issues and the recommendation of barefoot running; I live in the middle of Chicago, there is no where remotely convenient that I could do that safely. I also have two kids, and work full time so my exercise time is 5:30 am. (fortunately, our pool opens up at 5:30). And that’s when I used to run, in ANY weather. Ironically, we had one of the mildest winters in the history of Chicago and I couldn’t run the whole winter. I was killing me; it was basically in the 40′s the whole winter which is my absolute favorite running temp.
Also, I tried doing a walk/run thing (run 2-3 minutes, walk a few minutes) twice last week and my achilles is more sore than ever. Ugghhhhh.
Ok, just wanted to add those additional thoughts. Thanks!
Ahhh, just saw this post! I know exactly what you’re dealing with, as one of my good friends used to live in the heart of Chicago (now lives a little to the North, but can still run from her house to the Lakefront). You’ve really gotta troubleshoot what caused the Achilles pain, whether it’s compensation related, shoe related, or something else (going up/down stairs…. somehow tweaked it swimming?). I’m a firm believer is simply “barefoot activity”, but even doing something like heel drops eccentrically loads the Achilles and can be beneficial. Some people are proponents of heel inserts to alleviate the stress. If the Achilles pain only started with the walk/run thing, it could be a matter of your body getting reaquainted with the impact, and possibly the stress of going from street shoes to running shoes (both having different heel elevation?). You’ve gotta troubleshoot the problem yourself and figure out what provides relief.
For your hip, I would imagine the muscles around the hip would compensate for the slight “weakness/deviation” to stabilize the hip. That’s probably what you’re feeling, if the bone callus itself isn’t irritating surrounding nerves.
Thanks very much for your reply especially since I know you’re recovering from Boston! I, too, am very heat sensitive and love running in the winter way way more than the summer so I applaud the manner in which you took care of yourself!
It’s an interesting theory about my hip. So are you saying that the bone is probably healed and what I’m feeling does not necessarily mean I’m not healed enough to be doing weight bearing exercise? I really want to at a minimum start doing some walking but I’m so nervous about backtracking any healing and progress.
Regarding my achilles, I can’t imagine swimming could irritate it. I did go skiing two weekends in February, one downhill (midwest) and one cross country. Nothing too crazy or intense (I was with my small kids) but it seemed really sore after those weekends, could I have strained it then?
Yes, absolutely, the bone should be healed and stronger than ever. If you read my post, the reason for the lingering pain is usually because of the bone callus irritating the surrounding nerves/soft tissue. It takes a good several months-year for the bone to fully remodel itself and be normal again. Consequently, you may also change your gait slightly and overuse other parts of the body. Light, weight bearing activity enhances the healing process even further, which was the premise of my Master’s thesis. This idea that you need to do “non weight bearing activity” and layoff is off the mark. Have you heard the phrase “Use it or lose it”? You lose bone/muscle when you don’t use it. Weight bearing activity enhances bone/muscle mass.
It sounds like the skiing probably triggered the Achilles pain.
I totally appreciate the perspective of being active through pain, not letting it hold you up etc…. But I feel like that’s what got me into this mess to begin with, I’ve always done that. And I’m not so young any more. I always pictured myself and as being one of those little old ladies you see out on the running path some day and I’m so afraid of being sidelined permanently and not being one of those ladies in 20-30 years. I trained for my first marathon during plantar fascitis, and it was totally fine somehow, but I was 34. It’s very refreshing to hear your theory on weight bearing exercise being beneficial at this stage; my doctor had me completely freaked out about not taking chances with my hip and pelvic area and how the consequences could be very damaging. It’s very difficult to know what the right thing to do is!
I have an almost 2 year old that I am still breastfeeding. I had a stress fracture on the 3rd metatarsal in February 2011 and stayed away from running until August 2011. I did swimming and biking while it healed. Started slowly running and didn’t have any problems. I started feeling the same type of pain a couple weeks ago in my foot. I have been starting to run more lately because getting to the pool has been difficult with my toddler. Can breastfeeding be causing my body to become depleted of calcium? Could this be why I’m getting stress fractures? I haven’t been running more than 20 miles per week and I used to train for marathons before I had my baby.
Hi Michelle! Someone else posed the same question to me a few months ago. Ironically, this was a test question in grad school– how much calcium does a breastfeeding mother need to get every day to meet their own needs and the needs of their baby? The answer is 1200mg of calcium/day. If you’re not meeting this on a daily basis, definitely…. your body will resort to breaking down your own body tissue.
Regarding your foot, it should be healed by now. Maybe you need to try a different shoe? It may be that you’re in the wrong shoe and need something else to change the distribution of stress. I’m not sure at this point if your body is still “hormonally lax”– the other lady who messaged me felt like her arches had dropped. There definitely could be some body changes going on because of hormones, which could impact your feet and the type of shoes you need at the present.
Hope you can get all of this figured out and eventually get back to marathoning! Be careful not to do “too much, too soon”. Work on re-strengthening the feet with some ~barefoot activity (walking or running). Good luck!
Camille
Hi, I love running and do it twice a week, each time 1.5hrs and at least 15km. What’s your advice for a severely underweight girl? I’m suffering for ammnorrhea( pardon the spelling error) . Im looking for Adidas running shoes too. I’m wearing adizero Boston but not sure if I should buy adizero Boston 3 or adizero adios2. Adios is much lighter cos of less cushioning. I’m injury prone since I lack strength or muscles but I’m looking to try running thrice a week. Thank you for your kind attention. Hope to hear from you soon.
Hi Funk! You probably need to go see a doctor to figure out why you’re not getting your period. I’m not a doctor, but the research indicates if you’re not getting your period, you’re likely in a negative energy balance. You either need to eat more, run less, or some combo of both.
Regarding shoes, this all comes down to personal preference and what feels the best to you. It may or may not be Adidas shoes– try on lots of brands and styles and go with what feels the best.
Regarding being “injury prone”, why are you only running twice a week for 1.5 hours? That’s a lot of “infrequent stress” to the body. I did a really good post about this: http://camilleherron.com/2012/03/14/what-turkeys-and-other-studies-teach-us-about-frequency-intensity-doubles-and-rest-periods/
Your body would be better off running every day, 30 min. a day, rather than twice a week for 1.5 hours. The body likes routine and to move frequently. I get lots of messages from people like you (usually triathletes), who only run 2-3x/week… get hurt…. and wonder why they are hurt. Not only is 1.5 hours of running twice a week an unusual stress to the body, but you’re likely running it at a higher intensity than what your body can really handle. Your body is probably thinking, “What are you doing to me?!” So definitely, it would be more ideal to be consistent and in a more “routine schedule”.
Hi, I’m not sure if this thread is still up and running but I wanted to say thanks for taking the time to write such a fantastic article. I was diagnosed with a complete stress fracture in my 4th metatarsal and not complete in my 2nd. It’s been about 5 weeks now of no running and very minimal cross training which is driving me insane. I no longer have pain in my foot but am returning to the doctors next week to hopefully get the results I’m desperately hoping for.
Once again thanks you
Hi Nadia, good luck with your recovery! I too was diagnosed with a stress fracture of the 4th metatarsal about 4 weeks ago. Just went for my second set of x-rays yesterday which clearly showed that the bone is healing. I don’t know how just walking is for you, but I bought a pair of Skecher GoRun’s right at the start because they disperse pressure away from the forefoot. They have been so helpful in my recovery that I bought another pair and plan on wearing them when I start running again (as a transition shoe before getting back to my Merrell’s which are closer to a barefoot experience). Hope this helps.
Anne
Thank you for the comment and suggestion Anne! When I had my metatarsal stress fractures, they built me custom orthotics with a “bump” in the metatarsal area to take stress off the forefoot– it definitely did help (shorterm)…. but led to problems elsewhere (longterm).
I actually bought a pair of Skecher GoRuns a few weeks ago, out of curiosity, and I think they do feel quite therapeutic! Good thinking!
Hi Nadia! Thank you, and yes, the article is infinitely in WWW land! Still getting lots of comments. I’m glad my knowledge and experience has been helpful to a lot of people. Sorry about your metatarsal stress fractures. Definitely, the tests to know if you’re ready to get back to running is 1) No pain hopping on the foot and 2) No pain with palpation. If you pass these two tests, plus doctor’s approval… you can get back to running- yea! Walking is very helpful for easing the transition back to running, no matter your ability level.
This is a wonderful thing you are doing here, Camille. Thanks so very much.
I too ran Boston this year. About a month out, I started experiencing right hip pain after running too fast on a hilly course during my long runs. I tapered earlier and the pain sort of subsided. While running to get to my corral in Hopkinton, I knew my race was OVER! The pain was worse than ever. I gutted out the race and ended up in the ER on Tuesday due to the inability to ambulate. A preliminary x-ray showed an evulsion on the R side of my pelvis. I had an MRI done and it verified the pelvic evulsion and also showed an evulsion fx of my femur and a stress fx of my R hip. I’m going to see the ortho md next week to discuss rehab. Fortunately, I can bear weight and walk (very slowly and just touch tap with my right foot)–I can also tolerate the elliptical (actually feels good to do this). My question is about the evulsions. I’ve never heard of these before and my Googling said they are “thigh splints” Is this something new or am I just getting poor search results? I know the pain they describe them to have to be spot on with mine. To be kind, all I can say is the pain is ‘exquisite’! Like you, I’m a high mileage runner. Unlike you, I’m far from an elite! I’m a 59 year old 2nd waver. Many have lambasted me for running Boston this year, but to be honest, it was actually, minus the pain, the best time I’ve had running a race ’cause I was able to socialize with other runners as well as drink gallons of the Boston College frat boys beer (just trying to stay hydrated) as I limped through Brookline! I have already BQ’d for 2013 (ran well at the Bay State Marathon last fall), but I’m so concerned about getting back, healthy, as an aging, pushing 60-year old marathoner!
Thanks again for your website. I’m paying lots of attention now to the ‘little things’
Steve Sullivan
Yeah for Steve! I wish I could have found you out there during the marathon, because I, too, decided to “run” Boston despite my four stress fractures – including one in my left pelvis. I was six weeks into healing, felt great to walk, and even though I was offered the deferment, I just couldn’t pass the excitement or the opportunity. I made it 10 miles until I had to walk/run some, but it was THE most fun I have ever had in a marathon. I enjoyed the Boston College boys and the excitement of the crowd more than I would had I been running for a PR. Yes, it was my PW and yes, it hurt like heck, but would I do it again if I could – YES.
My stress fractures are screaming like never before and after the scolding my doctor gave me, I am out for another four-six weeks in the wheelchair and indefinitely for running. Hey, it was one heck of a send-off! : )
I hope you are able to heal soon, Steve. It does make me feel good to know that I am not the only one who gave in to the thrill of Boston.
Hi, Aimee.
Boy, we are of the same pod!!!
And I really do feel your pain…
Good Lord willing, we’ll shake hands in Hopkinton in 2013…
All for Boston!
Steve
Hi Aimee! Wow, that’s ironic to get two messages together, between you and Steve! Wow, that’s remarkable you persevered through so much pain like Steve! It’s really not surprising that both of you got hurt leading up to Boston– that’s pretty common, when you’re working towards a major goal. I actually had another friend who had a pelvis stress fracture…. twice leading up to Boston (’10 and ’11)…. and she toughed it out last year! Pelvic stress fractures tend to be more common in women, because of the shape of the pelvis and imposed stress of the bones on the bone. However, there could be any number of factors (~training errors– hill running), hormone/diet related, etc.. It sounds like you really overstressed your body.
Glad you had fun in Boston, regardless!!! Now you can rest up, and make a comeback when your body is ready. Be mindful for the future though when you’re training intensely towards a major race (~training, balance, diet/hydration). Take care and let me know if you have any more questions.
Maybe you and Steve will meet in ’13!
Camille
Hi Steve! Thank you for getting in touch and the kind words. I’ve always wanted to share my knowledge/experience…. basically how I became a student of bone so I could keep myself healthy and training consistently. I’m glad I’ve been able to help and reassure a lot of people like yourself!
Sorry to hear about the avulsion fracture, but glad you had a great time in Boston!!! I’m guessing the beer helped ease the pain you were experiencing.
Are you saying you have an avulsion fracture (and where?) and also another stress fracture, both in the same leg? If you’re referring to the adductor area, this is actually a very common area of overuse for runners. We have a tendency to overuse the adductors, due to pronation, and develop weak hip abductors (on the outside of the hip, since we never/rarely move laterally). This makes the adductor muscles very tight, and indeed…. the overused muscles pull on the bone. When I had my hip surgery in 2010, I went through 4 months of PT, and we had to work on stretching my adductors and strengthening my hip abductors. A lot of this comes down to being in the right shoes as well (firm, but flexible is good) and having strong feet muscles. W
When you’re able, you should definitely look into meeting with a PT and working on correcting any muscle imbalances. They’d likely be able to evaluate your gait and make a shoe recommendation. Longterm, when you can get back to running… start with walking first. Because your bone issues are muscle induced (and you can’t really avoid not using the highly overused adductors), you will likely have pain coming back– the muscle pulling on bone. Be patient and careful! The bone is stronger than it’s ever been because of the bone callus, but the surrounding tissue/nerves will likely still be inflammed (since it takes much longer for the bone to fully remodel itself). Give it time.
Best wishes getting through the healing process! Glad you had a great time in Boston! Hope you’re hydrating well.
Hi Camille,
I read the article on stress fractures and every post here with interest.
I had an osteotomy on my first toe a year ago for a problem in my foot related to a bunion I had before (had surgery for that 5 years previous) in order to open up space in the toe joint. It took me a long time to heal and I had a delayed union. It solved the original toe joint problem of increasing pain but may have caused another biomechanical problem since it shortened the toe. My foot has never felt “normal” since the surgery and it may be due to soft tissue and swelling and nerve issues that contributed to weakness of muscles from lack of use and an unnatural gait from months of healing. I am very active (normally) and am a runner and cycler and cross country skiier and also do social dancing, and I teach snowboarding and skiing. About 7 weeks ago I felt pain on the top of my foot and when I walked after a weekend of a lot of activity, including a leisurely walk in my VFFs which I was trying out again. My feet felt very sore and achey and I had a hard time walking without pain. After surgery, I as used to pain and usually I would feel this and it went away in about 2 days. This pain did not go away and after 3 weeks of limping and misery, I went to my podiatrist who did the surgery and he dx a 2nd metatarsal SF. The bone callous could barely be seen on the xray, but it was there. He told me basically to just lay off walking and running (of course) but that I could do bike riding and elliptical – anything not stressful to the area. He said it should heal in 2-3 weeks but to call him if I had a problem. But he also said, because the osteotomy made the big toe shorter, it created a biomechanical situation of putting more stress on the 2nd metatarsal, hence I was more predisposed to getting a SF there. So my question is, now that I have one, once it heals, will my problems be over, and that “predispostion” to SF be lessened? Or will I possiblly keep having problems and get another one in a different area. I sometimes think I made a mistake to have the surgery and it created a problem worse than the first. I do have an Exogen bone healing system which I use regularly, I don’t use NSAID’s, I have always taken calcium, D3, and have a good diet and I started to walk a bit more as per your recommendations for helping bone healing. I only now feel I can walk any distance (half mile to a mile) without feeling a LOT of pain later on. I do still feel pain on palpitation.
Thanks for your help.
Hi Jeanne! Wow, it sounds like you have a very complicated foot! I did a recent post about how I had to get my shoes customized to match my quirky right foot. When I had stress fractures in my left foot many moons ago, the only way I was able to finally get the foot sorted was custom orthotics (a good temporary solution to alleviate the stress, but led to problems elsewhere). It sounds like you really need to experiment on finding the right combo of shoes and/or inserts. Someone else posted on here about the Skechers GoRuns, which is more elevated in the midfoot– maybe that would help alleviate the stress on your midfoot?
Otherwise, you’re going to have to give this time to heal and become pain free. Definitely, some walking/weight bearing (as tolerated) can enhance the healing process. It’s up to you on what shoes to wear that are most comfortable at the present for walking– don’t force yourself to wear ~VFFs, assuming they are “better” for your feet. It may be that you need more “cushioning” right now to help rest your foot, but still some mechanical stress to enhance blood flow/healing (~bone stimulator, walking). Leave it up to your doctor to guide you longterm. Best wishes!
Hi, Camille. Yes The folks at Shield’s MRI sent me a copy of the wet read report and it said I had an avulsion of the right femoral diaphysis and a stress fracture of the right os pubis. When I had an initial X-ray before the MRI, I was told,I had an avulsion on the right side of my pelvis–not sure how that plays with the MRI. I have an appt with an orthopedic Wednesday
I’ve been injury free with the same shoe for 5 years, so I’m suspecting the origin of this injury is running too damn fast on my long runs and then exacerbating it in Boston. I’ve been very fortunate as a runner, having just nagging soft tissue injuries, up to now. I’ve never had a bone issue. The pain is frustrating since I really never have had to deal with much physical pain in my life–maybe I have a low threshold for it? I’m also frustrated by the progress of healing. I know it’s been only 3 weeks, but with previous injuries, when I’ve rested, I could feel improvement each day. With this injury one day can seem like I’m getting better but then the next I feel worse than I did a few days before.
I will try an extended walking session this week and try to do some exercises to strengthen my abductors. I’m so looking forward to being able to hop with my right leg!!
Thanks again, Camille.
Ahhh, ok, it’s the femoral shaft– that’s definitely muscle-induced. I’m curious as to where on the shaft though, cause that will indicate which muscle/action led to the stress fracture. Being a larger bone means it will take longer to heal. Also, because it’s muscle induced, there’s always going to be some amount of pulling stress on it– large muscles, large bone, stronger pull, more pain. You need some stress, ~walking as tolerated, but not an excessive amount to enhance the healing process. Sounds like it was your long, hard runs that caused this– a lot of downhill running, esp., can be excessively stressful.
Give it time– I know that’s hard to do! When I had my hip surgery in 2010, I found out I actually liked to walk…. like a slower form of running = take in the scenery more.
I ended up taking my camera out with me and going for walks on trails and such. It was pretty enjoyable! Best wishes! 
Wow, I am so grateful that I found this article. It was so helpful and I feel like my situation is almost identical to yours, except I have only had three fractures so far! And hoping not to have anymore. I would love your opinion and advice. I’m a 20 year old runner, I’m in college but I do not run for my school’s team. I prefer to run long distances at a comfortable pace, I don’t generally do speedwork. In Dec 2010 I had a stress fracture in my left foot, the 2nd cuneiform bone, did 3 weeks in a boot, then went back to running and was fine for about 10 months. Last October, I was having vague hip pain, and I got a bone scan to “rule out” a stress fracture, and it just so happened I had a stress stress fracture in the mid-shaft of my right femur and also at the top of my left tibia. Now, 7 months later, I have had two follow up bone scans and have been instructed to start a running progression at the beginning of July. I have not had ANY SYMPTOMS in these seven months, its very strange, except that when I touch the spot on my tibia, it hurts. I could have passed the “hop test” on both legs the day I was diagnosed. Unless its possible that the femur fracture caused pain in my hip.
I had my gait analyzed and I have flat feet and overpronate a lot, especially on my left side, which was probably responsible for the two fractures on my left leg. Previously I was running in neutral shoes, I switched to stability shoes (Brooks adrenaline) and got custom-made orthotics based on my Dr’s recommendations. It sounds like, based on your experiences and research, this might not be the best solution? What do you think?
I was in physical therapy right before my stess fractures for patellofemoral pain, and they had said that my right quad was significantly weaker than my left, but both of my quads were weak in general. Could this have been responsible for my femur shaft fracture?
During the past seven months I have been cross training by biking and doing the elliptical, and in the last month I started speed walking for around 30 minutes per day. I have been advised to stay only on the treadmill, although I walk at least an additional hour around campus everyday. In addition, I have been doing some major strengthwork for my legs and core. My legs have never been stronger, especially my quads and my hip abductors. Is there anything else I can be doing to prepare for returning to running? I have been consistently taking calcium as well.
I should add that I am thin, but not underweight, and I was found to have normal bone density and normal calcium and vitamin D levels in my blood. Again, thanks for this wonderful article, I bookmarked it and I plan on referring back to it often! Its also WONDERFUL to hear that someone with seven stress fractures is still running. A couple of professionals have told me that my body just wasn’t meant to be running as much as I was (which was about 40 miles per week at the most, and a slow pace, never did any speedwork or races). My orthopedist and podiatrist think that the orthotics should make a big difference.. but now I’m not so sure??
Hi Liz! Glad you found my article helpful. Sorry to hear about your stress fractures! You know, we’re all an experiment of 1. It sounds like you’ve got some anatomical/biomechanical discrepancies (~maybe a leg length issue?), and you have to figure out for yourself how to troubleshoot these issues. What often happens is you get one injury/stress fracture…. you compensate and change your gait ever-so-slightly…. and then you stress another part of your body. It takes bone much longer (few months-year) for the bone to fully remodel itself and be normal again. It may be that you need to take a longer break from running, try walking or other activities you enjoy (which you’re doing), to let your body fully heal itself before you progress back to running. If a PT/doctor recommends various strengthening exercises to troubleshoot muscle imbalances, by all means do what you’ve got to do to straighten yourself out.
Shoes and orthotics can definitely impact your mechanics– could help one problem, but lead to a problem elsewhere. You have to figure this out for yourself what helps you achieve the best balance and keep yourself mostly healthy. It’s up to you on what feels the best. Unfortunately, what the doctors and shoe store guys recommended for me was completely wrong…. I got tired of trying various shoes and orthotics for 4 years, and decided to scrap all of it and start training in racing flats (back in 2003) to strengthen my feet. I wouldn’t be where I am today if I hadn’t done this. My transition to “minimalism” is posted under my Health/injuries tab.
I should also mention that you have to consider outside, life stresses and also your menstrual cycle. If you’re not getting enough calories and/or missing your periods, hormonally and metabolically this can wreak havoc on the body. Stress in general and not getting adequate sleep (as can happen in college) can lead to inflammation in the whole body.
Best wishes getting yourself sorted. Run for stress relief– that’s the best advice I can give to anyone at any level!
hi Camille
I wrote you some time ago..but need your help again..as I am not getting better and am SO frustrated and truly concerned that I will be limping forever..I was diagnosed 7 months ago with a stress fracture of the 5th metatarsal..I’m not a runner..and dont know why it happened (my podiatrist insisted that there does not need to be a reason). anyway–an MRI showed a stress fracture and 2 small neuromas.. I was placed in a boot–which I unfortunately wore for 10 weeks religiously (not realizing that there was a point after which a boot was counterproductive)..after 10 weeks..my foot still hurt..My podiatirst had custom orthotics made..I have always used over-the counters (i have flat feet) and they have defintiely helped me..(though my customs dont feel as comfortable)..eventually–I sought the second opinion of an orthopedist who had come highly reccommended…he looked at me for about 20 seconds..before insisting that I needed P Therapy–said he never prescribed a boot without some PT afterwards (though my podiatrist said PT was “overkill” I have finished 10 weeks of PT–mostly geared toward increasing flexibilty (i have poor range of motion in the foot and toes) and strengthening of the foot and ankle muscles.. I have not been thrilled with my P therpaists..they dont seem that knowedgable and seem to just push each session through very mechanically..anyway–10 weeks later…my fracture site still hurts alot…there is no swelling but it feels ver tender and hurts to walk… I was recently in Europe–where a friend of mine insisted that I see her PT–who she raved about..I went…and this woman (who in fact DID seem much more informed and interested than MY PT–) had alot to say…She insisted that my issue was that –not only was i flat footed,..but that more inportantly–I had a poor forward arch..which wa what was giving me the sensation of “walking on bones” and she felt that it was putting me at greater risk for more fractures…She looked at my orthotics and claimed that she “didnt understand them” –said they didnt adress the forward arch at all..didnt have enough regulkar arch support..and most importantly…said that she thought they were too rigid.and that they would make my foot not work enough on its own…she reccommended a more flexible type of orthotic which supported but allowed the foot to do more work on its own..
she also had different exercises..and reccommended finding a therpaist who secialized in either Janda –or spiro-dynamics..
i came home..told me podiatrist about it..and he sneered….saying that making the otrthotics any less rigid would make them “useless” (he had also said that my over-the counter –orthotics were totally useless.)
i then went for my followup at the orthopoedists…who looked at My MRI–said there was no evidence of a fracture..no notable soft tissue problems ..and had “no insight for me at all”
he said he would “hope” that my pain would go away…but had no was of saying.
he reccommened i see ANOTHER orthopedic surgeon who specialized in feet
he aslo said–when I asked him about orthotics..that there was no research that proved that custom orthotics were in any way better than over the counter ones..and that he reccommended that i throw my customs out and use store bought..
im still limping…and have NO idea what to do.or if it is normal..
any thoughts?
camille
wanted to add that I had been complaining that i feel like theres a change in my feet….like Im “walking on bones”–neither the podiatrist nor the orthopesist had anything to say about it
The PT in Europe said that was because the poor forward arch was causing me to put alot of stress on my metatarsals and giving me that sensation..
she also said that the pain i felt in the fracture site was because my “capsule was swollen”
thanks
Hi Eugene! Wow, sorry to hear about your frustrations with your foot! The 5th metatarsal (“Jones fracture”) is a very tricky bone because of how much support/stability/BALANCE it provides the foot. It generally bears a lot of weight/stress, and because of this…. if it gets hurt, it’s difficult and takes a long time to heal. Healing is a matter of getting some stress (to increase blood flow to the area), combined with some rest (which is difficult to achieve with the 5th metatarsal). It is incorrect thinking to have “no weight bearing” with this type of stress fracture– you need to bear some weight, to increase blood flow and the healing process. Non-unions/slow healing of this bone are common, likely because doctors are a bit overkill on the “no weight bearing” concept. Combined with the neuromas you mention, the pain alone is probably causing you to compensate and alter your gait/foot mechanics, hence you feel like you’re “walking on bones” (so many bones in the feet = very complicated).
This is definitely an injury where it’s a matter of seeing a foot specialist who understands it, combined with getting the properly PT– probably doing one-leg balancing exercises and band exercises. It sounds like you need to see a proper pedorthist who really understands mechanics of the foot and how to care for the 5th metatarsal. I actually recently blogged about my experience with a very good pedorthist, which you can read about here (I also have a quirky 5th metatarsal and cuboid): http://camilleherron.com/2012/04/24/foot-pain-art-by-kevin-jones-and-shoe-modifications-by-james-drain/
It sounds like you need to get in the right, maybe modified shoe (with or without an insert), so you can at least be more comfortable and able to walk. I’m thinking if you can get into some more comfortable shoes that alleviate the stress…. AND AT LEAST WALK…. that this alone will help you heal. If you read my post above, the pedorthist I visited was able to “excavate” my shoes, to alleviate the pressure on my 5th metatarsal tubercle. I’ve been running in these shoes for 2 1/2 weeks now, and what a remarkable difference it makes! Not to scare you, but I’ve been in pain for 2 1/2 years, and no one had suggested this! It’s all a matter of finding/seeing that one person, who understands your feet and knows what you need. So don’t give up on finding someone who can help you and guide you! Definitely though, seeing the right PT to get you on a strengthening/one-leg balance routine will be helpful.
Be patient– this is a difficult injury to get over. Makes you appreciate how complicated our feet are! Best wishes getting healthy!
Hi, Camille. I’m so happy I stumbled upon your website. I am currently in my third week of wearing the dreaded boot for a calcaneous (heel) stress fracture. It has been four and a half weeks since I ran and it is killing me to not run. I was having peroneal tendon issues right before I was diagnosed with the stress fracture (cortisone injection was administered as I was training for a full marathon). In all of your research, what is the likelihood that my tendon issues (overuse and running on the outside of the trail) contributed to the fracture? Is there anything I can do to strengthen the tendons and/or the surrounding muscles that might help prevent another SFX in the future? You seem to be a huge advocate for walking and putting some weight on the bone to help it heal. Do you think that is a good idea at this point? I have zero pain and the occasional twinge/ache in general area. I also only wear the boot while at the office and while I’m out and about. I never wear it at home, as I’m generally not doing more than walking short distances to and from the couch! I’d love to hear your thoughts. Thanks in advance.
Hi, Camille.
I’m in the que with another question.
I went to my orthopedic MD appt today. He said my right proximal femoral SF is pretty significant and that I was fortunate not to compete the fx while running Boston. (blush)
He essentially told me not to attempt to run until after the follow up visit/xray in 6 weeks.
I asked him some questions and he pretty much parroted everything I’ve already learned from you.
My question is about walking. My job requires me to be on my feet most of my shift and I have to do a bit of walking (I’m an RN). I do get tired and feel some pain when at work, but it’s mostly out of being tired and not totally due to the injury. I’d like to start a walking program to help stimulate healing and I was wondering since I go to the gym to use the elliptical if maybe I could use the treadmills and maybe start at increasing the incline while starting at a 20 minute/mile pace?
I’m on day 23 of my running Lent–I have high hopes to be able to pass the hop test on my right side by day 40!!!
Thanks again, Camille…
Ahhh, ok, so it is higher up– the adductors I’m assuming. This is definitely a common issue for runners due to the pronation. The adductors get overused/tight/pulling on the bone, while the abductors on the lateral hip aren’t used as much and are weak. It’s a muscle imbalance that’s easy to address if you meet with a PT– stretching the adductors and strengthening the abductors.
So you’re an RN– have you thought (or maybe you already have some) compression pantyhose or tights? I’ve had a few male friends who have inquired about this. I got some compression pantyhoses at CVS pharmacy– if you look under my “Little Things” tab, I talked all about compression gear. Maybe you can find some that would fit you?? I like the full-length compression pantyhoses because of the butt/thigh coverage, my two problem areas post-marathon. Compression tights or full-leg sleeves would probably be good too, but may not work as well under your clothes.
I’m really not a fan of the elliptical. It’s unnatural, kinda messes with your gait, and can put added stress on certain parts of the body. Walking is a more natural activity, of course. Sure, try the treadmill and experiment with the grade! If you can, even regular outside walking/trail walking would be good. Don’t increase the grade though if it adds pain– do what you can that makes you feel good.
Well be patient and give it time! The walking will definitely be of benefit, but don’t overdo it!
Hi Michelle! Sorry to hear about your calcaneal stress fracture and peroneal issues! I’m actually going to email you, as I’ve dealt with a similar problem the past 2 months.
Great! I can’t wait to hear what’s on your mind and what you’re going through.
Oh, man, 7-14 weeks? I’ve been off from running for 9 weeks for a 2nd metatarsal stress fracture and it’s killing me. I really thought I’d be running again by now. This is my first stress fracture in 25yrs of running. It happened after running in vibrams for almost a year. I’m just terrified that I won’t be able to run again (irrational maybe, but I can’t help it). I was in a boot for 4 weeks. Now I’m walking. It doesn’t hurt to the touch anymore, but I can’t walk completely normally and I definitely can’t hop on it. I get a little pain if I do a completely normal stride and push off at the end. I guess I just have to be patient, but it sucks. Really thought I’d be working back into running by now! Anyway, thanks for the blog. I’ll take any advice you have to offer.
Hi Annette! Wow, that’s impressive you’ve gone 25 years without a stress fracture! It definitely stinks, but be patient– bone heals amazingly well, if you let it… AND, also if you “encourage” the healing process through weight bear activity. The feel are tricky, since they bear so much weight/force– it can be tough to strike a balance between allowing them to ‘rest’, while also stressing them some to enhance the healing process. Start with walking, before running. Give it time– you probably need a more substantial shoe right now than the VFFs. Have you thought about trying the Skechers GoRuns? They have more medial support, which might alleviate the stress on your metatarsals. They’re kinda like the Nike Frees, but with more medial support. Look into them. You’ll be fine– best wishes healing and progressing back to running!
Thanks so much for your reply Camille. I’m actually feeling a lot better this last week. I feel like I’m finally seeing the light at the end of the tunnel. My foot is feeling really good and I’ve been going for hour long walks on the trails where I usually run (which helps my outlook and makes my dogs much happier too). I think I’ll try some very easy running in about a week. I am kind of in a quandary about shoes now so I’ll look at those Sketchers. I usually buy trail shoes since 95% of my running is on trails. I’ve been trying to decide between going back to my Salomon trail shoes (with the typical 12mm drop) or trying Brooks PureGrit which have a 4mm drop, but if the Sketchers have some medial support that would probably be good because I do pronate a little bit.
Thanks again! It’s really great that you take your time to respond to all these posts. You are really helping a lot of people!
Hi Annette, as long as you pass the two main tests (~no pain with palpation, no pain with hopping), you should be ready to resume running. It’s definitely worth a shot trying out various shoes. The Brooks Pure line is supposed to be great. I mention the Skechers– out of curiousity, I got a pair a few weeks ago, and just the other day I tested them out on trails. They work great. You kinda have to get used to the medial support (not like a typical arch support at all). I have pretty flat feet too, but I really like how they feel. When I had my metatarsal stress fractures, they’d built it my orthotics with a “metatarsal pad” to support the metatarsals– the Skechers feel like that, but more comfortable. It’s an interesting concept!
It sounds like you like trails. Hopefully your trails aren’t too knarly for your foot! I would worry about too much “torque” on your foot coming back. If when you start running you feel you need a flat, predictable surface for your foot, don’t be afraid to get on ~bike paths or roads. Go with what feels the most comfortable.
Best wishes coming back successfully!
First thanks for all your support to all these people it is so nice that you take the time to reply.
I have been running since high school/college mostly a 800/1600 runner. It is just in the last couple of years that I started to dabble in the half marathon as a competitive masters runner. I started having plantar issues after my first daughter was born and have been in orthotics ever since (7yrs) and now have a lower back issue and a hamstring attachment injury that comes and goes. I have never been able to log more than 50mpw without some issue popping up. A week ago I was in a half marathon and hitting 6:35 pace when around mile 5 I felt a strange pain in my right foot, I thought “this is a new one” but it went away, then at mile 6.5 it came back very intense then in the next step I felt the pop..So I have a complete fracture of my 3rd metatarsal..I have never in my 30 years of running/racing had foot problems so I am very confused where this came from. I had no previous pain prior to the start of the race. I have been racing in the addios, but training in the addidas mana and nike lunarglide 3. The only thing I can come up with is I had REALLY backed off the training because the hamstring had flarred up again and maybe I was compensating in the race I have also been having more bunion pain on that same foot. Any input you have would be great, maybe it is time to ditch the orthotics I only wear them when I run now anyway, but when I don’t my back seems to be worse. I also have the boot, but it really hurts if I try to weight bear so I have been wearing the splint and the Dr doesn’t want me to do any type of cross training for 3 weeks. He also warned me that if this heals in a higher postion I have a greater chance of fracturing the other metatarsals…I am not ready to retire, but all these things are starting to add up! thanks for your time!!
Tracy
Hi Tracy! Glad to be of help! Sorry to hear about your 3rd metatarsal fracture. It sounds like you’ve compensated for whatever body quirks, and that led to the added stress on the metatarsal. Sounds like you just need a break to let the body heal up and sort itself out. It’s up to you if you want to try and ditch the orthotics. I ditched mine cold turkey back in ’03 and started training in racing flats (which you can read about here: http://camilleherron.com/2011/06/08/how-i-became-a-minimalist-and-went-from-average-runner-to-elite-marathoner/)
I had to be very, very patient with this (ankles sore/stiff for 3 months!). I can’t say it would work for everyone. If you’re always dealing with some sort of body quirk, it’s definitely worth experimenting with or without orthotics and various shoes.
I might add– you mentioned getting plantar issues following pregnancy. Ironically, I’ve had a lot of women message me about developing foot issues following pregnancy. It seems pregnancy makes the feet more “lax”, which may just be a temporary thing? It could very well be that your feet are different now, than when you got the orthotics post-pregnancy. Food for thought!
Interesting what your doctor said about the “healing in a higher position”. This actually happened with me, such that my left foot is still deformed (but eventually adapted so I don’t have problems). Following my 2nd metatarsal stress fracture (which completely fractured, like yours)…. I ended up getting stress fractures in my 3rd and the 4th metatarsals. That’s when they prescribed the orthotics, which as the story goes…. cured my foot, but led to problems elsewhere!
Anyways, someone commented that they recommend the Skechers GoRuns for added midfoot support. They might be a good shoe for you to try. I actually got a pair just to try for the heck of it, and I like them for both running and walking. They’re reasonably priced as well for running shoes.
Sounds like you just need to take a break and enjoy the rest of life! Not a bad thing– I took my first real break in 7 years back in 2010 (for hip surgery), and it was very enjoyable! I learned I like to walk, play video games, and take pictures.
You’ll be Ok– experiment with finding the right ‘balance’ for your body.
Thanks for all the encouraging words!! Funny I started reading up on the Skechers GoRuns after seeing you mention that somewhere else on your site. I think I will give them a try. I agree, I think by fracturing my foot my body is trying to make me listen because I obviously wasn’t listening before. It just gets harder to come back the older you get and takes much longer so I almost get into a panic that my fitness will never come back..Type A runner!!! So you mentioned that your foot didn’t heal correctly, is there anything I can do to avoid this and if it does heal in a higher position is it pretty certain that one of the other metatarsals will fracture?..It seems weird to me that they don’t set the bone, but maybe they can’t. Anyway, thanks again for the encouraging words and I am going to take the time to spend with my two little girls and heal everthing up!
Tracy
Hi Tracy, I have no idea if there’s a way to get the bone to heal in the correct position. As I said, I fractured the 2nd, 3rd, and 4th metatarsals, until they finally put me in orthotics with a metatarsal pad, which was a good temporary fix. Time will tell what happens with your own foot!
Camille,
I ran across this blog when searching for information on femoral neck stress reactions. I’ve been lurking here for a while, and I appreciate your knowledge, your straightforward approach, and your responses to so many people who are in need of support. I am currently rehabbing a femoral neck stress reaction, which I caught very early, and at 8 weeks it seems to be going well. I won’t ask the same questions all over again. Instead I want to raise a new question regarding osteoporosis and the older runner.
I have been running for 37 years, have completed 33 marathons, including 2 in 2011, and never had a stress fracture or reaction until now. It was the farthest thing from my mind in late February when my upper thigh pain developed and persisted. I was admittedly doing a lot more than my usual mileage, not resting enough, and dealing with considerable life stress. I was using running as an escape. In hindsight, it was a recipe for injury. But I felt fine until the mild pain came on very suddenly. Still, I thought, “I don’t get stress fractures. I have never had them.” Then I had an MRI and I couldn’t deny that.
The explanation came with a bone density test. At 57, I was told I have osteoporosis in both femoral necks (T score of -2.4 in the uninjured hip and -2.7 in the stressed one). My internist immediately suggested a bone building drug such as Fossamax. I raised the question of side effects and the warnings about spontaneous femur fractures occurring after 5 years of use. She more or less shrugged off those concerns, saying that I could “take a holiday” from it after 5 years. I did some research and found that some people have successfully maintained and even built bone density with alternative treatments such as strontium. Since the stress reaction was diagnosed, I have been taking 1500 mg of calcium, 2000 I.U. of vitamin D (I am slightly deficient), as well as magnesium, silicon, and a multivitamin. I have eaten a balanced diet including meats, fruits and vegetables, grains, and dairy products all my life, so I don’t think my nutrition has been terrible. However I didn’t supplement much with calcium until now. I guess I thought being a runner would strengthen my bones. But I guess heredity trumps everything else. Osteoporosis runs in my family.
My sports ortho seems comfortable with me trying an alternative treatment and supplementation for a year and then rechecking. She doesn’t think I have to stop running, but I love long distance running and don’t want to have to give up marathons. I’m concerned that one stress reaction or fracture might be a sign of more to come, and I surely would like to prevent that. I have been searching the internet and have been unable to find many examples or stories of older runners with osteoporosis, much less any scientific studies. It seems that the research focuses on younger women with diffferent issues such as eating disorders and amenorrhea. While bone density may be the same concern at any age, younger women may be able to reverse the problem, while I probably cannot. Any thoughts on how someone in my situation might be able to manage running and bone health? Thanks for your ideas.
Sue
Hi Sue! Thank you for the detailed comment! I say GOOD FOR YOU, going all these years without a stress fracture! That’s ‘awesome’! Unfortunately, osteoporosis is often a “hidden disease”, where people don’t think anything is wrong, until something “breaks”. For most sedentary people, a bone spontaneously breaking is a scary, scary thing. For you though, you’ve got running + osteoporosis, so there’s more going on in terms of stress and hormonally. You didn’t mention being post-menopausal, but assuming you are– you are essentially the equivalent of an ammenorrheic, young woman…. except that what you’re going through is a normal part of life.
This being said, there is a lot of conflicting research on the pros and cons of bisphosphonates (~Fosamax). Short term, yes, they’ll increase bone mass. Longterm though, they can make bone more “fragile”. There’s a lot of risk factors (~osteonecrosis of the jax for example). I’m not a doctor, so you’ll have to leave this up to your doctor on the pros and cons and if it’s something you should pursue. There’s some other alternatives (~PTH, hormone replacement therapy), but leave all of this up to your doctors and you.
That’s great you’re pursuing “health alternative”. Vitamin D is very, very important! Amazingly, even as runners, it is possible to develop a deficiency, esp. in the winter. 2000 IUs is good, unless you have very low Vit. D, which a doctor can prescribe larger doses.
One cool thing I learned in grad school is that exercise sort of “directs” the nutrients where they’re most needed. Getting the extra nutrients won’t speed up the healing time, but it’s very important to the structural integrity and strength of bone.
Another thing I should add– have you thought about doing strength training? Running/weight bearing is generally good for bone, but the right sort of strength training for your spine/hips could really help. I’d suggest working with a PT or strength and conditioning person. It’s never too late to give it a try!
It’s good you’re now aware of the state of your bone health. I don’t think you’re too old at all to make a difference. Our bone mass reaches it’s peak around age 35, but you can always do stuff to prevent the decline thereafter. You’re probably undergoing a lot of hormonal changes right now, which may have played a role into all of this as well. It sounds like you really want to be pro-active, which is good! That’s great you care about your health and want to do something about it.
Best wishes healing up! Enjoy some other hobbies right now!
Camille,
Thank you so much for your offering your thoughts and your detailed reply. To fill in a few of the gaps: yes I am postmenopausal by about 5 years, but being of the opinion that menopause is not a disease and having gone through it with no discomfort, I didn’t even consider HRT. My thyroid function is normal, so I don’t believe PTH would help. I was just tested for most things that could cause bone loss or malabsorption, and everything was normal. I believe it’s just genetics. I have been doing weight training and specific strength exercises for running and XC skiing (my other passion) since I was in my 20′s. I’m sure I got some bone-related benefit from it, and I don’t intend to stop, but it was a wake-up call to find out that I wasn’t superhuman, and aging happens to the most active of us. I am working with a PT who specializes in treating runners, and she showed me some specific exercises that I can add to my routine that will strengthen my hips, glutes, and core. I also just read your article about strength training, and it gave me some things to think about – particularly the point about doing enough but not too much, and the cumulative effect of doing multiple forms of exercise. Even after all these years, I still have a lot to learn, but it keeps life interesting and challenging, which is a good thing.
Thanks again,
Sue
Hi Sue, I totally agree that the hormonal changes you’re undergoing on a normal part of life, and why change this?! In fact, our lab at Oregon State was really interested in natural alternatives and the positive influence of exercise. It may be that you do have a genetic predisposition, but don’t let that hold you back! It’s really up to you and your doctor on whether to pursue drug treatment methods, which might be temporarily beneficial. I mention PTH because it’s a newer mode of treatment (has nothing to do with thyroid function). Our lab at Oregon State studied PTH as a treatment method– whereas Fosamax works by slowing down bone resorption/removal, PTH treatment works by increasing bone formation. It’s a newer treatment method, and I believe it’s pricey and may not be covered by insurance yet (~inquire with your doctor). Both labs I worked at (Oregon State and Purdue) looked at nutritional alternatives, including soy products and the benefits of alcohol in moderation.
That’s great you do strength training and are working with a PT. Something else to throw out there– have you ever done ~box jumping/plyometrics? Or even drills like ~skipping/high knees? Squatting with free weights? Bone mass is ~proportional to how much muscle mass you have as well. Of course you’ll have to heal up first, but I’m wondering if some higher intensity, weight bearing activity would be of great benefit to you. Our lab at Oregon State did a box jumping study with kids, and they retained increased bone mass many years later. Intriguing! I did an interesting blog post about what the research tells us and how to best maximize bone mass from a mechanical standpoint:
http://camilleherron.com/2012/03/14/what-turkeys-and-other-studies-teach-us-about-frequency-intensity-doubles-and-rest-periods/
It’s great you’re seeking out ways to help your bone mass and prevent more stress fractures. Best wishes on your pursuit of a stronger body!
Hi Camille, I’m glad I found your blog – it’s been really interesting to read about these experiences. I’ve currently got a stress fracture in my 4th metatarsal and was in plaster for a week (A&E doc overreacted slightly) but now am using an air boot. It’s been nearly 5 weeks and certainly feels like it’s on the mend, but I’m feeling very apprehensive about running again when the time comes (will be following the doctor’s advice on that, don’t worry!). I took up running about 2 years ago but have been very sporadic with training, only really doing it properly for a race (a 10K and a half marathon so far) and then lapsing and not doing much running at all in-between. So it’s not entirely surprising that I ended up with a stress fracture – I was definitely running too far for my fitness levels, I think. I’m concerned though that I switched to minimal shoes about a year ago – initially I followed the advice about taking things slowly and was fine, but lately not so much. Now people are telling me I should ditch them and go back to supportive trainers when I start running again, but I feel like I’ll be going backwards! Intuitively it makes sense that running in minimal shoes puts more strain on the metatarsals though, so I’m wondering if they have a point. What’s your view? Should I completely go back to basics and build up some proper barefoot running – and if so should I also run in more supportive shoes alongside this training? I’m really nervous about getting another stress fracture from running barefoot/in minimal shoes. But maybe this is unfounded as long as I take it slowly. Any advice would be much appreciated! Thanks very much. I run off-road and on-road and I currently have a pair of Nike frees, a pair of Merrell pace gloves and a pair of Adidas trail shoes that are fairly cushioned/supportive.
Kirstie
Hi Kirstie! Sorry to hear about your stress fracture! I did a very detailed post about my switch to minimalism 8 1/2 years ago: http://camilleherron.com/2011/06/08/how-i-became-a-minimalist-and-went-from-average-runner-to-elite-marathoner/
Sounds like you did too much/too soon. You probably need to be in a more supportive shoe until you heal up. It’s really up to you, longterm, if switching to minimalism is right for you. It definitely takes patience and consistency in your training. Go with what shoes feel the most comfortable to you.
Best wishes figuring out the right shoe and balance in your training!
Thanks! I’ll read your other post and will stick with the supportive trainers for a while until I figure out what to do long-term.
Hi, Camille! I really enjoyed reading your post. It was very helpful. I am a 20 year old who loves to run. However, it is never pain free. I played a lot of soccer in high school and developed stress fractures in both shins. After taking several months off from soccer and running, my fractures still did not heal (the surgeon told me it was from taking too much Advil). So, I had a rod inserted into my right shin. Now when I run, I am completely pain free in my right leg. But my left shin still hurts. I have custom-made orthotics that I wear in my shoes and I still experience pain. In the past couple of months, I have also developed a stress fracture in my foot and have pain in my hip. I only average about 12 mpw. That is not a lot and I don’t feel like I should be experiencing any pain. Any ideas as to why I can never run without fractures? I am not over-weight, I eat healthy and take vitamins. Several years ago, the Podiatrist told me I was “just not built for running.” I would like to think otherwise, though. Any ideas? Is it possible that I have low bone density? Do you think I should ditch my orthotics?
Hi, Camille!
I am a 20 year old who loves to run. However, I always end up with stress fractures. I played a lot of soccer in high school and developed fractures in both of my shins. When the fractures did not heal (the surgeon told me I took too much Advil), I had a rod inserted into my right shin. Now, when I run, I only have pain in my left shin. I have also developed a stress fracture in my foot and pain in my hip in the last month. I use orthotics that were made for my feet but I still have pain. I only average 12 mpw and don’t think I should be having any type of pain. I am not overweight, I eat healthy and I take vitamins. Is there any chance that I have low bone density? Do you think I should ditch my orthotics? I just want to be able to run without pain and I am tired of having to rest so much. Any help would be appreciated. Thank you!!
Hi Camille. What an informative post, thank you! I have a few questions and I would massively appreciate if you could give me your advice.
In the last 6 months I have gone from a slow once-a-year marathoner to competing in ultra’s. In the last couple of months i’ve had an ultra or stage race every other weekend. I tend to do my week day runs on the road and long runs on trail. I have two injuries which have reared their head.
1) i did an 8 mile tempo hill run on tarmac. After this my calf hurt a bit and i had a bit of a limp. I then did a 2 x30 mile day race on the weekend on trail. I ran on it once more and now I am limping when I walk and have pain radiating into my knee and down into my ankle. There is one spot to the left of my shin bone which is very sore to touch. It is not that painful really, I can walk on it ok but it hurts to hop on it. My physio thinks this is a small stress fracture on my tibia – does it sound like it to you?
2) Ive had an achy feeling at the base of my 4th and 5th toes in my other foot for about 6 weeks now. Nothing too painful. I did one more run after the 60 mile race and the night after seeing the physio about the above (he did do a bit of calf palpitation) I woke up with really painful throbbing in my foot and swelling and heat on the top of my foot from the base of the 4th and 5th toe and about 6cm towards my ankle. It is painful to walk on and even just sitting down it is throbbing. My physio thinks this is tendonitis but Im wondering whether this is also a stress fracture. Do you have any ideas of what this could be?
Im completely gutted as although I have 5 weeks off races now, I have a lot of races coming up in the summer. Any advice would be much appreciated.
Hi Camille!
I have been on your site commenting several times in the past few months. I have been back to running after a stress fracture in calcaneous ( have been running 3-6 miles about 5 days a week along with biking and swimming) i just had a follow up xray and now my family doc is telling me not to run and saying nothing else. I have been slowing it down at the onset of pain ..the pain seems to be in the area of the fracture but tends to hurt more after a run …but I tolerate it? My recent xray today said ” the vertically oriented sfx of post calcaneous is again noted w linear sclerosis that appears less dense than 4/2 (which to me sounds like it is better than last xray ..after adding running to my life again after 3mos off
no new fx identified. Accessory os trigonum is again noted (whatever that means ) . I can’t seem to get anyone ortho, or family doc to tell me where I go from here. I was excited about running again since I am trainng for 2 tri’s (july and augh) and and half marathon (not until fall..good thing) but now being told “don’t run”. any advise would be helpful. I pass the hop test, and I DID pass the palpatation but it seems to come and go now)
Lisa Hanks