Tibial Stress Fracture NOT Healing…What Gives?

You're probably correct about both of your guesses. Are you able to swim for cross training rather than elliptical? A little less impact on the injury. Also sheesh with multiple previous tibial stress fractures it sounds like you should seriously bulk up your nutrition and probably examine your running form.

You said you didn’t think it’s healed at all, then said it no longer hurts to walk.

It’s healing

It takes time

My tibial SF took about 9-10 weeks before I felt it was ‘healed’ and then it continued to have night pains / throbbing for a while after that. Those moments of throbbing were worrying but with time they went completely.

Be patient and stay calm. It will heal, it’s already showing signs of healing.

It does sound like you healed crazy fast previously which is making this even more frustrating than it already is.

But my experience is that even 7 weeks is a bit optimistic.

* Baseball pitchers sometimes suffer throwing arm stress fracture. They do not throw form a couple of months.

* Do you believe elliptical training would encourage bone healing?

* Also take vitamin K2 (talk about K2 with medical doctor and pharmacist).

appleapple wrote:

sheesh with multiple previous tibial stress fractures it sounds like you should probably examine your running form.

+1

3D laser gait analysis. Do it.

patience is key wrote:

My tibial SF took about 9-10 weeks before I felt it was ‘healed’ and then it continued to have night pains / throbbing for a while after that. Those moments of throbbing were worrying but with time they went completely.

Be patient and stay calm. It will heal, it’s already showing signs of healing.

It does sound like you healed crazy fast previously which is making this even more frustrating than it already is.

But my experience is that even 7 weeks is a bit optimistic.

This is great advice, thank you! Did you also have a healing experience where it hurt and hurt until one day it just…didn’t?

There is a bone healing ultrasound thing you can use at home to heal it faster, try to get prescribed one of those if you can.

I get stress fractures and reactions all the time. yes I know it sucks don't @ me but I run a lot... anyways I once got one in the shin just below the knee as you are describing and it took MUCH longer to heal than many of the ones in the middle/ lower parts of my shins. also have had them in the sacrum so lmk if you get one of those and we can talk. I find that some minimal level of reduced bodyweight stimulus ie elliptical or better yet alter G or LEVER running device (pulley system) which attaches to any treadmill to speed up the healing process. start back by testing it out on grass. if it still hurts then go back to the cross training for another week and then try again. now that you are at the 7 week mark you should be able to begin thinking about this sort of testing. also maybe try to do the hop test to determine if you are feeling just phantom pains or if the fracture site isn't quite ready. the healing time will of course be longer if it took you a while to get off of running on the injury in the first place, which would have allowed the fracture to increase in severity. good luck.

BrokenLeggy wrote:

patience is key wrote:

My tibial SF took about 9-10 weeks before I felt it was ‘healed’ and then it continued to have night pains / throbbing for a while after that. Those moments of throbbing were worrying but with time they went completely.

Be patient and stay calm. It will heal, it’s already showing signs of healing.

It does sound like you healed crazy fast previously which is making this even more frustrating than it already is.

But my experience is that even 7 weeks is a bit optimistic.

This is great advice, thank you! Did you also have a healing experience where it hurt and hurt until one day it just…didn’t?

Pretty much, yea.

I could tell it was improving (albeit slowly) as it was less tender to touch the area (although I was trying not to constantly test it). But I continued to have soreness at rest and night pains even though the pain on palpating was gradually reducing.

Then I managed to go a night without ‘feeling it’

Got excited. But then it was back the next night

And over time, I felt it less frequently…

Eventually it seemed to have gone!

Then for ages I would feel it occasionally but thankfully it was brief and isolated.

I got a pretty good report at the follow-up the other day, even though I had been prepared for the worst.

Although it still hurts, the leg is apparently healing per the X-rays. The ortho didn't think it was at all unusual that me leg was still hurting after 7 weeks; he said that these things can take up to 12. With pain being my guide, I miiiiiight be able to run over the Christmas holiday.

The doc was helpful in explaining the mechanism as to why this all happened. I was under-fueling by hundreds of calories per day — I was eating less than 2500 calories per day at 90+ mpw. This left my body in the hole, jacked up my cortisol, tanked my testosterone, and crashed my metabolism. In turn, this was compounded by running too fast every day, which put unnecessary stress on the body itself.

Low T -> low bone density -> bone and tissues not recovering -> boom, one day the tibia said “aight, Imma head out.”

Planning to keep those easy days easy and fuel up well once I’m back at it!

BrokenLeggy wrote:

The doc was helpful in explaining the mechanism as to why this all happened. I was under-fueling by hundreds of calories per day — I was eating less than 2500 calories per day at 90+ mpw.

I’m curious if you were maintaining weight or losing weight. If you were on a caloric deficit, you should’ve been losing weight, were you? The intent of my question is whether maintaining weight is reliable enough evidence of not under-fueling.

fueling wrote:

BrokenLeggy wrote:

The doc was helpful in explaining the mechanism as to why this all happened. I was under-fueling by hundreds of calories per day — I was eating less than 2500 calories per day at 90+ mpw.

I’m curious if you were maintaining weight or losing weight. If you were on a caloric deficit, you should’ve been losing weight, were you? The intent of my question is whether maintaining weight is reliable enough evidence of not under-fueling.

Actually, I was maintaining weight and finding it easy to gain. I talked to my doc about this, and he looped in a well-regarded sports dietician. So, this isn’t some family MD talking out of their arse.

Anyway, the expert said that when an endurance athlete heavily undereats while training at a high-level, the resulting stress hormone imbalance causes the resting metabolism to crash, in turn signaling the body to hold onto every calorie and bit of fat that it can.

She diagnosed me with Relative Energy Deficiency in Sport, better known as RED-S; it’s more readily seen in female runners in the form of a lost period, but occurs in guys as well. In males, RED-S often shows up via low testosterone and low bone density / stress fractures.

As I’ve been injured and crosstraining, I’ve been eating far closer to my daily expenditure and have actually leaned out. Even beyond that, I’ve been sleeping and recovering better on more food.

I hope that helps!

BrokenLeggy wrote:

Anyway, the expert said that when an endurance athlete heavily undereats while training at a high-level, the resulting stress hormone imbalance causes the resting metabolism to crash, in turn signaling the body to hold onto every calorie and bit of fat that it can.

She diagnosed me with Relative Energy Deficiency in Sport, better known as RED-S; it’s more readily seen in female runners in the form of a lost period, but occurs in guys as well. In males, RED-S often shows up via low testosterone and low bone density / stress fractures.

As I’ve been injured and crosstraining, I’ve been eating far closer to my daily expenditure and have actually leaned out. Even beyond that, I’ve been sleeping and recovering better on more food.

I hope that helps!

Thanks, that helps, and a follow up. Given that you were not maintaining weight, did you not have any overt signs like fatigue because of reduced BMR? Was the stress fracture the only symptom?

I’m asking because I’m considering the possibility of RED-S for myself being naturally skinny at 18.5 BMI and seemingly prone to stress fractures, but on the other hand, I’ve gained a few pounds — seemingly leg muscle weight, which is all great — since I started running (only up to 30 mpw) and have felt no signs of abnormal fatigue or anything abnormal. I don’t trust my calorie math to be certain that I’m under fueling, but always have eaten when hungry till I felt full, and never had a reason to think that there was anything wrong with my hunger signals.

Back in mid-to-late August and early September, I was feeling like Superman; I was crushing workouts like 13+ miles at marathon pace and 10 x 1K @ 3:07, and I felt so solid that I rarely ran slower than 6:35 pace, even on "easy" days. I felt like my fitness was rocketing up to where I needed it to run sub-2:30. However, I was running 90-100 mpw at 2,500 calories….I was burning the candle at both ends.

Then the shoe dropped: toward the end of September, I felt like I had gotten hit by a truck. Everything started to feel hard; my perception of easy pace slowed by over 20 seconds per mile, I struggle to run workout paces that I was hitting with ease mere months ago, and I started dealing with a constant series of niggles and aches and pains that won't seem to go away, which culminated in the fracture.

As long as I’ve run high mileage on likely underfueling, I’ve had random fatigue that comes and goes; it’s rarely super “in your face.” I will also note that, like you, I’d almost never be hungry and would eat to fullness, even though it wasn’t enough.

Even though I got a decent report from the ortho last week, the fact that I’m almost at 9 weeks and still feeling pain leads me to believe that I’m still putting too much pressure on the tibia.

I’ve been doing 70-95 minutes of elliptical per day throughout the injury, but I’m going to cut that out in favor of stationary biking. The elliptical is an awesome workout and is keeping me in good shape, but I think I’m putting juuuust enough pressure on the bone to delay healing.

BrokenLeggy wrote:

Even though I got a decent report from the ortho last week, the fact that I’m almost at 9 weeks and still feeling pain leads me to believe that I’m still putting too much pressure on the tibia.

I’ve been doing 70-95 minutes of elliptical per day throughout the injury, but I’m going to cut that out in favor of stationary biking. The elliptical is an awesome workout and is keeping me in good shape, but I think I’m putting juuuust enough pressure on the bone to delay healing.

My sports doc had told me that even the elliptical is too much for the first 6-8 weeks. I got an indoor trainer and an indoor rower to cross train. And also started deep water aqua jogging that feels very much like running (except for impact), and studies seem to show that it tends to preserve 80-90% of pre-injury fitness.

Oh man, in that case, I hope I haven’t completely wasted this time off by using the elliptical since about the second week….

I’d take all recovery and fitness numbers with a grain of salt. For healing, I learned the hard way that I need to be more conservative than average, so I decided to at least stick strictly to the doc’s advice. He’s a marathoner himself and said he didn’t do elliptical or even underwater treadmill for almost two months when he had a stress fracture.

For fitness, you’ve likely maintained your activity-agnostic aerobic fitness. For running-specific fitness, there are two scientific studies referred to in the aqua jogging article below, for whatever they are worth. On the plus side, most fitness decline plateaus after a few weeks and decreases very slowly after that, and once pain free, you should be able to regain it quickly.

https://runnersconnect.net/coach-corner/aqua-jogging-for-runners/

Passed 9 weeks since my last run this past weekend. Still no noticeable improvement in the past couple week.

My doc recommended that I start supplementing with high-dose Vitamin D and a bone-building supplement called Bone Up.

BrokenLeggy wrote:

Passed 9 weeks since my last run this past weekend. Still no noticeable improvement in the past couple week.

My doc recommended that I start supplementing with high-dose Vitamin D and a bone-building supplement called Bone Up.

Did you ever discuss vitamin K2 with your medical doctor & pharmacist as I recommended? K2 most likely is not going to be in a multivitamin & supplement. K2 is different from vitamin K.