Is the under eating a common cause for a stress fracture in that area?
Yes, even more so than for other types of stress fractures. The bones of the upper leg are much stronger, more dense as compared to the bones of the lower leg. So if you are getting fractures of the sacrum, it's much more of a red flag than a stress fracture in the foot or tibia. When you are consuming insufficient calories/nutrients, the body's ability to recover becomes comprised. This in turn negatively impacts the body's endocrine function, which in turn reduce bone mass and density, thereby making stress fractures of the sacrum much more likely.
All of this. Also another reason they've been seen as "on the rise" is that docs used to not image that area to rule out bone issues. I imagine many "SI joint issues" were actually sacral stress fractures but it was before sports docs knew to consider that as an issue and order an MRI.
Please note that most Kenyan elites are almost vegetarian or vegan in their approach to nutrition, at least that is what I gathered from looking at what they eat during the past five weeks.
Most of the Kenyan runners who run around 60 to 62 minutes for the half marathon told me that they usually only eat meat once or twice a month. Some of them eat meat once a week and the favorite is typically goat meat.
Interesting. Watching the NN Mission YouTube videos on the Kaptagat runners seemed like they regularly eat meat dishes at the Global Sports Camp. Is their meat avoidance for performance reasons or other reasons like affordability or cultural or what?
I will try to answer your question with regard to the minimal meat that I saw being consumed by the runners that I encountered who ranged from 59 minute half marathon runners to 208 marathon runners.
1. Most of these guys have limited income so obviously the price of meat is quite high in Kenya and is considered a luxury so it’s not consumed regularly.
2. Kenyan runners also told me that meat will slow them down because the digestive process for absorbing meat is so much slower compared with basic carbohydrates and vegetables.
3. I think Kenyan runners also know that meat from an intuitive point of view is not good for people health wise.
4. Basically all or most of the K. runners that I have met come from modest backgrounds and sometimes and often quite impoverished backgrounds with meat eating not usual. I spoke with a lot of farmers especially in the Iten Elgeyo Marakwet region, and eating meat and even eggs is considered a luxury and they basically eat Ugali, green vegetables, white bread and their “go to” are the sweet cups of tea with milk and sugar. Fruit is also a luxury. Eggs are consumed rarely, perhaps once a week. I was really astonished at the apparent lack of protein in their diets but they claimed that they get protein from beans which they eat regularly. I think the name for that dish is “kideri” or something similar, at least that is what it sounds like. These people including the farmers and the runners also told me that they get protein from the spinach dish that they eat, “sukuma wiki.”
Yes, even more so than for other types of stress fractures. The bones of the upper leg are much stronger, more dense as compared to the bones of the lower leg. So if you are getting fractures of the sacrum, it's much more of a red flag than a stress fracture in the foot or tibia. When you are consuming insufficient calories/nutrients, the body's ability to recover becomes comprised. This in turn negatively impacts the body's endocrine function, which in turn reduce bone mass and density, thereby making stress fractures of the sacrum much more likely.
All of this. Also another reason they've been seen as "on the rise" is that docs used to not image that area to rule out bone issues. I imagine many "SI joint issues" were actually sacral stress fractures but it was before sports docs knew to consider that as an issue and order an MRI.
These are all good points. I had a sacral stress fracture about 15 years ago, and it was initially misdiagnosed by a series of sports docs. Eventually, because I knew some other elite runners who'd had sacral stress fractures, I insisted on a bone scan, and sure enough there was a sacral fracture. The sports doc was completely surprised, didn't even know it was a thing.
The best part of the misdiagnosis is that they initially thought it was a soft tissue problem, so sent me to a massage therapist who tried to "loosen it up" by digging his elbow into my lower back with his full body weight. Took me 30 minutes to walk a block back to my car afterwards because I was in so much pain.
Presumably there's greater awareness now, which might fuel the apparent rise in diagnoses.