Stress Fracture - Where Was the Warning?

if it was only yesterday how do you know it is a stress fracture?

Get enough calcium? Consume dairy products? Anything can happen. Especially when you run a lot.

You run a lot. There is your warning.

I'd like to know too. Why do some get gradually increasing pain, and others get out-of-nowhere fractures?

old guy... similar experience several times. Now I eat chalk to appease the gods. There is always pool running.

gotta go with j elway on this one. How do you know what the injury is?

I had a similar-sounding injury a month or so ago, although I wasn't training at anywhere near the same intensity. I was wrapping up a moderate/hard distance run on grass, backed it off to an easy pace with the intention of doing 3-4 more miles. Then all of the sudden my foot hurts like hell on the outside just below the ankle for no apparent reason (i.e. no ankle twist, no funny foot-fall or anything). Took a few days off, came back gradually over the following week, and it healed completely in the 2 weeks after that. I'm not sure what I strained, but after some poking and prodding, I was pretty confident it was a tissue injury (in addition to the fact that I've never had a stress fracture), so I ran on it.

Sunarm said it best. I don't know how many times I have heard coaches tell me "man, so-and-so is going to rock the world this year. He's FIT. He's done 12 straight weeks of 100 miles. He looks lean, he runs so much easier now than he ever has" The next week he is in a boot and everyone is going "WTF happenned"?

The rules of training apply to distance running as well. Running has an accumulative effect, both in a positive and a negative direction. The more you can do on a consistent basis the better you will progress. The problem is there has to be some cycling of some sort. You cant train your volume in a straight line for several consecutive weeks.

This is so hard for distance runners to grasp because if you miss one day you feel like you are getting out of shape. The constant positive reinforcement that you get from hammering everyday keeps you sane...until it hammers you back with a sudden injury.

The trick is to assume that what happened to you is going to happen. Now, what are you going to do to combat that. Take some down says, some down weeks, undulate your training. Otherwise you will twist the vice until something gives. In your case it was a bone in your foot.

pissed off wrote:

Malmo, I know you had a mighty similar experience.

Looking back, should anything have tipped you off?

Yes, I was running on a lot of soft surfaces at the time. I should have known better, right? Afterwards most of my running (95+ percent) was on hard surfaces and at higher weekly mileages. Never had a stress fracture again.

Correlation does not equal causation.

Injury goes with the territory. Every day you lace up the shoes you expose yourself to risk. Shit happens.

Im dealing with a similar situation. Was running my most mileage on singles and was running my best workouts of my life then I started to have some aching pain running by my left ankle on my tibula but not to serious where it was effecting my run then I did a 3 by 2mile workout and on the 2nd one the sharp pain just shot up in my foot. Now im dealing with recovering because I want to get back so badly. It had been 6 weeks on monday so I gave running a try did not feel to bad running 5 miles on the 1st day and then the 2nd day the pain came back. Now im looking at taking another 6 weeks off sucks and im kind of depressed about it. But oh well nothing you can do I guess.

Saw two separate stress fractures today (rather unusual), one in a runner and the other in an elderly lady. Two completely different scenarios, yet exactly the same result on x-ray. Just like you said, Shit happens.

The runner has upped her mileage lately and could seriously use some well-made orthotics, but is listening to her minimalist friends and plans on drinking a lot of milk in the future and wearing racing shoes.(One worthless and the other detrimental.) Education is wasted on this type but I try anyway. I'll see her again in the future with a similar problem so I'll get another shot.

The little old lady has severe osteoporosis and her bone just "cracked" on her way to the dining room at her nursing home. She will heal just as quickly as the runner, with the same treatment.

And the bone stimulator won't speed up the healing of the runner, but she will purchase it anyway, because her friend told her it will! P.T. Barnum never saw a runner he didn't like.

http://psutafalumnigolf.blogspot.com

The exact same thing happened to me! Except I was slowing down at the end of a hard stride and felt something pop. I eventually figured out that it was a tendon on the outside of my ankle. No warning, either.

See that's the thing though - I did alternate. That's why I said I listened to my body.

I definitely had some periods were I felt shitty and took a day or two. I also said I averaged 95, I didn't mean every week was 95. It was more like 80, 90, 105, 100, 70, 110, 95, 75 - that kind of thing. No real pattern, just went how I felt.

Upon full recollection, I realize that I really had no way of seeing this coming, so I'll just chalk it up under the "Shit Happens" category.

Although there is one weird thing - I did start running more on soft surfaces at the beginning of Sept.

I moved to a new town and there's a lot of grass running available here, so I thought I'd take advantage of it.

Who doesn't like running on grass?

The relation Malmo's implying seems counter-intuitive, but I was running some pretty substantial volume on 100% pavement through July and August.

So, run on pavement and fine, run on soft and watch out.

Anyone care to explain this one?

Maybe you're onto something, Malmo.

I'm pretty damn sure.

Localized to the 2nd met., 1/4 " above the joint, sore to touch spot.

Can't put weight on my metatarsal pad (have to limp around on my heel - good thing it's a small town with decent transit service or I'd be screwed.).

skwilli wrote:

The little old lady has severe osteoporosis and her bone just "cracked" on her way to the dining room at her nursing home. She will heal just as quickly as the runner, with the same treatment.

Wrong.

[Osteoblast cells] in the body decrease as a person enters old age, therefore bones don't regenerate as quickly as in someone younger.

Clinically, in four weeks she will feel fine and almost all swelling will be gone, and she will be in her regular shoe again. Technically, on x-ray she will take longer to show full bone healing, but runners usually only care about the clinical aspects and "when can I run again". I was specifically referring to clinical healing in this instance, not radiographic union (which will take months, bone constantly remodels so full healing is a meaningless term unless you can measure the tensile strength of the bone). I'll post again when both patients are "healed" and healed next month. "Osteoblasts and osteoclasts forever".

http://psutafalumnigolf.blogspot.com

I got a medial tibial stress fracture a few years back. In my case, it came at much lower mileage and was clearly prompted by a combination of running on hard surfaces, old wornout orthotics, and trying to get back in shape quickly at 45. It came after my first hard 15 miler on hard surfaces.

I'm OK now, but I made a lot of changes--including taking 1000 mg of calcium a day, every day.

I ice the place 20 minutes after every run.

It's very important that you go back through your training and figure out why this happened. You mentioned that you'd just come off a period of great training w/long miles. How does the mileage of this period compare with what you were doing 6 mos. and 1 year earlier?

As you know, bones & joints take longer to adapt than muscles. It's possible that this is what's going on here: that your muscles were in shape but you were flirting with too much too soon from a bone standpoint.

It sucks, doesn't it? Just give it the time it needs to heal completely. I took 8-10 weeks with NO running whatever.

I've run a hundred races, marathon to 5K, since then. You'll get past this. Learn to love a bike for the next little while.

I've had 2 stress fractures and both surface the morning after completely normal workouts - no warning.

Malmo, hello.

You've never given me any reason to question you over the past X months, but why the hard surfaces to reduce the risk of stress fracture?

Is this true, but kind of tongue in cheek?

If you check out Rupp, Salazar has him on grass, anti-g, water etc to limit the roads on his legs.

I've had 2 stress fractures, both at the end of winter (transition)... this March I plan some down-time!!!!!

'Foot'

That isn't what Malmo is saying. Training on soft surfaces and so on might help, but at then end of the day if you happen to exceed the bodies ability to adapt (which is impossible to know ahead of time) something is going break.Personally I think it is the whole I need 12 weeks at x mileage in a row that kills a lot of people. Doing 3 weeks a x and 1 week at 2/3 x would work a lot better. The extreme example are the I am going from 50 to 75 by adding 5 mpw every week for the next month people.

Foot wrote:

Malmo, hello.

You've never given me any reason to question you over the past X months, but why the hard surfaces to reduce the risk of stress fracture?

Is this true, but kind of tongue in cheek?

If you check out Rupp, Salazar has him on grass, anti-g, water etc to limit the roads on his legs.

I've had 2 stress fractures, both at the end of winter (transition)... this March I plan some down-time!!!!!

'Foot'