Bringing back an athlete from 2 stress fractures

I'm a guy so um not sure its any different, but the winter break before my sophomore year track season I had a stress fracture in my foot and was out for 6 weeks with a boot. It wasn't from running too many miles, but from running miles to fast and not getting breaks. I would tell her to maybe try slowing down her easy runs by a considerable margin. I got a road bike and cross trained through it which ended up helping me a bunch and kept me in shape. I used to do 30-50 miles on the bike every day and it kept me in very reasonable shape when I came back to running. Within a few weeks, I ran a PR of 10 seconds in the 1600 and then slowly kept quickening my time until I ended up running 4:22. In essence, slow her down and build miles slowly. Get her to do long bike rides during injury.

I agree with the slowing down the easy run part. I honestly don't think the girls were doing them too fast during cross though. They were usually slower than 8 min/mile on easy runs....more like 8:15-8:20.

I honestly think that there is some sort of correction that can be made with her gait, but I haven't figured it out. When she gets tired, she really stomps the ground. The day she told me about her leg at the end of cross, I rode my bike alongside the girls during the run and the last mile, her footsteps were FAR louder than those of her teammates. She lives in the country and has a gravel driveway. I told her to walk around on it barefoot to make her more cognizant of footstrike and not stomping down when she lands.

Here is a bit of a more detailed look at what she is doing right now.

M (Speed): Warm Up, drills, 5 x 35m up stadium ramp. Weight Room Heavy, multi joint, ground based (Squats, Clean, Dead Lift, Etc....)

Tue (Recovery, Aerobic) 1 mile on grass, 30 min on elliptical

Wed (Aerobic Power) 3.2 mile progression run. 1.6 easy, 1.6 tempo effort. Weights (lighter, more upper body included)

Thu: Same as Tue

Fri: 4 miles Fartlek, Weights. Weights as on Wed.

Sat: 3 easy on soft surfaces

Sun: Off

You know more than me, but if you think it's her form when she gets tired, get her to run on grass and soft ground as much as possible. Concrete sucks to run on my knees always hurt after any sort of miles on concrete. Maybe it could be her shoes. maybe a minimalist shoe might help correct her stomping and begin to land on the ball of her foot more. Or she could go the way opposite direction and get a some Hokas. How many miles are on her shoes? Is running in the grass or concrete mostly?

Most of our runs are on the levee alongside an irrigation canal. I'd say we do 60% of our total volume on dirt.

Maybe Hokas might not be a bad idea. I don't think a minimalist shoe would solve the problem. She stomps pretty bad in racing shoes as well as training shoes. I actually helped her pick out a pair of DS racers for next cross country season and potentially for fast stuff on the track during this spring.

In that case, maybe try the Hokas, but make sure she doesn't begin to heel-strike too much. Try to add 4-8 strides barefoot on grass after every run to counteract that.

Maybe give her an extra day off, she could just do core work that day or literally walk.

CoachB wrote:

She stomps pretty bad in racing shoes as well as training shoes

This was my first thought when I read the OP. I used to have terrible pains in my shins and lower legs in general back in the days because of this. I eventually worked for a few months and started learning how to run more silently and it made a huge difference. I went from 30 mpw then to 50 mpw in 2 months without any kind of pain. The impact really adds up.

Is she getting enough calcium? Enough calories?

Does she also happen to overstride?

CoachB wrote:

What am I missing?

Nutrition.

As a former female teen runner and teammate of teen runners, I can tell you that most do not get enough calories, even the ones without eating disorders. At that age, most don't realize they need more calories because they're active and growing/going through puberty. You can run on all the soft surfaces you want, but the main cause of stress fractures is weak bones.

AdrianCh wrote:

Does she also happen to overstride?

I have some pictures of her in races where her foot has not contacted the ground yet and is way in front of her COG. So, when I took slow mo video of her running at different speeds, I expected to be able to show her exactly how much she was over striding. However, in the video, not much overstriding showed up. As a matter of fact, as I had her run faster, she ended up with a footstrike almost directly below COG.

That being said, I recorded her form when she was fresh. I think that when she is fatigued is when stuff breaks down and that is where the damage is done.

txRUNNERgirl wrote:

CoachB wrote:

What am I missing?

Nutrition.

As a former female teen runner and teammate of teen runners, I can tell you that most do not get enough calories, even the ones without eating disorders. At that age, most don't realize they need more calories because they're active and growing/going through puberty. You can run on all the soft surfaces you want, but the main cause of stress fractures is weak bones.

This is a good point. I think my top girls have pretty good nutrition, but I don't really know. I will emphasize this more during the spring.

Disclaimer: not a coach or PT

I second the nutrition comment. I'd also add sleep, and stress (tough classes, family/dating drama etc) as being possible points of concern, since you seem cautious and proactive about training.

I'd recommend prunes and green leafy vegetables in addition to the normal bone healthy foods. I like treadmill walking with it set to as steep as it'll go for the transition back to running.

Putting some focus on strength in the pre season could also be helpful: weights, body weight exercises, hill sprints etc

Maybe, just maybe, you should advise her to take a season or two off? You know, encourage physical wellbeing and a balanced mindset?

Bubbadeeboos wrote:

I second the nutrition comment. I'd also add sleep, and stress (tough classes, family/dating drama etc) as being possible points of concern,

I was just going back over my team's mileage spreadsheet which runs from June 1 to the end of November (well I never uploaded the november mileage, but I have it in a filing cabinet).

About 3 weeks into the school year, lots of very low mileage weeks show up all over the place, up and down the roster (kids missing days due to injury). I'm sure the lack of sleep/rest that comes with the resumption of school is responsible because I purposely back our training off during the first 2-4 weeks of school as we transition to running in the heat of the afternoon.

Please listen to those who are suggesting nutrition and calories as a cause for her stress fractures. You sound like a coach how genuinely cares. Some coaches would just ignore the harder problem to solve. Most HS girls are not eating enough calories out of fear of slowing down due to weight gain. I ended up with a few sfx my senior year of HS. I thought I was eating enough and as it turns out, I wasn't. Not for the load I was running. I was well over 45-50 mpw. 30-35 mpw shouldn't cause the constant stress reaction. Her go rm could be a piece of the puzzle, but more than likely, more calories, more calcium and vitamin D will fix the problem. See if you can find out if she's still menstruating. If she's lost her period for more than 3 months, that's a huge red flag. I lost mine and ended up with the sfx. We didn't know then what we know now. I've heard these same stories with my daughter's XC team (and other local teams). People need to think about long term health over a few successful XC/track seasons. Running should be for life.

As for me, once I upped my caloric intake for mileage, I never got another sfx again, even with higher mileage.

She has not lost her period (I realize that might be kind of creepy that I know that). I know this because I got her in to see my friend who is a well respected sports medicine doctor prior to the state meet to help make a determination whether or not she should run (at this point, stress reaction had not been diagnosed).

She may be a little calorie deficient (or maybe not), but there is not female athlete triad going on. Either way, I will certainly continue to address the nutrition aspect with her and all the girls

Please don't think about periods as being "creepy." It's a normal bodily function for ~50% of the population and an indicator of health.

Knowing about your female athletes' periods is NOT creepy. It's actually the responsible thing to ask about. I'm glad she hasn't lost hers, that you do know she's still menstruating regularly. Perhaps the triad isn't an issue here. I hope she is able to get back into running without more incident. A slow, gradual return with some work on form (if she is indeed pounding) is sound advice. Core work is usually a huge help in lightening her foot strike. I still would pursue a quick check of her vitamin D levels just to be safe.

Good luck!