Bringing back an athlete from 2 stress fractures

Focusing on your nutrition is so extremely important- I trained really hard in the winter before my sophomore year of track (heavy lifting, lots of faster than necessary "easy" runs) and did not eat much because I thought it would make me lighter and faster (was heading down the path of an ED- lost my period, too). After about 4 months of lots of training and little food, I got a stress fracture in my left fibula and was out for all of outdoor season. All of the hard training went out the window, and that was when I really realized how close I was to a full blown eating disorder. Remind all of your athletes (not just her) to eat an adequate amount of calories and SLEEP because your body is not able to recover properly without enough calories/rest and that is when the cycle of injuries begins. To prevent sfxs in the future, also try using resistance bands to strenghten the connective tissue in her legs (can also prevent shin splints, etc.). Good luck, I know how badly stress fractures suck :(

Coach I am extremely concerned. As a Sports Medicine physician who deals in FATS (Female Athlete Triad) cases my practice is loaded with adolescent women with repetitive strain based injuries.

You are not qualified to be creating a rehabilitation and recovery program for athletes you are merely a coach not a medical professional. The fact that you are asking for advice on a running forum is troublesome.

I will not give specific medical advice because you have not provided enough information to provide possible causes and solutions.

If you are a club coach or worse a school based coach you must immediately contact this girl's parents suggest that she see her orthopedic specialist. This girl should only be allowed to return to your training group once she has received medical clearance from her treating physician.

Coach you are opening yourself and your school/club to a lawsuit because you are providing "expert" advice outside of your knowledge base. The Ortho should only be allowing an athlete to resume any form of training once the fracture is completely healed. This can be 2-4 months of no running then a gradual return to running should take 8-12 weeks and only then can an athlete return to training with the team.

The fact you admit that you allowed her to run in the championship race with pain is frightening. Were her parents aware of this pain? Since you were aware and did not tell them or prevent the girl from running given her recent medical condition you and your school/club are negligent.

If you think I am over reacting almost every state has cases where high school coaches pushed athletes back too soon and caused further injury. In circumstances where the athlete had potential for a college or pro career the awards have been in excess of $1,000,000

Coach you need to step back and admit to yourself and your school that you are not qualified to be dealing with this situation.

Doc

Her parents and I sat with a sports medicine doctor for over a half an hour. He's the one who gave her the clearance to run at state, not me. I was pretty skeptical of her running, as were her parents. The doctor's advice was:

"There is no fracture right now, although the bone is stressed. Running one race on a fibular stress fracture, even if there were a crack visible on an x-ray would not cause the bone to break. If it was the Tibia, you'd be in a boot right now, but the fibula only bears a small percentage of your weight and it won't break. This is the last race of the season and you get weeks of rest. It's up to you".

On returning to running, his advice was:

"Let your pain be your guide. When it no longer hurts you can gradually ease back into running. It will probably be about 4 weeks based on the location and nature of the injury."

She was actually pain free after less than 3 weeks. I attribute this to the fact that from the time she first experienced pain to the time of the state meet was 2 weeks and during that time, she did not run a step. So the healing process had already started. Even after she was pain free, I did not let her start running again for another week, just to be safe. That was over 3 weeks ago now and she is still pain free.

I came here to ask for advice from people who have had similar situations. Not to formulate a rehab protocol. I've already had advice from a doctor who has actually looked at her x-rays and examined her thoroughly

Any other information you have not shared?

What coach goes to a doctor appointment with parents?

Clearly very bad advice from this doctor and very wrong advice! One race can cause the bone to break again.

She needs a new doctor. Would you agree?

The fact that you have not mentioned that the Doctor didn't do a complete bloodwork up and refer her to a nutritionist leads me to believe that was not done either. Or was it?

Stress fractures in adolescents are extremely serious much more so than in adults and must be completely healed before any return to running. A 4 week rehab program is too short.

If you suffer a stress fracture you are either exercising too much on too hard a surface or you have a nuitional deficiency. If you merely let the fracture heal and return to the previous activity you will suffer another stress fracture. Its a fact.

This girl needs a complete blood work done also needs national advice. I suspect she has not had her period or if so just started. Calcium and D3 should be taken plus a multi-vitamin. Did she have a recent growth spurt? If so stress fractures are a possibility.

She needs to reduce her workout intensity and running where she is is still too hard. Grass and mulch trails are better.

This young lady is an example of why coaching teens is so difficult especially middle distance female runners. A top level middle distance runner will always get injured because these girls push themselves too hard to achieve the results they want. As a coach you must reduce the loads and frequency of the workouts. A stress fracture ends a season there is no return so you must prevent them at all costs even if it means reducing workouts more than you think is necessary.

Last point...teenagers must NEVER run with pain! Your protocol must be if you feel pain you must stop immediately and only return to training when you are pain free. You are not qualified to diagnose the cause your advice should be the the RICE principle that is it. If after 48 hours they are still in pain they see a doctor and only return to training with a doctor note in hand.

Any coach that believes otherwise should not be coaching

Some good insights here including continued stress of all runs hard, style of gait (particularly when tired), and caloric intake.

Another thing I would look at is when she eats. I suffered three stress fractures in a ~ 3 year span and finally in addition to asking about vitamin D and calcium and overall calories a doctor asked how soon j ate after running. Restoring the system within the first 30 minutes after a run is what he suggested.

I have been injured since, but nothing on the stress fracture or reaction compendium. It could be worth adding to her plan.

Doc

I went to the doctors appointment because the doctor is a personal friend of mine. He works for a well respected medical clinic here in town that specializes in sports medicine. Before working here, he was on the medical staff of a large division one university's athletic department (probably one of the 10 biggest sports schools in the country). Their clinic is very well known locally and is not taking new patients. I was able to arrange an appointment with my friend, after the advice from the girl's primary care (HMO, she got to spend 3 minutes with the doc) was, "You can run but I advise against it". Knowing the girl would choose to run if given the opportunity, I strongly wanted a second opinion.

I attended the appointment, because I had already looked at the x-rays. I teach anatomy and physiology, so I knew I would be able to accurately describe to the doctor, in a way the girls parents probably couldn't, exactly what was already known about the injury. Plus, her parents thought it would be a good idea if I was at the appointment.

As far as blood work, that is something I had not considered but will recommend it to the girl and her parents.

As far as me being qualified to design a protocol for rehab, that is debatable. I've been doing this for over 20 years and do hold an MS in exercise physiology. Based on my experience, and what I have observed in this particular girl, my hunch is that there are underlying biomechanical issues rather than Triad related issues (she is conscientious to have a snack ready to eat directly after practice, for instance. She mensturates regularly. She takes part in an on campus "leadership academy" that promotes healthy lifestyle/nutrition/sleep/digital heatlh. She is pretty educated and savvy about nutrition and follow the power back diet pretty strictly

Here is a copy of said diet. All of our kids get this. A fair number have said they follow it

http://www.warriorathletics.com/custompages/forms/Staff_Forms/Manuals/Power%20Back%20Diet.pdf

Of course, I cannot truly know if they follow it or not. I don't go cook dinner for them, but I do see what they bring for lunch and post workout snacks. When we have morning workouts, they eat breakfast in my room, so I see what they eat then too.

Your story just gets a little more bizarre with every post!!!

Have you ever heard of patient/doctor privilege? You should not have attended that appointment,

a Sports Medicine clinic that does not accept new patients? I call BULL SHIT!!

If he is a personal friend you are not objective in your opinion because I will agree that this doctor made some horrible decisions.

He didn't think of blood work up, nutrionist either? That's very odd?

what makes it even more hilarious is now you claim you are an exercixe physiologist YET you are asking for advice on Lets Run.

I will say it right now.....TROLL POST.

TIME WASTER

Not a troll post. Parents wanted me at the appointment. Perhaps my opinion of my friend is not objective.

You guys going on about bloodwork and what not..... I get that it might be a good idea, but the girl does not have disordered eating and other than the fractures, is not showing any of the other Triad type signs.

Believe it or not, even those of us who know a lot of stuff can still learn something on a site like this. I'm not trying to be defensive and I really do read all of the serious posts seriously.

Hey coach, I know this is 5 years later, but I am wondering how it is going and what ended up happening