D1 Female Runner with Repeated Stress Reactions- Desperate

So there is no female triad syndrome (or RED-S as they call it now), and there is no bone density issue? What screening was done to determine this? Did they do a full body DXA or did they do hip and spine or what? Has she had a gait analysis done by someone good? Are you on the east coast? If you PM me on Twitter @runthe8 I have a couple of resources for you.

First thing I would tell her is to eat. Starving oneself(not saying she has a eating disorder, but if doing a lot of exercise it is easy to under eat), especially if the diet is low in quality protein, it is just asking for stress fractures if you're a runner.

I have NEVER heard of a female who was having issues with stress fractures that weren't related to eating/nutrition. All other tests are good meaning no abnormal blood values/thyroid issues etc?

Did you examine other biomechal factors that can cause stress fractures? Along with the increased mileage, is the runner running on different surfaces than she did in high school? Some peoples' biomechanics make so that they tend to get injured running on uneven surfaces, while others get injured while running on harder surfaces. Did the runner change shoes since high school and what is her pronation pattern?

Also even though you said there is no female athlete triad, has she done a diatary analysis to make sure she is getting enough nutrients and calories to match the level of activity she is doing? Many female runners do not realize they are not eating enough to match their caloric expenditure.

She isn't doing enough strength training. There are probably several muscle imbalances that have gone unaddressed. Hips, glutes, hamstrings, adductors, abductors. Her knees probably come in too much (due to imbalances) and cause a lot of additional torque because women have wider hips then men and the femur bone is never perpendicular to the ground, it's always at an angle. Also weight training will increase bone density.

Another common issue is treadmill running. Most doctors/trainers are dumb and will have runners only run on the treadmill as they return back to injury, but the treadmill doesn't prepare them for the impact they'll face running on harder surfaces. Stress/impact from the ground is important as it strengthens the bones to the point where they are healthy (treadmill running does not strengthen). There people running 150 miles per week with no injuries because they've built their strength up gradually and now their bones are almost indestructible.

If she had a halfway competent coach, her coach should be able to fix all of it. Might be time to transfer.

Deficient wrote:

I have NEVER heard of a female who was having issues with stress fractures that weren't related to eating/nutrition. All other tests are good meaning no abnormal blood values/thyroid issues etc?

Totally agree.... The reason the doctors don't want to speculate is probably because it is rooted in an eating issue, that orthopedic doctors will likely not want to get into. Even people with the worst running form don't get stress fractures if they are eating properly. I know many people with bad running form above 100mpw....no stress fractures...other injuries maybe.. but the density of her bones should be increasing to compensate for the stress of training, but the only way they can is with proper nutrition. Her bone density (if it was tested) might fall within normal limits, but be below what is needed to maintain the level of training she is at....(which requires more than just average bone density, say a sedentary person requires).

D1dad - Our daughter is going through the same thing you describe your daughter went through except in high school. She’s having stress injuries in her femurs without finding an underlying cause. We’re struggling to find answers and someone to help us get her back to running. Did you find any good resources, doctors, or PTs that were able to help? I hope your daughter is doing well and was able to get back to her D1 running career.

See above comments. It's most likely a RED-S issue. The average person, even a doctor, can easily underestimate how many calories growing female runners need.

there are sports centers that analyze gait but you might need to go out of state depending on where you are. I believe CO has one, a lot of pro athletes there. Maybe look at the docs that the pros use. Is she taking enough time off to heal between fractures? Has she tried cross training?

Food, nutrition, this is the answer.

In my experience as a coach nutrition and recovery are the factor. A great Dr that we worked with said the higher off the ground the stress fracture the more food related it is. The lower the more training causes. So foot and shin, could be shoes training surface, training in general.

Femur, sacrum, hip and back. Under recovering and the bones are weak do to the body no being able to replenish them.

Rarely are these over training injuries, they are under recovering. Sleep and lifestyle play a role but usually it’s food

Thanks for the suggestions! She took six months off running after the initial fracture. She played a short tennis season four months after the injury after being cleared by PT. She started weight training after her Tennis season ended then started easing back into running when her leg started hurting again. How do I find the docs that the pros use?

Lean steak and two hard boiled eggs for breakfast every day

Like many on this thread, this is likely a nutrition issue. Just because your daughter said she is eating enough doesn't mean she is. People don't get 3 stress injuries in 2 years very often, and anyone I know who has dealt with this was borderline eating disorder status.

Hi. Sharing my experience in case anything rings a bell. I was an OTQ 70 mi/week runner after college for 7 years. Definite eating RED-S issues, but only one femoral stress fracture. For me the injury happened when I was running a route that involved lots of cement sidewalks (instead of my usual aphsalt) AND I was using a pair of shoes that felt good but were far less cushioned that the most cushioned shoe out there that I usually wore. After it healed I went back to the cushioned shoes and avoided sidewalks, and never had another stress fracture or similar pain. This is not meant to support undereating. You may want her to check in with a sports nutrition RD to see about her eating, if even inadvertently it's contributing. Good luck.

Stop all dairy it's acidic and the body leeches phosphorus from the bones to neutralize the acidity, also stop drinking any drinks containing carbonic acid for the same reasons.

Tennis does not seem like the best choice since that has impact and those players get stress reactions too. Maybe she has not taken enough time to fully heal if she keeps reinjuring the same area. There is always a rush to get back to it, but some fractures take a very long time.

Orthopedic surgeons that specialize in sports medicine may have clinics that do biomechnical analysis. If she is running D1, can her school help you find something? Some universities will as well. For example, clinics like the Steadman Clinic or Steadman Hawkins in CO treat athletes and runners.

ummmm..... you got some sources for this?

I was injured my entire college career until my final year. Good bone density, still had a period, no one could figure it out. It was what seemed to be bad luck.

The only thing that changed my final year was date another athlete which forced me to eat/make more food since he as also needing to perform at a high level. Ever since then I have yet to get hurt (knock on wood). And I’ve done more mileage and more intensity throughout the years.

I didn’t know I wasn’t eating enough. I thought I was just eating healthy and right. But when eating “healthy” you really aren’t getting calories or key-nutrients. It’s also hard to get enough calories while eating “healthy” when food is as expensive as it is. And this might not even be the issue. But a competitive female runner should be getting 3000-calories minimum.