Running Stress Fractures

Stress fractures typically cause localized pain that you can put your finger on and know exactly where it hurts.

As a high school runner, I was consistently averaging 50 – 60 miles a week, but as I began my first collegiate running season, my average weekly mileage quickly increased to nearly 90 miles a week.

Halfway through the season, I began to feel a general shin splint pain. This pain became more focal in the middle of the shin as the weeks progressed. I could pinpoint the pain, but I continued to run. The day after the conference championships, my foot was put into a boot and I wasn’t allowed to run for eight weeks.

Stress fractures are common injuries for runners. The repetitive motion of running causes the bone cells to begin to break down. This repetitive stress leads to tiny cracks in the surface of the bone that cause inflammation and pain. The bone will continue to break down until the repetitive motion is stopped, and the bone is allowed time to heal.

Common stress fractures in runners:

• Tibia (shin bone) stress fracture – often starts as shin splint pain but with continued running can develop into a stress fracture.
• Metatarsal stress fractures – occur in the middle of the foot. Metatarsal stress fractures can cause pain even from simple activities like walking.

Stress fracture symptoms:

• Sharp aching pain in or near the bone.
• The pain starts as you begin to run and progressively becomes more painful and localized.
• The painful area can typically be pinpointed with one finger.
• The pain often improves with rest.

X-rays are often used to identify stress fractures, but initially, the fracture may not be seen on x-ray. At OrthoCarolina, a stress fracture is often primarily diagnosed by the consistent history of pain progression and localized pain found with a physical exam. An X-ray may be used during a follow-up exam. If the X-ray shows a healing bone, the diagnosis is confirmed.

Risk factors:

• Rapid mileage changes: the body adapts to stresses that are put on it, but a rapid change in stress does not give the body time that it needs to adapt. Quickly upping mileage increases your risk for stress fractures. Aim to increase your mileage by only ten percent per week.
• Running form: heel strikers have a higher incidence of tibia stress fractures than other runners. Slowly try to adjust running form to more of a mid-foot strike to reduce impact.
• Footwear: padding in running shoes protect you from injury, especially if you’re a heel striker. As padding wears, your foot absorbs more impact and can increase your risk for stress fractures. Wear properly fitted footwear and replace shoes about every 300-500 miles to ensure adequate padding.
• Running surface: running on concrete is harder on your bones than running on a soft trail. Mix up running surfaces to give your bones rest.

Stress fracture treatment:

• Ice and anti-inflammatory medications can help alleviate symptoms. However, the bone won’t heal until it’s allowed to rest and recover.
• A walker’s boot is often recommended. It helps to slow you down, distributes forces among the bone and decreases the likelihood of repeating trauma. Most boots are worn for six to eight weeks.
• As you recover, cross-train with non-weight-bearing activities such as swimming and cycling.

A stress fracture can return if you don’t modify the factors that led to injury in the first place.

As a heel striker, I suffered a second stress fracture during my junior year. The stress fracture was in a different spot but was still a result of the same training problem. Post college, I worked on modifying my running form and adding in calf and shin muscle strengthening exercises. Since making these adjustments, I have enjoyed running injury-free.

Matt Dobler, PA-C, ATC is a Physician Assistant and former athletic trainer with OrthoCarolina Huntersville. He was a competitive cross country runner in college at UNC Charlotte.