- Common causes of stress fractures include overuse or ramping up your mileage too quickly.
- While a stress fracture is healing, you should stay off the bone and give the injury time to heal.
- During recovery, you can still exercise by doing low-impact cross-training, such as swimming or biking, with clearance from your doctor.
It can happen in an instant, and it usually starts with a flinch—something that doesn’t feel right—then a sinking feeling in your stomach, and a hope that it’s nothing serious.
But sometimes (and all too often for runners) the result is a stress fracture in your foot. Runners most often get stress fractures in the foot or lower leg. These can be caused by too much loading force on the bone. One way this happens is when you tack on too many miles too quickly, and with so many new runners taking up the sport it’s easy to crank up your mileage before your body is ready to handle it.
If you suspect a stress fracture in your foot or other parts of your body such as your shins, knees, or hips, take a break from training and check in with your doctor. Here, Jordan Metzl, M.D., a sports medicine physician at the Hospital for Special Surgery in New York City, breaks down everything you need to know about stress fractures.
What Is a Stress Fracture?
A stress fracture is a tiny crack in the surface of a bone, usually in the lower leg or the metatarsals of the foot for runners. Stress fractures often occur when we increase the intensity and volume of our training over several weeks to several months. Muscle soreness and stiffness can progress during this period, and a pinpoint pain may develop in the area of the sore bone.
Stress fractures start as a stress reaction. “A stress reaction or a stress injury happens when the bone starts to swell inside,” says Metzl, creator of Runner’s World’s IronStrength workout (available in the All Out Studio app). “The worse the symptoms get and the more you don’t pay attention to them, the more likely you are to turn a stress reaction or stress injury into a full-blown stress fracture.”
If you suspect you may have a fracture, see a doctor or podiatrist immediately, as further running will only worsen the issue . “Like almost every overuse injury, the worse the symptoms get and the more you try to run through the pain, the worse you’ll make this injury,” says Metzl.
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Identifying Stress Fracture Symptoms
Runners typically get stress fractures in their feet, shins, knees, and hips. And according to Metzl, there are three main ways to identify one at home: point tenderness, swelling, and changes in your typical running form.
If you experience point tenderness—when a specific bone is sore to the touch—that could signal a stress fracture. If you suspect a stress fracture in your foot, performing what’s called “the hop test” is a good way to figure out if you have point tenderness. Carefully, hop a couple of times on the injured foot. If you have pain when you land, it could be a stress fracture.
Swelling in the affected area is another common sign. While you could see swelling anywhere, the most common place people experience noticeable swelling is on the top of foot due to a stress reaction or fracture in the metatarsals. Metzl notes that you may lose the contour of the veins on the top of the foot when you compare one foot to the other.
Changes in your biomechanics while running could also be a sign of a stress fracture. So if you’re in so much pain that you need to adjust your form, consult your doctor right away. “If you notice you’re not landing on your foot the same way you usually do because it hurts too much, get it checked out,” Metzl says.
In the end, a stress fracture is a clinical diagnosis injury meaning that your doctor can tell you if you have one with some simple tests. So if you expect you might have one, skip the at-home stuff and just head in to your doctor’s office to be sure.
Common Causes of Stress Fractures
There are a few things that could lead to a stress fracture, and most are related to putting too much loading force on your bones. The first is ramping up your mileage too quickly. “Bone needs time to get used to the more loading force of running, so make sure you give your bones enough time,” Metzl says.
People who overpronate are more prone to stress fractures because they put a lot more medial loading force on their legs. Having osteopenia (lower than average bone density) or osteoporosis (much lower than average bone density) can also cause stress fractures. Both genetics or not getting enough calcium in your diet can cause these two issues. Your doctor may order a bone density test to determine if you are at risk.
What’s more, a pair of studies from Thomas Jefferson University in Philadelphia sought to identify overlooked physiological factors and lack of knowledge that contribute to stress fractures in women who run. They found that those who increased their training load more quickly and those who didn’t pay much attention to nutrition and strength training were more likely to suffer a stress fracture than those who did pay attention to these factors.
Stress Fracture Treatment
Upon suspecting you have a stress fracture, treat the area with ice and take a recommended dose of anti-inflammatories, but keep in mind that stress fractures are not a self-diagnosis or self-treatment type of injury. A proper X-ray or bone scan is necessary to prescribe treatment and depending on the location of the fracture, recommendations may differ, so consult your doctor immediately.
Some stress fractures won’t show up on an X-ray, so MRIs are typically done to definitively diagnose a stress fracture because they can detect both stress reactions and stress fractures. (An X-ray can only detect severe or already-healing stress fractures.)
Once you’ve been diagnosed, you’ll mainly want to stay off of the bone and give the bone enough time to heal. One thing Metzl notes is that stress fractures farther away from your heart heal slower because they receive less blood flow.
However, just because you have a stress fracture doesn’t mean you can’t still exercise. You can still keep your cardiovascular fitness going by cross-training. Metzl recommends low-impact activities such as cycling or swimming, but talk with your doctor to discuss the activities you should and shouldn’t be doing as your stress fracture heals.
Stress Fracture Prevention
First and foremost, Metzl advises adding mileage to your long runs gradually to prevent injuries. If you haven’t run more than four or five miles in few months, don’t suddenly jump up to a 20-mile long run without working up to it first. Experts recommend increasing your weekly mileage by no more than 10 percent each week.
Metzl also recommends shortening your running stride and quickening your cadence. A stride of 80 to 90 steps per minute with your right foot (160 to 180 with both feet) can decrease your chance of injury.
Finally, make sure you get enough calcium in your diet to prevent osteopenia or osteoporosis. Adult runners should aim for 1,000 milligrams of calcium per day, and a good source of calcium should have at least 100 milligrams per serving. Foods such as yogurt, milk, cheese, tofu, and dark, leafy greens are all great options.