#164 What causes stress fractures? - DOC

#164 What causes stress fractures?

Today on the Doc On the Run Podcast, we’re talking about what really causes stress fractures.

I was recently at a medical conference and I asked all the doctors in the audience … I said, “What causes stress fractures?” 

Now in this case I was actually lecturing on stress fractures and what we as doctors should do different with runners who get stress fractures, because most doctors just tell runners to stop running. That’s not always necessary. 

So I posed this question to the audience, which of course is all doctors, foot surgeons, physical therapists, all kinds of practitioners that treat running injuries and things like metatarsal stress fractures, and I asked the audience what really causes stress fractures. 

A doctor raised his hand and the very first thing he said is, “Running too much.” Well, that is not true. That’s the default answer, but that doesn’t make any more sense to me than telling you that not running will cure your stress fracture. Now it’s true if you don’t run, you stop running, it’s not going to bother you anymore, but if you’re a runner not running is definitely going to bother you, right? 

So this is the thing. We have this thing that we hear about, we’re taught this in medical school, that stress fractures are caused by the terrible toos, and that’s T-O-O-S, not T-W-O. So it’s the “terrible too’s:” running too much, running too fast, increasing your mileage too soon, all of these things, and that’s not really true. 

So the premise here is that someone decides to take up a new exercise regimen. They decide they want to start running to get into shape for a New Year’s resolution or something like that. They start running and they run too many miles, they increase their mileage too fast, and then they get a stress fracture. 

It’s not too many miles. It is too much stress, and I would be willing to bet that virtually every person who is running and gets a stress fracture could look at what they did over the preceding few weeks and without reducing their distance they could look at some things they could have done differently to reduce the stress to that metatarsal and have prevented that stress fracture from occurring in the first place.

So if you’re a runner and you get a stress fracture you really need to look back at the runs that you did and not think about what is it that you did in terms of your distance that caused the stress fracture, but what is it in terms of your technique, your running shoes, the surface you were running on, the side of the street you were running on. 

Were you running on the side of the street where it’s sloped and basically one foot is pronating and the other one is supinating so you’re getting different kind of stresses? If you do that, you may get a stress fracture on the fourth metatarsal or the third metatarsal on this foot, but you could get a fifth metatarsal stress fracture on the other foot because it’s downhill and there’s different forces.

What is it that you did? Was it that you were running in really stiff trail shoes on the road? Is it that you were running in shoes that have actually a little bit too much stability for you when you have really high arches? Is it that you’re running in the wrong type of shoe altogether? Were you running in minimalist shoes and you ran way too far with your first run?

But if you look back when you get a stress fracture and you take an assessment of what you really did to cause the stress fracture it’s not the mileage. It’s the stress. Is it that you were doing workouts back-to-back? You had too much stress too close together and you didn’t actually recover fully? Is it that you were doing long runs, but you’re super busy so you were doing your long run basically running to work, and then you shower at work, and then you go to work and you’re dehydrated, you’re not eating, you’re not refueling, you’re not sleeping appropriately?

What is it that you did that really increased the stress and prevented you from recovering fully after those workouts so that you compounded all those things into an actual stress fracture? Remember, it’s not too many miles. It’s not running. It’s too much stress. That’s why it’s called a stress fracture. 


Top 10 questions to help decide when you can run if you have a stress fracture. Watch this video now!


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