DOC » #406 Can I run if MRI shows stress fracture but no pain?

#406 Can I run if MRI shows stress fracture but no pain?

Can I run if my MRI shows a stress fracture, but I don’t have any pain? That’s what we’re going to talk about today on the Doc On The Run podcast.

This question comes up a lot. In fact, in the last week I had this question twice from different runners with different types of stress fractures during telemedicine calls. You’ve got to understand that with stress fractures, it’s really confusing when it comes to classification of those injuries when you’re talking about imaging.

The classification scheme that I actually use actually has five different gradings, one through five. One is where you have this thing that I actually referred to as a stress response. It’s a normal physiologic response. You have something changing. The bone is actually getting stronger, but in the process of it actually getting stronger, if you do an MRI during that phase, you have inflammation or edema within the bone showing up on the MRI. And we call that a stress fracture. In fact, according to that classification scheme, it’s actually called a grade one stress fracture.

So the thing is, is that a grade one stress fracture when you look at that classification scheme, the important thing is that you have no pain, there’s no tenderness. So you have an imaging thing that looks like an abnormality, but you don’t have pain and it’s not pathologic. There’s actually not really a problem.

In fact, a lot of different studies have looked at this both in long distance runners and professional runners, ultra marathoners and they’ve shown that this is a normal thing that happens throughout the course of training and sometimes throughout the course of multi-day stage races. And the authors of those studies have actually said that you do not need to modify your training program.

Now, whether or not that applies to your exact situation, I don’t know. But it’s worth having a call with somebody to figure out exactly what that means. Because I see this a lot where somebody has a stress fracture, they get an MRI, it hurts. It’s painful. They’d say, well, there it is. You can see it on the MRI. You can’t run. You’re going to make it worse. That’s true. You need to do something to back off and reduce the stress to that injured metatarsal so that it can actually start to recover. But once it is recovering, the rules start to change.

Now, if you go and get an MRI and you don’t have any pain and you try to get an MRI to make sure that it is safe for you to run, you’re going to get an MRI that says you have a stress fracture showing up on your MRI. Now all of these are cases where there’s no visible cracks. So by definition, a fracture is a crack. And so when you have an MRI to see if you’re actually completely healed, you’re going to be waiting a long time before it’s going to show that it’s completely healed.

Meaning the absence of this signal change that the radiologist reveals to you, that it’s a stress fracture, but it’s a grade one stress fracture. That’s really a stress response. It’s not really pathologic most of the time. So when I do these telemedicine calls with athletes who have metatarsal stress fractures or tibial stress fractures or whatever, and they’re trying to figure out, can they run?

The more important thing is actually how you feel. It’s how you feel when you compare your pain to what it used to be. It’s how you feel when you do certain activities that are increasingly stressful. That’s part of what we talk about in the metatarsal stress fracture course about how to very carefully ramp up your activity in a way that doesn’t overload the bone suddenly and give you a setback and go from a stress response that’s not pathologic to a thing called a stress reaction that is a problem.

So you have to make sure that you’re talking to an expert, that you’re ramping up carefully. You’re keeping track of your numbers. And then pay more attention to what’s going on with your symptoms, how you actually feel when you do increasing levels of activity, pay attention to your numbers, and talk to your doctor and talk to an expert to make sure that you know you’re on the right path. That’s really the big key to getting back to running as quickly as possible when you got a metatarsal stress fracture.