Is stretching safe with a calcaneal stress fracture? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was recently doing a call with somebody who had a calcaneal stress fracture, and she was having some issues because she was returning to running. She was doing great, but she noticed a lot of stiffness and irritation around the ankle joint, because she’d been immobilized and off of it for quite a long time, and when you do that, you get lots of indiscriminate scarring.
Well, how does that happen? It’s pretty simple. When you think about this, when you look at your foot and you have your heel bone back here, your heel bone looks basically like that, and your talus sits on top of the heel bone. Then your tibia sits on top of that. Your Achilles tendon comes down and attaches back here, all back here on the back of the heel bone. You have your plantar fascia on the bottom. You have a whole bunch of other stuff that we’re not going to draw in here because it’s not really that important.
So what happens? Well, when you have the heel bone and you get a stress fracture, several things happen. One of the worst things that happens is that you get a little crack in the bone. Okay? So that’s obviously a problem. Depending upon where the crack is – it could be here, it could be up here, it could be in several places – but irrespective, what happens is that when you start running, you’ve got stiffness in your ankle, because when you’re immobilized in the fracture walking boot or a cast or something like that for a long period of time, you get all kinds of scarring that happens around your ankle. It makes it stiffer. What that does is it means you have to push harder on your forefoot to get it to come upward. So the ground’s pushing harder and your Achilles tendon is also pulling more in order to actually get the ankle to move.
The question is, should I do stretches for the Achilles tendon or not? Well, yes and no. You have to remember that when you have a stress fracture in your heel bone, if you do really aggressive Achilles-tendon stretches and you’re pulling up with your Achilles tendon here, what’s that doing? Well, that’s actually pulling the fracture apart, right? Because your foot’s planted on some surface, you’re pulling up to stretch the Achilles tendon and you can pull the fracture apart. That is not good.
The short answer is yes, you can stretch it when it’s the right time, but you cannot stretch it at the wrong time. When it’s still healing and you know that the heel bone is sore, if you squeeze it, if you push it, if you’re walking on it and it hurts, you should definitely not be stretching the Achilles tendon, because you can likely pull on the fracture site in the heel bone and make it worse.
After it’s healed enough that you’re already running, you’re already training, you’re already walking, you’re doing some things, and it’s not causing any pain in the heel, well, you can probably start stretching it then.
So how do I tell? Well, obviously, I do calls with people who have these issues and I walk them through it step by step, but at the same time, what I’m asking them to make that decision is, “What did you do yesterday? Did you have pain when you were doing it?” If the answer is no, it was probably safe. Next question is, “Did you have pain that evening?” If the answer is no, it was probably safe. “Did you have pain when you woke up this morning?” And if the answer is no, that activity was probably safe.
I always have people keep a pain journal. Now, the pain journal’s really simple. It’s a thing you can get for free. Got it already made for you, so you can just print it out and use it. You can actually get it when you sign up for the quiz, where you go to docontherun.com/quiz and try to figure out what you need to do, what you’re probably missing with your injury right now. Well, part of that is you’ll get the pain journal anyway.
The point is that you can track this on your own. So if you know that you’re not having pain and then the only thing you add is some Achilles-tendon stretches and your doctor gives you a set of stretches to do, or your physical therapist gives you a set of stretches to do, and you add those stretches, but your pain level goes up while you’re doing them, that evening or the next morning, not a good idea.
If the pain is someplace else, if the pain’s up here because you haven’t stretched your calf muscle, I don’t really care about that. But if your pain is in the heel and it reminds you of the discomfort you had when your stress fracture was going on before you saw the doctor, that’s a bad idea. So you got to pay really close attention.
Remember, the three things that give you the best indication the fracture is getting worse because you’re doing too much: pain, bruising, swelling. The swelling happens if you injure it and it makes an inflammatory response. You get more fluid in the tissue. The bruising happens because you actually cracked the bone again. That’s obviously the worst thing. But pain is the most sensitive thing. It happens very quickly. You can tell within a few hours, or at the most the next morning, whether or not it’s safe for you. But pain really gives you a great thing to follow to make these decisions as you ramp up your activity when you’re getting back to training and running.
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