What’s the difference between a fibular stress reaction and a stress fracture in a runner? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you start getting pain on the outside of your ankle and you push around on that lump of bone on the outside of your ankle, you may realize that you have pain on the bone specifically, and you might become worried that you have a thing called a fibular stress fracture. Well, if you start looking into this and trying to figure out what to do, one of the first things you’re going to find is that there’s a lot of discussion about something called a stress reaction instead of just a stress fracture.
I just got on a call with somebody who, we did a webcam call because she was having ankle pain and she was trying to figure out what was going on and we were talking about the specific differences between a stress reaction and a stress fracture in the fibula bone.
The fibula bone, one of the interesting things about it is that when I was in med school, the anatomy professor was giving a lecture and he said that the fibula was a useless bone and it’s a non-weight bearing bone. He argued that it really didn’t do much structurally but it does do some stuff structurally and if you’re a runner and you get a stress fracture in it, obviously it must be taking a lot of abuse and it must be doing something to keep your leg together or it wouldn’t get stressed to the point that you could get a stress fracture in the first place. So, that’s probably another episode entirely. But I think it’s important to understand the difference between a stress fracture and a stress reaction.
The difference when you have a bone that gets injured because you’ve been overtraining, all that’s happened is that when you stress the bone, physiologically, the very first thing that happens is called a stress response. It’s because you’ve applied stress to the bone. The same way that if you stress your muscles like you’re doing biceps curls, your biceps muscles respond to that stress by repairing the tissue, you get inflammation to begin that process. It hurts, it’s a little bit swollen and then those muscle fibers repair and become stronger.
When you run and you stress the fibula bone by applying forces to it, you get a stress response where you get increased strength building in the bone. But if you get too much stress in the bone, it changes from what we call a stress response where you actually don’t have any pain but you do have this process of inflammation and tissue repair going on within the bone to one where you have a little bit more inflammation within the bone to the point that it can actually distend the covering of the bone or there’s so much swelling in the bone that it actually hurts. That’s when we actually call it a stress reaction in the fibula as opposed to a stress response in the fibula. So, basically they look the same on an MRI, but one of them has pain and one of them does not.
If you ignore that pain on the outside of your ankle and you continue to run and that inflammation actually continues to get worse and goes on for a period of time, the increased blood flow within the bone can actually decrease the bone density and then the bone actually finally cracks and when it gets an actual crack, that’s when it’s a stress fracture. So, if you get an MRI or a CT scan and X ray, and there’s no crack anywhere in the bone, but it hurts and you push on the bone and it’s painful. It’s a stress reaction. That’s the primary difference is that a stress fracture has a crack, a stress reaction does not have a crack but has pain and inflammation associated with it. You could even see on something like an MRI, a stress response looks like a stress reaction on a on an MRI, but you have no pain. It’s not pathologic. There’s nothing wrong with it in that case.
So, if you’ve had pain on the outside of your ankle when you’re running and you’re concerned you have a fibular stress fracture, maybe it’s just a stress reaction, and maybe you could do some simple things to calm it down. But if you have had that as an issue, I hope this episode will help you understand a little bit more about it so that you can get back to running faster.
If you liked this episode, you might also want to check out the stress fracture masterclass. That was really something that I did. A presentation that does a deep dive into the difference between these things. It was mainly about metatarsal stress fractures, but the principles all apply here. So, if you think you have a fibular stress fracture, you might want to check out the stress fracture masterclass.
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