#821 I had a sudden injury but my doctor called it a stress fracture - DOC

#821 I had a sudden injury but my doctor called it a stress fracture

I had a sudden injury, but my doctor called it a stress fracture. That’s what we’re talking about today on the Doc On The Run Podcast.



I had an interesting discussion with an athlete recently and she was saying an interesting question and she said, “I had an injury, I went to see the doctor and got an X-ray. There was no crack on the X-ray, but my doctor called it a stress fracture. So, I’m confused. Number one, I thought that a stress fracture happens when you run too much too far too soon, and it overloads the bone, and you get a little crack in it. I didn’t do that. It was trauma and it was sudden injury, not a bunch of force applied over a long period of time. So, I wasn’t training for anything, and there’s no cracks. I don’t get it. Why is my doctor calling this a stress fracture?”

Well, it’s a couple of ways that I’ve tried to explain this and one of them is that you can get an injury to a bone that causes basically a stress fracture where there is a crack or a stress fracture or a stress reaction where it doesn’t have a crack, but it’s almost about to crack. Well, they’re similar and you can get that because you apply too much stress or force to the bone.

In the classic description of a stress fracture, we consider it to be caused by repetitive stress applied in a small amount of stress the same way to the same bone over and over and over and over, a long period of time. However, there is a simple way to think about this.

If you think about an analogy, if you have a scale and you put a rock on one side, and then you start pouring grains of sand on the other side of the scale, as you apply more and more sand eventually you get the same amount of weight and you have the same amount of weight on both scales, one of them was a big rock and one of them was applied one at a time with a little grain of sand. That’s the way you can do that.

Also, if you’re a runner and you’ve done marathons, you might have seen another analogy to this yourself where you get a bruise toenail. So, if you apply a tiny amount of force by hitting your toe on the inside of the shoe over and over and over every time you take a step over 26.2 miles, it’s the same cumulative force as if you had hit the toe once with a hammer. And what do you get in either case? you get a bruise under the nail.

So, that’s the thing, the only difference between a stress fracture and a pathologic or traumatic fracture is when you actually apply all the force at one time, as opposed to in little increments. And so, if the amount of applied force is equal, you get the same amount of bruising under the nail or the same injury to the bone and it can happen with just one single blow.

But the reason that doctors might call it a stress fracture or stress reaction is we don’t really have a better term for it. Sometimes doctors might call it a bone bruise. Sometimes I’ll call it a stress fracture. But you basically if it’s really mild and you don’t see a crack on your X-ray, they’re going to treat it like a stress fracture.

If you have that sort of situation or you do have a stress fracture and you want to learn more about it, and how I think about stress fractures specifically when you’re trying to get back to running, you can get a free training I created for you. It’s a stress fracture masterclass where I go into a deep dive on all these topics. You get it for free at www.docontherun.com/stressfracturemasterclass. So go check it out, and I’ll see you in the training.