Does a stress fracture always hurt when walking? Well, that is a great question, and that is what we’re talking about today on the Doc On The Run Podcast.
If you are a runner with a stress fracture, I know you probably got more questions from answers from your doctor, but that is why I do consultations for runners with stress fractures and I am not trying to get you to book a consultation.
I just think that if you understand a little bit of the difference about the way doctors make decisions on these things, it may help you either not go see a doctor or understand how to communicate with your doctor better when you do go see her.
Here is the way to do it, when you get a stress fracture, you get a stress fracture because you have done too much training before the bone is fully recovered in a way that causes inflammation, pain, and irritation of that specific bone. It may be one of the metatarsal bones in your foot, the second metatarsal and the fourth metatarsal are two of the most common bones that get stress fractures in runners.
What happens is that you get pain that is increasing over time generally the more that you beat it up. It’s not complicated. At first, when you do your runs, you get inflammation in the bone that would show up on an MRI, but it’s not even painful. You can push on the bone, you can stand up on your toes, you can do all kinds of stuff, and it won’t hurt.
Even if you see that inflammation on an MRI, it’s not a problem. It’s not what we call pathologic. It’s not actually bad. It’s normal. When you get abnormal swelling within the bone, you get a stress reaction. That is when it actually starts to hurt. So, it shows up the same way on an MRI as a stress response that is not a problem, but this one is a problem because it hurts. You can push on it. You can reproduce it.
The reason I’m doing this episode is I just got off a call, a consultation, second opinion, with a runner who called me because he thought he had a stress fracture, and he asked a great question. He said, “Well, I don’t get it. It hurts every time I run, but it doesn’t hurt when I walk. So, it means I don’t have a stress fracture, right?”And I said, no, that is not true at all. Let me explain why.
When he’s running on the treadmill, he’s actually increasing the stress in that structure enough that it actually starts to hurt, but when he walks, he’s not stressing it enough, and I was explaining to him that many years ago, stress fractures, if you looked up the research on them, they weren’t really called stress fractures. They were called march fractures because they developed in military recruits who put on heavy packs, combat boots, and were forced to march long distances in basic training in a way that would increase the stress and strain in bones, and they would develop stress fractures, but they actually called them march fractures when the doctors actually wrote these things up and these research studies and information that they learned from military recruits and published it in medical journals.
If you are running and you are increasing the stress very rapidly by taking a whole lot of footsteps really, really quickly at a fast pace, and you are putting more stress on it, then it hurts, but then if you walk, it may not hurt at all. It might hurt if you walked 30 miles. It might hurt if you walked barefoot on hardwoods, but there’s a gradation in these things.
Part of what I teach in the stress fracture masterclass is about the strategies I use to figure this out on your own, and all the specific tactics and stuff are in the stress fracture course for runners, and in that, I show you how you have to track these things.
Step one is to figure out how much pain you have, how much it really hurts, and when it really hurts, because then you can decide how bad it is, but if you don’t know how bad it is, you don’t understand the severity, you can’t really make good decisions about the strategies used to get it better, to reduce the stress and strain on that one injured piece of tissue, but you’ve got to figure out how much it really hurts and where it really hurts in order to really make progress, and it’s good news, by the way, if it does not hurt when you walk, but that does not mean that you don’t have a stress fracture.
It may be that it’s very mild, it’s just starting, and with some really simple strategies, you could reduce the inflammation in and around the bone and keep running without any trouble at all, particularly if you have no pain when you are even walking, but you have to think about when. Are you walking on carpet? Are you walking in running shoes that are really cushy and supportive? Are you walking barefoot? Are you walking upstairs, downstairs? What is it? You’ve got to really pay attention to those little subtle things to figure out whether or not you actually have a stress fracture and what you can do to get it better as quickly as possible.
If you want to learn more about those strategies, you can come join me in the Stress Fracture Masterclass. It is free, and you can get it at www.docontherun.com/stressfracturemasterclass.
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