Are there really only three reasons for stress fracture re-injury? Well, yes, there are and that is what we are talking about today on the Doc On The Run Podcast.
If you get an aching pain in your foot when you are running, and it turns out it is a metatarsal stress fracture, you are not alone. These are extremely common, but just because they are common does not mean it is convenient and the last thing that you need is to stop running, take all this time off, do all this stuff to get it to heal, and then get re-injured when you start running again. And there really are only three reasons that I see in runners when they get re-injured after they have fully recovered from a metatarsal stress fracture. So, we are going to talk about those today.
The first one is what I think of as kind of an unforgivable sin. It is where you are letting your body get weaker while your bone is recovering. Now, I will concede that the bone does have to have relative rest compared to what the stresses were applied to it that caused the stress fracture in order for it to actually heal. That is for sure. However, complete rest, meaning that you don’t exercise, you don’t work out, you don’t move, you don’t do anything, you just wait for it to heal, that is not a good plan. That will make you weaker.
I was just on a call this morning with a runner who is getting back to running, and he was off for a very long period of time before I started talking to him, and he was on crutches, he was in a fracture walking boot, and he got a lot weaker. And when you return to running, if you have done that, if you’ve let your body get weaker, your form is going to be terrible, your ability to absorb forces dynamically is going to be very, very low, and then you are going to wobble and sway, and you are going to load things in a way that puts you at very high risk of re-injury. So, number one, do not let your body get weaker while you are recovering.
Number two, the bone is not getting stronger fast enough, or you did not wait long enough and those are the same thing. So again, I always say that if a doctor tells you, oh, just wait, we are going to do an x-ray in six weeks, oh, we don’t see anything, we’ll do another x-ray in another four weeks, so 10 weeks of waiting. Waiting is not a treatment plan. You need to think about everything that you can do to get that bone to heal as fast as possible. There are lots of different things that go into that, but you cannot just wait.
Waiting is passive. You have to be active. Just like you can’t wait until you are fast enough to run a three-hour marathon. You have to train to be fast enough to run a three-hour marathon. So do not underestimate this. You have a lot of power in the process of getting the bone to repair itself, and there are lots of strategies you can use to do that.
But if you start running and you didn’t wait long enough, or you didn’t do something to speed up and compress the time for the bone to heal, and you start running, well, at that point, then the bone’s not strong enough to withstand the forces of running, and then it gets re-injured. That can happen too.
The worst case of this I ever saw was a woman I saw that was in a fracture-walking boot for eight weeks with a sesamoid fracture, which is a terrible injury. She got it to heal. I made custom orthotics for her so that she could have the pressure spread out as much as possible to make sure it didn’t get re-injured. Well, she was in a boot for two months.
The next day after she got the orthotics and stopped using the boot, she called me, and she was crying. I went to see her. Her foot was black and blue, and I said, what happened? And she said, well, I know you told me that I should just start walking in these, but it was a beautiful day. I hadn’t run in two months. I thought if I just go to the marina and I run three miles on the little crushed granite trail there, it is not going to be that stressful and I just really felt like I needed to do it. Then my foot started aching at the end of that run, and she had completely broken her third metatarsal, completely different injury. But that is because she was weak and deconditioned from being in the boot.
The last thing, which kind of goes along with that, is that you have failed to match the stress in the bone, its capacity to absorb that stress with the activity that you are applying to it. Now, this woman that just got out of the fracture walking boot, who’s got decreased bone density, as a consequence of being in the fracture walking boot, she has a much lower amount of stress that can be applied to any bone in her foot before it breaks.
Your goal is not just to not lose your fitness. Your goal is to actually make sure that the stresses you apply to that one metatarsal bone as you are returning to activities, as you are training, you want to make sure that the stress is low enough that that bone can withstand it.
There are lots of strategies you can use to make sure that that is happening, but you have to match the stresses applied to the bone with the activity to make sure that they match. That means very carefully and systematically applying stresses to the bone as you return to running and that is a huge mistake when runners don’t do that.
So, you have to really think about this. For sure, if you go out and you run and you have pain, you are doing something wrong. So that doesn’t mean you can’t run, but you have to figure out how you can make sure that you are not having too much stress applied to that bone.
All of these kind of things that I have thought about over the years that I teach to physicians at medical conferences that I have learned from working with runners who have stress fractures and are making mistakes, I have put them all together and started working on these things and preparing a talk for you in the Stress Fracture Secrets presentation to show you the things that I think are secrets because nobody seems to be paying attention to them. If you want to come check it out, it is free. You can get it at www.stressfracturesecrets.com. So come check it out and I’ll see you in the training.
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