Can a 5% incline on your treadmill reduce the stress on a tibial stress fracture? Well, that is a great question, and that is what we’re talking about today on the Doc On The Run Podcast.
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Today’s episode comes from Jordan, who was watching a video called “Proof you do not have to stop running with a metatarsal stress response”, and Jordan wanted to know, “Do you think treadmill at a 5% incline will take some of the stress off the tibia?”
Obviously, Jordan’s thinking about this. If you get a tibial stress response, first of all, that is not pathologic. You do not stop running at all. But if you have a stress reaction or a stress fracture, that is totally different. You can get stress fractures, stress reactions for different reasons. One thing is when you have muscles that are pulling on the bone, that can cause a stress reaction.
The tibialis anterior is a muscle that attaches to the front of the tibia and if you put the incline on the treadmill up, your foot has to swing harder, and your tibialis anterior has to pull harder in order to clear the ground. If you got the tibial stress fracture or tibial response or tibial stress reaction, whatever it is, from the muscles tugging on the periosteum or the covering of the bone, and you have anterior shin splints, well, putting your treadmill at a 5% incline is actually going to make the problem significantly worse.
One way you can test that is by putting it at an angle and seeing if it gets worse. Of course, your doctor would probably not recommend that, and neither would I, because you don’t want to make the problem worse, particularly if you don’t know if it’s a stress reaction or a stress fracture. You’ve got to know how severe the injury is.
The other thing is that a lot of people think that tibial stress fractures, since you basically stand on your tibia, that it’s always from axial loading, from landing as a heel striker, from having a lot of vertical up and down oscillation when you run, and that it’s really pounding of your feet on the ground and all of that shock wave getting sent up your tibia that causes a crack in the bone. That is not necessarily true.
Axial loading is only one of those causes. There are really four different causes that can happen that really cause it. Axial loading is a big one, no question, but that is not the only one. If you’re running and you get a tibial stress fracture, before you try to figure out which thing will make it better, try to figure out which thing actually caused it, and make sure you understand the severity of the injury. That is really the crucial piece. Now, sometimes you get tibial stress fractures because of that tugging of the muscles on the bone, because of the way your form gets manipulated a little bit, if you will, from running on the treadmill itself, from the rubber grabbing the sole of your rubber shoe when you’re running on a treadmill.
Sometimes that causes it, not all runners, but in some, but you’ve got to understand the cause and you have to understand the severity to figure out how much stress you need to reduce it, and you also need to know what caused it if you want to know which stress you need to use, try to modify to reduce the stress so that your tibial stress reaction or stress fracture can heal faster and you can get back to real running.
Try to figure that out. What do you think it was? Was it because you’re an over pronator and the muscles are tugging on the bone, trying to hold your foot still? Is it because you are swinging through on the gait cycle, trying to clear the ground with your foot and the tibialis anterior is tugging on the muscle as you’re running because you’re doing lots of hill work or even putting your incline on your treadmill at an angle. Because if you have been doing those things and that was really the cause of the injury, putting it at an angle on your treadmill will make both the tugging of the muscle on the front of the bone worse. It will also make pronation worse because pulling your foot upward is one of the three motions that is a component of pronation, and that makes your foot less stable.
So, you got to figure out which one causes your problem, and if that is the problem, then it would make it worse. If it’s because you had axial loading, and I think what Jordan is getting at here is that if you think about it, if it’s axial loading, if it’s forces of shockwave of you landing with the force of gravity and pounding shockwaves up the tibia, well, if you put the angle of the treadmill up higher, then as your foot swings in front of you, you fall less before you land on the treadmill.
I think that is really what is at the base of Jordan’s question, but I’m not sure what the cause of Jordan’s trouble is. But they’re worthwhile things to think about, worthwhile things to discuss with your doctor. Just remember, when you have a tibial stress fracture or any other kind of stress fracture and you’re talking to your doctors, the biggest mistake I see doctors make is that they do not focus on your goals. They just focus on the injury itself, and they tell you that your goals are not important. That is not true. It is your job as a runner to make sure they understand that the race that you have signed up for that you want to do and might still be able to do, it might be possible if they will help you, but you have to get the goal on their radar, and it will not naturally be on their radar.
The biggest mistake I see runners make is they don’t understand the severity of the injury. If you want to know more about those details and about the strategies I use with runners that get stress fractures and how you help them figure out the severity and the exact sort of step-by-step strategy I use to make sure they maintain their running fitness and get back to running faster, that is all free. You can get it for free at www.docontherun.com/stressfracturemasterclass. So come sign up, and I’ll see you in the training.
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