What are the three ways a stress fracture can turn into a non-union in a runner? Well, that is what we’re talking about today on the Doc On The Run Podcast.
One of the most common injuries I see in runners is of course a stress fracture. All overtraining injuries in runners are stress induced injuries and a stress fracture of course implies this. A stress fracture is a thing that you get because, not because you ran too much, not because you ran too far too soon, the bottom line is with a stress fracture you trained and exceeded the bone’s threshold to recover before your next workout.
So, basically it is a training error and in most cases when somebody got a stress fracture, if they just taken one additional day off, rested a little bit more, slept a little better, done something to allow the bone to recover just enough before that next workout, it would have never happened in the first place. But if you get one you have to let it calm down so that it does not get worse.
A stress fracture is a very small crack in a bone that basically has just started. A non-union fracture is a fracture that never healed, it didn’t unite, it didn’t get back together, you didn’t close the gap where the crack exists in the bone. A non-union is a thing that develops over a long period of time and some insurance companies define a non-union as a bone that has not healed in 90 days and some insurance companies define a non-union as a bone that did not heal in nine months. Think about that.
Do you really want to have a stress fracture that goes on for nine months where you can’t run, you can’t train, you lose all your running fitness because just stop and think about that for a second, no matter where you are in your running injury recovery right now, what would happen to your running fitness if you literally did not run for nine months?
You would have no running fitness at all, completely lose it all. Years of base training gone out the window. You have to make sure you don’t let this happen. So, that might be helpful for you to understand three of the ways that it really happens.
The first way is simply too much motion. When you have a stress fracture and you continue to apply too much stress to it, you will get bone forming around the crack in the bone to try to stabilize it. This can often show up on an x-ray as what we call a large bone callus. It looks kind of like a knot in a tree limb if you’ve ever seen one of those and it is a big lump and although it looks very stable because you have all this bone right around the fracture, it often signifies that there was too much motion at the fracture site. That is number one.
Second reason is too little healing. So, let’s say you have a heal bone like you have a thyroid problem, pituitary gland problem, not enough vitamin D, not enough calcium in your system. You have something that inhibits your body’s ability to heal. That is the second one. Now, it is true that the bone has to heal during a period of time where you have the bone holding still. Once it starts to heal, if you have micro motion, meaning a little bit of motion, it can stimulate the bone to remodel and become stronger faster. But I talk to runners all the time who say that they’re trying to get it healed by using this micro motion principle, but they’re doing it too early in the phase of the recovery.
That brings us to reason number three is that you have just way too much stress applied way too early. I have made tons of podcasts, tons of videos. I’ve written a number of different articles that talk about why I think runners end up in fracture walking boots too long. I think that if you’re in a fracture walking boot too long, meaning four weeks, six weeks, eight weeks, twelve weeks, some long period of time, it is really detrimental to you as a runner because it decreases your ability to run normally. It increases the stress and strain applied to your foot as a whole because everything is stiffer. It also can increase peak forces to specific things like that bone that was injured because you wobble and sway because your form’s terrible and you’re weak. Those are straight consequences of being a boot too long.
But I also go to medical conferences many times a year and lecture to physicians and tell them, you should really try harder to take the stress off of the bone that is injured in this initial phase of the recovery. When you really want to reduce the stress and strain to the bone, it is really important that you do that.
You cannot apply motion too early. You have to let the bone heal and figure out why it is not healing. If you have some underlying metabolic disorder or your nutrition is terrible or you don’t sleep well or something that you can control yourself and you have to make sure that you don’t have too much motion in that critical phase when it really needs to hold still and solidify and get going.
If you want to learn more about stress fractures and the specific strategies I use with runners who have stress fractures when they call me for consultations, you can get it for free. It is the Stress Fracture Masterclass. It is at www.docontherun.com/stressfracturemasterclass. So, come sign up and I’ll see you in the training.
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