Today on the Doc On The Run podcast we are talking about how a runner can heal a stress fracture.
When you get a stress fracture, there are really 3 issues:
You have to address all three if you really want to get better quickly and get back to running.
You can also have inflammation within the medullary canal, or the hollow cavity inside the bone itself.
The first thing you have to do is address the inflammation. You have to get that fluid out!
There are a lot of different ways to do this:
We created a separate lesson that actually show you the specifics on each of the strategies to reduce the inflammation and that lesson is actually in the Metatarsal Stress Fracture Recovery course.
The first benefit of reducing inflammation is that you are going to have less pain. Less pain is a good thing for many reasons. Most importantly, when you stop the inflammation, you have less inflammatory fluid around the injured structure.
The inflammatory fluid contains enzymes that are supposed to break down collagen. Since collagen is one of the primary building blocks of healing during the initial stages of any injury, you have to make sure you are not slowing down the initial healing process just by having all that inflammatory fluid marinating around the injury site.
One of the biggest benefits of getting the inflammation out is it helps you make a better assessment of how severe your injury is. Don’t ever forget, no matter what a doctor tells you…
Every runner is different.
Every patient is different.
Every injury is different.
If you’re younger, you’re going to heal faster. If you’re older, you’re going to heal slower. Most people understand and accept that as fact. But what most doctors don’t seem to want to accept is that mild stress fractures heal a whole lot faster than severe metatarsal stress fractures. They don’t all take 6 weeks!
If you just have some inflammation around the bone or within the bone, you may completely calm it down just by doing all of the things we teach to reduce inflammation in the Metatarsal Stress Fracture Recovery course.
But don’t think that means just taking one pill because I don’t think that works. The more things you actively do to reduce the inflammation and get that fluid out of there, the faster the stress fracture is going to calm down.
So that’s step one. Get the inflammatory fluid out.
The second step is to heal the injury. You have to do something to repair the damaged tissue.
If you have a stress fracture, we presume there is a crack in the bone. Although most people think if they get an X-ray and have a stress fracture they’ll see some little line on the X-ray which indicates a visible crack, but that’s not the case most of the time.
As an aside, I think most runners who get pain in the foot that has been labeled a “stress fracture”, it’s not really a crack. Technically it’s not really a fracture at all. It’s really just a “stress reaction” or a “stress response.” If you just have some swelling in the bone because you have a stress reaction you don’t really need to heal a crack in the bone.
But if you do have a real stress fracture then you have to heal that crack.
You crack the bone and the bone bleeds. You get a blood clot that forms between the ends of the bone in that crack. The blood clot starts to solidify and turn into this plastic-like material doctors refer to as “soft bone callous.” Once the inflammatory phase of wound healing ends (within a few days), the proliferative phase of wound healing takes over. That second phase of wound healing (the proliferative phase) is where the real magic happens.
You start getting little strands of collagen forming within that blood clot. These little fibers reinforce the soft bone callous and make it much, much stronger. That’s all collagen. The collagen starts to stabilize the bone.
In that point you start to have a lot less pain because the injury site has so much collagen stabilizing it that the bone doesn’t even hurt when you move or push on it.
There are two key points here.
You need to make sure you have a diet that will support the healing process. Collagen is a type of protein. To build protein in your body, you need to eat protein and have collagen in your diet. If you eat lots of meat then you probably get enough of this.
If you’re concerned that you don’t have enough protein in your diet, you can also take collagen supplements specifically formulated to help rebuild collagen. It’s not just collagen alone. Your body also needs vitamin C, copper and other micronutrients to really build collagen efficiently.
After you get some stability and a little initial healing around the stress fracture, your body will start to turn the fracture site into stable, hard bone. At that point you also need to make sure that you have plenty of calcium and vitamin D in your diet. You also need to make sure that you stay hydrated to help facilitate the ongoing process of rebuilding and reinforcing the strength of the bone so it gets back to maximum strength.
During this process of collagen formation and maturation of the bone, you have to make sure you don’t do anything to disrupt the healing. If you’re running on it every day just to do a “test run” to check it out and see how it feels, you’re just going to be ripping apart all of the collagen fibers. Obviously that’s going to slow down healing.
Now that doesn’t mean that you can’t maintain your fitness. And it doesn’t necessarily mean you have to quit running entirely. You just have to make sure you’re not disrupting the healing process.
Now that takes us to the third issue which is too much stress applied to that particular structure.
Don’t forget, whatever you did, whether it was running hills, running on uneven surfaces, doing too much speed work before your body could fully recover…you did something that injured that tissue.
If you keep doing the same thing, you can expect the damage to get worse. Now, obviously you’re not going to keep doing the same thing, because it would hurt. But to get it to heal you definitely need to have less stress on that tissue than you did when you injured it.
So you have to do something to decrease the motion that would apply stress to that tissue. You have to do something to decrease the pressure applied to that structure to let it heal.
Doctors often refer to this as either “immobilization” or “offloading.” Immobilization just means you are holding a body part still so can heal. Offloading means you are taking pressure away from one particular structure to reduce the stress, so it can heal.
The most effective form of offloading is using crutches. If you don’t put your foot on the floor and you don’t walk on it, obviously there’s no pressure at all. But that’s not going to work for a runner.
Sometimes doctors think of “not running” as a form of “offloading” just because you’re applying less stress to the foot once you stop running. Of course,”not running” doesn’t really work for runners either.
The point here is that you should think of relative immobilization and relative offloading.
If you use shoes that are stiffer and have a curvature under the ball of the foot which decreases the stress to the metatarsal bones, that’s a form of relative immobilization.
If you put pads underneath your shoe insert to take pressure away from that particular metatarsal bone, that’s a form of relative offloading.
When you want to heal a metatarsal stress fracture, you really have to focus on all the different strategies and ways you can decrease the motion, decrease the pressure and decrease the stress to that particular metatarsal bone.
We discuss all of this in vivid detail in the rest of the lessons in the Ball of Foot Pain Course for Runners and the Metatarsal Stress Fracture Recovery course for runners. We are going to walk you through all of the different strategies you can use as a runner to decrease the stress to the structures at the ball of the foot in those courses.
You don’t necessarily need a cast and crutches. But you have to do something to reduce that stress. Most of the time runners can do this at home without even seeing a doctor. You just have to understand what the options are, and then pick the ones that are going to work for you.
Again, if you want to run and you want the thing to heal you just have to make sure that the total amount of stress applied to that injured structure is low enough that you are below your threshold for healing.
Then, monitor your symptoms closely. If the pain is going away you’re on the right track!
If your swelling is going down you’re on the right track!
Once you’re on the right track, start ramping up your workouts so you can stay fit. The goal should be to keep ramping up activity, while your symptoms keep going down.
Don’t just rest! Don’t just stop running! Be proactive!
Make sure you understand the ways to heal and get back to running.
There are several question you need to ask if you think you have a stress fracture and want to get back to running as quickly as possible. I’ll walk you through them.
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