What do you do when you are only five weeks away from a half marathon and you develop a metatarsal stress reaction?
This episode came from a real Strategy Call with a real runner who was planning to run a half marathon in Argentina. He had already invested in the trip, the race mattered to him, and then a fifth metatarsal stress reaction put the entire plan in question.
Click here to block my calendar for a 10-minute Strategy Call.
On the call, we worked through the information he needed in order to make a better decision about his race and, just as importantly, how to maintain as much running fitness, strength, and stability as possible without simply guessing about what the injured bone could tolerate.
He had trained for a marathon in a relatively short period of time. During the marathon, an injury on the left side caused him to limp and spend more time loading the right foot. That additional stress appears to have contributed to the fifth metatarsal stress reaction.
A stress reaction is an overuse injury in which the bone becomes irritated and inflamed before there is necessarily a visible crack. If excessive stress continues, the injury can progress toward a true stress fracture.
One of the most useful things this runner had already done was track his symptoms. He knew how the foot felt in the morning, in the middle of the day, and at the end of the day. He also knew how hard he had to press on the metatarsal before he could reproduce tenderness.
Those details are far more useful than simply saying, “I think it feels better.”
Useful measurements can include:
He had X-rays that did not show a crack. We discussed how a small crack can sometimes be missed on an X-ray, while MRI may show inflammation within the bone and subtle fracture changes. Ultrasound can sometimes help identify inflammation around the bone.
Advanced imaging can provide additional information, but the central issue is still understanding the severity of the injury and how it responds as activity changes.
Running fitness is not only the ability to run. Strength, stability, coordination, and cardiovascular fitness all matter.
If you simply stop everything and wait, the injured bone may improve while the rest of you becomes weaker. That can create another problem when you finally start running again.
The strategy we discussed was to identify activities that should not overload the injured metatarsal, add them one at a time, and then monitor the baseline measurements to make sure the symptoms do not worsen.
Going out and hopping on the injured foot or suddenly running several miles simply to see whether it hurts can apply far more stress than necessary.
A more systematic approach is to increase the components of activity incrementally while continuing to monitor the response of the foot.
If the amount of activity increases but the pain does not increase, that can be useful evidence of improvement. If activity stays the same while pain trends downward, that can also indicate improvement.
One of the most important concepts in this episode is establishing measurable baseline numbers before increasing activity.
Instead of relying only on whether the foot feels “better” or “worse,” you want specific measurements you can compare as you progressively add activity.
That gives you a way to determine whether the injured metatarsal appears to be tolerating the additional stress or whether your symptoms are beginning to move in the wrong direction.
The calendar alone cannot tell you whether you should run the race.
The more useful question is whether you can systematically increase the components of running activity while your objective measurements continue to improve or at least do not worsen.
That is why establishing the severity of the injury, maintaining the fitness you can maintain, and carefully monitoring your response to increasing activity are so important.
If you are trying to determine whether you should cancel a race, or you need help identifying the pieces you may be missing in your return-to-running strategy, you can get on a 10-minute Strategy Call with me.
We can talk about your injury, your race, what you have been monitoring, what you have been doing to maintain fitness, and the information you still need in order to make a better decision about your next steps.
Click here to block my calendar for a 10-minute Strategy Call.
«« #1047 How Much Ankle Motion With a Metatarsal Stress Fracture? | #1049 Noise From Your Healing Running Injury Is a Good Thing »» |