Tuesday, January 20, 2009

So... You Have A Stress Fracture

In the past two weeks, I've heard from several fellow runners who also have suffered from stress fractures. And although I've tried to give some advice here and there in emails, I thought it would be useful to dedicate one entire blog entry to stress fractures (from running). So, this entry is intended for those of you who have a confirmed stress fracture, or aren't sure and think you might have one.

This experience has been the toughest thing I've gone through as a runner, but I want you to know that you CAN do things to speed your healing, and you CAN come back stronger than ever. I am living testimony to both!

Funny thing, only humans and racehorses get stress fractures.

Background: After several weeks of increasingly severe pain in my lower right leg (where I continued to run 50-55 mile weeks), I completed the Chicago Marathon on October 12, 2008. A little over a week later an MRI confirmed a significant tibial stress fracture. Continuing to to run on the fracture is not something I'd condone. Stress fractures are serious business, and continuing to injure the area will lead to a complete break in the bone. As bad as taking a couple of months off of running might sound, having a few pins in your leg and being in a cast and on crutches for many weeks is far worse. And that brings me to my next point.

Get a confirmed MRI-based diagnosis. If you already have this, then you know for sure. If you've had an X-ray, and nothing showed up, request an MRI. Mine didn't show up on X-ray at first either. If you think you might have a stress fracture, please get this checked out immediately. What you do next depends very much on what kind of injury you have. A soft tissue injury is of a different nature, and while some things below might apply, many do not.

The bigger the bone, the longer recovery. Unfortunately, the tibia is the most common site of a stress fracture in a runner, and it's also one of the bigger bones. It simply takes more time to repair the damage.

Active recovery. I was diagnosed a little over three months ago. Neither my primary care physician (an Internist) nor my referred orthopedic surgeon had any specialties in sports medicine, nor were they athletes. My instructions were as follows: Do nothing for four months. At the end of that four months, I would be permitted to do some stationary bike pedaling with no resistance. A few weeks of that, and I could begin running again. I was initially horrified. And, in some cases, this amount of time off may be required. But I'll give you some suggestions below to help you heal faster and determine when you are ready to run. Whatever you do, don't stop moving. It keeps your blood flowing, your cardiovascular fitness maintained, and your mind in a better place.

Initial rest. In order for you to heal quickly, you need to do two things immediately: Get ALL stress off your fractured body part, and start filling your body with the building blocks you need to recover. We'll get to the latter in a moment. For a few weeks (if you caught this early and it's not too severe, this is about two weeks) take it very easy. Only walk when absolutely necessary. No grocery shopping, mall walking. Limit stair climbing. Give your bone time to start that initial mending process with zero interference. This should include allowing yourself to sleep a little extra each night. Sleep is the time your body restores itself.

Cross training. For the first few weeks, while you are getting to the place of "no pain," this should be undertaken carefully. My fracture was serious enough that even kicking in the water was painful. So, obvious cross training (like swimming or rowing or elliptical) were completely out. I lifted weights, especially upper body. After two weeks, you can begin incorporating other things like aqua jogger, swimming, rowing, pedaling with low resistance, other obvious non-weight bearing activities. After another week or two, incorporate things like spin class or elliptical. Add lower-body strength training. The important thing is to get your heart rate up and keep it up, while maintaining muscle tone. The more cardiovascular fitness and strength you can hang onto, the easier your return to running will be. If anything causes you pain at the fracture site, stop immediately, and try again in a week or two.

Weight gain. You'll need to reduce your calorie intake, but don't worry too much about it. It's more important during this time to fill your body with what it needs to heal. I gained both muscle and a little fat during the process. If you're like me, you know what your body looks like at its peak. You might even have a special 'vein' that pops when you are super-fit. Get over it, you're going to lose that for a little while. Don't deny your body good, healthy food during this important time of recovery.

Get calcium supplements. Your body can only process 500 mg at a time, so plan on taking this twice per day. I like Viactiv, as it's a chewy caramel. I pick them up at my local grocery store. Enjoy dairy products, if you can tolerate them. I now have organic whole milk yogurt each and every morning.

Get vitamin D supplements. You need 1000 mg (yes, 1 gram). Take that with the calcium, preferably with the first dose. Viactiv has some, but not enough. If you can get a little sunlight too, that's great.

Increase your protein intake. I like muscle milk ready to drink form. It's readily available at GNC and many grocery stores.

Consider an aircast if you have a tibial fracture. Be sure it has the front tibial plate (otherwise, it's useless). I used this. The front plate is removable. I have done runs in the air cast, and I have removed the front plate and put it into a moderate to heavy compression sock as well (like the kind you would buy at Walgreen's or Osco). You can take it off if you're just sitting around, or only walking a few feet. But if you are walking from the parking garage, or grocery shopping (you get the idea), put the cast on. It's useful for the first several weeks. Don't get a boot or a cast if you can avoid it, as you cannot walk normally and it will weaken other parts and make you more vulnerable to other injuries.

Don't take any pain meds. That includes any Acetomenefen (Tylenol) or NSAIDs (such as Ibuprofen or Naproxen Sodium). Pain is your body's most important communication line with you right now. Don't hamper it in anyway. This is one time if you feel any twinge of pain, you need to stop what you are doing immediately. Don't ride it out or push through it. In the case of a stress fracture, pain means more stress on the already fractured bone. Continued use will cause further damage and delay your recovery.

New shoes. Toss any running shoes with more than about 50 miles and start over with a fresh pair. You'll need as much cushioning as possible.

Readiness Testing. When you haven't felt ANY pain for about two weeks (this might be about four weeks from the last time you ran if you caught your fracture early; longer if more serious), give yourself the 60-minute walk test. This is a brisk walk on a treadmill so you can stop at the first twinge of pain if necessary. The 60-minute walk test is your friend. Make sure you can complete it successfully a couple of times before you even think about running. If your stress fracture flashes even once during this test, stop immediately. Light jogging will put about twice the stress on your bones as walking does. So, a four mile walk is equivalent to a two mile easy jog.

Those first runs. When you do go out for a test run, it's better to run, take two days off, run again. Make these about two mile runs. Remember, the force on your legs for light jogging is about twice that of walking. Gradually work into more runs during the week, substituting cross training workouts for runs. First week, just run twice, three days apart. Second week, try running three times. Third week, try every other day, and work into it that way. If you experience pain at the site of injury, stop for a few days and go back to your 60 minute walk test.

Soft surface training. When you do run, only run on soft earth for awhile. Gradually work in treadmill runs. Don't run on concrete or asphalt for quite a while.

Consider acupuncture. I never did this, but several folks recommended acupuncture to stimulate the healing process. I have heard this is particularly good for stress fractures. I was about to finally try it, but ended up being able to run again.

Psychological issues. I had the pain long enough that it is entwined in my memory. I recently watched Prince Caspian, and the hard marching of the soldiers as they went into battle, and seriously felt pain while sitting still. When I began running again, I felt lots of interesting sensations. Buzzing, itching... a heaviness, almost as if there were a bubble there on my leg. I still fear the pain. Not because I can't handle pain, actually I have quite a high tolerance of it. But I do fear what it would mean if my fracture suddenly got worse. I've been through some pretty dark days, and I got through them. If you need help dealing with this injury or just want to talk to ensure you are not crazy, feel free to direct message me in twitter, http://twitter.com/run350. I'm here to listen. There is also a stress fracture forum in Runner's Lounge.

I'm back to running now, six days per week. I have been doing some light to moderate speedwork for about two weeks. My pace is better than it ever has been, and I feel quite strong. I think there are some specific reasons for that I won't go into here, but I do want you--as a fellow stress-fracture sufferer--to leave this blog entry knowing that you can be back exactly where you were in just a few months, probably even faster and stronger. The rest might actually do you some good! Take advantage of it, and don't give up hope! You can recover from this, and unlike some soft tissue injuries that can linger for years, your bone will heal completely.

185 comments:

Rick said...

Great post, Alex. As a current stress fracture sufferer this information is invaluable. The way you have come back since your SF is an inspiration.

runner-grrl said...

Thanks, Rick! I'd hate to waste a perfectly good stress fracture and not help someone! Best wishes to you for a speedy recovery. I can't wait to hear about your first 60-minute walk test.

Sharney said...

Thank you so much for this! My pelvic stress fracture has really been getting me down. I totally agree with you about being able to handle the physical pain and not so much the mental pain that comes along with these types of injuries.

You made me feel so much better and I have a renewed hope that I WILL run again!

runner-grrl said...

Sharon, I totally know where you are right now! But, you're going to come back from this more fierce than ever :-) because it will mean even more to you! Hang in there.

Joanna said...

I came across this post 4 months into my separation from running due to a pelvic stress fracture, and the day before my ortho appointment when i was finally given the ok to start running again. Still, despite the official word that I could progressively integrate running back into my routine (luckily I had been able to bike and later elliptical throughout the injury), I was hesitant and somewhat terrified to run that first mile.

You're totally right; it's not the physical pain (I think as runners maybe we are more tolerant of pain in general) that was unendurable. The mental pain of uncertainty and the fear of further injuring (and therefore prolonging the no-running time) was more excruciating.

Anyway, just wanted to say that I found the information here really accurate and comforting in knowing that my experience wasn't an isolated one.

runner-grrl said...

Joanna, So glad to hear from you, and I'm pleased your return to running has been granted. From the jealousy of seeing other runners, to the heartache of not being able to do what you love the most... being out with a serious injury is extremely difficult. Let me know how you are doing! I hope, like me, you find that you come back very strong!

Anonymous said...

Thank you so much for this article. I was diagnosed with two stress fractures on the pelvic bone. It has been almost 3 months (!!!) since my last run. Your article gives me hope that someday I will run again. I will probably be very scared to run at first but hopefully will overcome this fear of getting injured again. Thank you again.

runner-grrl said...

Anonymous,

I'm so glad you stopped by and wrote. I, too, lived in such fear of the pain.. and re-injuring my stress fracture. I had stops and starts, but am so grateful to be running again. Sorry to hear about your double fracture :-S That sounds awful. Would love to hear more of your story, but especially more about your recovery. Best wishes, and a speedy comeback!

kdph said...

Thanks for the post. I'm getting over my stress fracture too (it's been over 5 months). However, I've been running about 4 weeks - 3 times a week now and I noticed a little pain in my foot at night (never on a run). Did you ever experience pain again? Just wondering if others feel this or if I need to see my dr.

runner-grrl said...

Kdph, Tell me a little bit more about your fracture (where in your foot, how severe, how long before you stopped running), and if you did a good job in addressing the factors that led up to it (e.g., vit D, calcium, good diet, rest). In general, I did have many sensations in the area (still do, nearly 4 mos. later). But, they are not "pain" related. Pain is the best guide you have right now, be sure not to take any pain reliever of any kind. I'm more worried about whether you've addressed the underlying issue that got you here. If you aren't feeling anything DURING the run, and you're doing a good job of recovering, you are probably OK. But, take some caution, and don't run the day after you feel some pain at night. Try again the next, next day, and be sure you are using a soft surface (e.g., trails or treadmill).

kdph said...

Well, my stress fracture was in my 2nd metatarsal of my left foot. It was so severe that it was almost a complete break. Fortunately, the reason it happened was my PT made a poor orthotic (gave me 1/2 an inch lift in only one foot). I ended up fracturing it in just one run (only 2 miles in). My orthopedic dr. said it was directly due to the PT's negligence. Anyway, so the issue should not be an issue any longer. My dr. cleared me to run, but just said run until it hurts. I started up really slow - walking for an hour every other day. Then, I increased from 5 minutes to 10 minutes and after 4 weeks - I got up to running 25 minutes on a treadmill. Then, I went out for a run (really slow paced) outside for 25 minutes and my foot started to flare up at night. It never hurt on the run, and still doesn't hurt (just constantly reminds me that it's there). I've taken my 2nd week off (have just been walking again for an hour every other day - still no pain). So I may try to start back again, but not sure how long or how far. My foot just goes numb and twinges - but doesn't really hurt. I just don't want to re- injure it. My ortho dr hasn't really given me much advice and I can't trust my PT so I'm not really sure what to do! Any input would be appreciated. Thanks!

runner-grrl said...

Kdph, Sorry to hear this has lingered on so long for you. I am glad that the underlying cause was a simple fix, but wow, what a bad break (and I mean that literally). I have a fellow runner who had a similar fracture, and she said she felt some pain for almost a year. But, she was back running in about the same time frame as you, just mixing it with biking and swimming. She went on a do an Iron Man a few months later, but continued to complain about some lingering pain. (Just saw her a few weeks ago.)

You *might* want to get another MRI or a bone scan just to check the healing. But it sounds like you are on the right track, it's just taking a while. Some of the recommendations around diet (putting the right healing building blocks) might speed things along a little for you (if you aren't doing it already.)

I don't want to advise you to push on through pain, even if you are feeling it only at night. But if it never occurs on the run, and only pops up occasionally or briefly at night you are probably OK for easy workouts (the MRI could help support this). Be certain that this never increases. If it does, back off on the walking / running for a few days.

I really like the 60 minute walk test, which is about equivalent to two miles of jogging / easy paced runs as far as impact goes. Maybe you could try alternating the two, but give yourself a "rest" day in-between, where you are doing something non-impactful to the fracture site (swim, bike, weights, row, etc.)

Avoid going back-to-back day walks / runs until you have not felt even a twinge of pain, and if at any time you notice it getting worse, take more time off and cross-train.

Hope that helps! --Alex

Lorraine said...

I'm three months into rest/crutches for bilateral tibial stress fractures. (Four months undiagnosed before that.)Doc says to start adding weight to legs but this doesn't seem right; I'm still quite sore on palpation. Been swimming without kicking, but no weight on legs. Lost lots of muscle. I feel that buzz and pain in muscles. I can't quite trust the doc's direction to add more weight-bearing when bones are still sore. What do you think?

Lorraine said...

I'm three months into rest/crutches for bilateral tibial stress fractures. (Four months undiagnosed before that.)Doc says to start adding weight to legs but this doesn't seem right; I'm still quite sore on palpation. Been swimming without kicking, but no weight on legs. Lost lots of muscle. I feel that buzz and pain in muscles. I can't quite trust the doc's direction to add more weight-bearing when bones are still sore. What do you think?

runner-grrl said...

Lorraine, I think you are having a very tough time! I'm so sorry to hear about your bilateral stress fractures :-(. I'd love to get more of your background. I'm sure I can help you. My stress tibial stress fracture was months old also before I was diagnosed. Please drop me an email at fongrrl at gmail dot com, and tell me about your diet leading up to those four months undiagnosed, your height / weight and your training. I will have a bunch of questions after that too. Let's get you back on your feet soon! --Alex

sunnyrunner said...

Thanks very much for the info. I just found out today that I sustained a pelvic stress fracture after an MRI scan. Wednesday before Boston Marathon 2009, I thought I had a minor groin muscle pull. I nursed it for the next 4 days prior to the race but the pain resurfaced as I started the race on Monday. I ran for 13 miles with pain (which was not a smart thing to do). With the excitement of running Boston for the first time, I couldn't stop until mile 13when the pain was unbearable andI can hardly walk. I saw an excellent sports medicine orthopedist who thought it was a pelvic stress fracture but wanted to confirm it with an MRI scan. I just got the results today which confirmed what we suspected. I was advised to not weight bear for 4 weeks after which if things improve, I can start PT and perhaps cycling or elliptical. In retrospect, I should have stopped earlier in the race but mentally I couldn't process that until it was too late. I did undergo an intense training regimen including fast interval work prior to the race which I suspect caused this. The important thing is I can heal from this and continue to run. It's a set back but reading other's stories has helped me to see things in perspective and look forward to running again. Thanks for the important information and I look forwad to the 60 minute walk challenge.

runner-grrl said...

Sunnyrunner, First of all, congrats on getting to Boston! I can totally understand your excitement and wanting to push through the pain. (I did the same through through Chicago, finished somehow, and then had the MRI.) Maybe not the wisest.. but that is how we are wired! I'm really sorry to hear about your pelvic stress fracture. You are right--you are going to run again. But, I know your road to recovery will be a tough one. Please write me back in a few weeks and let me know how it goes (or sooner if you'd like). It's an up and down journey, and you will probably go through some low points. I'd be happy to listen, either here or in my email at fongrrl at gmail dot com! --Alex

sunnyrunner said...

Thanks Alex! It's been helpful to have other runners understand what you're going through. I certainly need it at this time. The people I run with are a little freaked out about my injury since they are worried that this can happen to them. Obviously, if I was in their situation I would think the same. So I don't talk about it much.

As you know, it is very fraustrating both psychologically and physically when one is not able to work out after being so active. My ortho doc said I can swim so I have been for the past week (maybe a little excessive - at least 45min to an hour). It hasn't bothered my hip or my leg. But, reading some postings of people who have had pelvic stress fracture, they are recommending not do anything at all including swimming for faster recovery.I thought swimming would be okay but am I paying the price of delayed recovery?

I appreciate any thoughts on this.

runner-grrl said...

Sunnyrunner,

I'm encouraged to hear that swimming for 45-60 minutes at a time is not causing you any pain. I think pain should be your guide at this point. If the exercise is non-impact, and it doesn't hurt the injury site, you should feel free to do it vigorously.

The more fitness you can maintain throughout this, the better both your physical and mental healing will be.

Conversely, not exercising at all will make your comeback that much more difficult (muscle loss, cardio fitness loss), and will leave you a very frustrated runner.

Write back soon and let me know how you are doing! I also left you my email in the above post if you want to write there.
--Alex

Anonymous said...

Great post. I have been nursing a tibial sf for 4 weeks and was told I could try running very gently. 2 miles every 3rd day. The first two runs were pain free however I ran a slow outdoor couple of miles today and my leg is really sore at the injury site. Do I need to back right off again or can I try another run in 3 days?

runner-grrl said...

Anonymous, Sorry to hear about your TSF. If you were able to squeeze in two 2 mi runs, three days apart with no pain at the four week point, you are healing very quickly and nicely.

However, since you were "really sore at the injury site" on your last run, I'd give yourself more than 3 days rest. To be honest, in those six little words you wrote and the timing, I'd back way off and take two weeks of no running. Then try a few of the 60 minute walk tests on alternate days. If during your first few weeks of come back you feel this sort of pain, it's important to stop right away and rest your leg for a few days (don't push through, as tempting as that is).

Make sure you are running only on soft surfaces for a couple months as well (dirt trails, even grassy fields or treadmill). I'd avoid anything paved for awhile.

If you have an aircast with a tibial plate, I would wear that during the day to take all stress off the tibia as well for a couple more weeks. You can even try your early walk / runs in it when you are ready (I did). It just aids the healing process, allowing a little more activity sooner.

Best wishes in a very speedy recovery! Would love to hear how it goes :-) --Alex

Amanda said...

Hi
I was diagnosed with a tibia stress fracture 11 wks ago (it had been misdiagnosed 6 months ago and I was told it was ok to continue running which I did for 6 months). I have now been told to stop running but it is ok to go on an excercise bike and swim. After any activity it tends to hurt afterwards from anything from a couple of hours to a few days and sometimes it hurts when I have done nothing - back at week 6 the consultant said it would hurt after use and that was ok. Over the last week I have not been swimming or cycled to see if it helps at all and have just had the odd gentle stroll. On Saturday it felt alot better but yesterday it hurt and the pain actually woke me during the night and I had very little sleep and it is still hurting, again all I did yesterday was a 20 min stroll. I have had some night pain but not any that has woken me before. Also, the swelling over the general area is still the same. Just wondered if this was normal.
Cheers Amanda

runner-grrl said...

Amanda,

Thanks for writing, and I'm really sorry to hear about your TSF and such a long recovery time.

Having gone through this myself, and heard from countless others, either your fracture isn't healing, is much worse than you were told, or there is something else going on. So, no, I do not think this level of pain is normal this far out.

Were you told about the degree of your TSF? I imagine if you ran on it for 6 mos (I ran on mine for a few months as well), its quite possible it is very significant and that could be part of the problem. (In which case, you need to take some more drastic measures to kick start the healing process.)

Correct me if I'm wrong, but I don't think you've had a good, solid two to three weeks with no pain. If that is the case, I think you really need to go back to ground zero.

If you have the ability to have another xray, bone scan or MRI to confirm your healing state, you should do that. How was the TSF confirmed 11 weeks ago?

I would get the aircast with the tibial plate and wear it non-sleeping hours and do as little walking as possible for a good solid two weeks (e.g., don't go to the mall, long stroll, even long grocery shopping if you can avoid it). You need to get the stress completely off the tibia, and you need to get ahead of the healing curve.

Ensure that your diet follows the guidelines I wrote above (adequate calcium, vit D, calories for healing).

Please feel free to write to me directly at fongrrl at gmail dot com. Once you get to that pain free state, I think you can come back pretty quickly. (I am not a proponent of a long time of no running.) But, I'd love to discuss more details with you. This is a tough injury.. but you can come back stronger than ever. --Alex

Lindsay said...

I got my first stress fracture 2yrs ago in my 2nd metatarsal and it healed up beautifully...I haven't had any problems since. Well after the San Diego marathon a few wks ago, I injured my left tibia. I couldn't walk for a few days but slowly it started getting better so I didn't think it was a stress fracture. I finally went in for a MRI and low and behold it is. I'm registered for the Chicago marathon in October...do you think I think enough time to still train for it once this heals? It's been 4wks since the break and I can walk okay I just can't do any running so all my workouts have been deep-water running. Any ideas?

runner-grrl said...

Lindsay, Sorry to hear about your TSF. You are in a tough spot with regard to Chi. You probably need another 2-3 weeks of no running on your leg. Unfortunately, the reality is that Chi is 14 weeks and 6 days away. Which means 12 weeks to really train before taper from now, translating to 9-10 weeks max for you, and you probably should be testing some low mileage at the start of those weeks. I don't know much about your goals for Chicago, and therein probably lies your answer. Can you run a marathon in October if you heal quickly--probably, if running to completion is your only goal, though you will be undertrained. If your goal is more time oriented, I'd probably look at a December marathon, and give yourself a few more weeks to train. Maybe look at CIM? Let me know if that helps. --Alex

Chris said...

Runner Girl,

I am entered to run the Chgo. Marathon on October with Team World Vision. Sadly, I began to experience pain and stopped running July 6th. About 2 1/2 weeks later I was diagnoses with a TSF. The doctor put me in a boot about two weeks ago. I see him again on 8/24 to see if it has healed. In the mean time I have been cross training on a stationary bike and doing deep water running. At first I was doing so rigorously--2 1/2 hours, etc. but backed off for fear it may impede the healing process. Two questions:

1) How long can I do the bike or swim per session? If there is no pain, can I basically follow along with our running schedule? That is, bike for an hour for a 5 mile run; two hours for a ten mile run, etc.?

2) If the doctor gives me the go ahead in late August or the first week in September to begin walking again that leaves me just 6 weeks before the marathon. What do you think about me still aiming to do the marathon--though only trotting and walking? I am unconcerned about the time, I just want to finish, even if it takes seven hours? Is six weeks back on my feet just too short a time?

Thank you. Chris

runner-grrl said...

Chris,

I'm so sorry to hear about your TSF. Interestingly, I am also signed up for Chi marathon as part of Team World Vision... although you probably already know that from my sidebar :-) So, I understand your motivation especially to ensure that you finish. Team World Vision is a great cause, and one in which I passionately support.

For your first question, and answer honestly to yourself, if you experience no pain while biking or swimming, go for it, without limitations. I was unable to bike without pain for several weeks. But, on the bright side, you also discovered your pain and stopped running immediately. I ran for quite awhile on my TSF, actually ran the Chi marathon last year on a TSF that had been there for some time (not recommending that, sheer stupidity on my part).

For your second question, I would say, if you get clearance to walk on it, start working towards the 60 minute walk test I speak about here and follow that schedule. For a more detailed return-to-running schedule and further discussion, feel free to email me at fongrrl at gmail.com.

For your final question, "Can you do Chi this year?" I'm really glad you told me your goals. You can briskly walk the marathon in 6:30. If your cross-fitness is maintained, you might even feel pretty good at the end :-) If you can do any strength training in the meantime (e.g., ankle weights for leg extensions, curls), you'll do a lot to maintain your strength.

Let's chat a bit more in email--I'd like to follow your progress a bit more, but I think you can pull Chi off to completion and be very happy you did! --Alex

caitlin said...

Hi I love your blog about the stress fracture. I was wondering if you could help me. I was diagnosed w a tibia stress fracture about 2 mo ago. Of course, I had for for about 5 or 6 mo but kept running on it. I was in an aircast for about a month and a half. Then the doctor said I could cycle and do non-weight bearing activities for 3 weeks. After that, I could run every third day. I followed this schedule:

http://www.pfitzinger.com/labreports/stressfracture.shtml

I'm sure you've seen it. Well, I was doing fine until I got to about the 4th week. I ran two days in a row and the pain returned. So i backed off and ran every other day or every third day for only 20-30 min. But they pain is getting worse.
Any suggestions!?? I'm taking vitamin D and Calcium. Do you think I should take two weeks off? Am I ever going to be able to run again?? I'm in complete fear right now!

runner-grrl said...

Caitlyn, I just DM'd you my email address in twitter, so please feel free to write to me there. I have a lot of questions, but for the moment, let's not run on your leg until we get them sorted out. Do anything else that will keep you fit but not cause any pain (e.g., strength train, swim, bike).

Tell me more about your weight; your diet; whether you've had a bone mineral density test; how you were diagnosed w/ the stress fracture in the first place; any history of osteopenia or osteoporosis, and what degree your SF was when it was finally diagnosed. Also, I want to hear if there was a follow-up x-ray or MRI done when your doctor gave you clearance. You are in a stage where we need to be especially cautious before we start loading your tibia. --Alex

Phil said...

ok, after reading all these comments this may seem like a stupid question but here goes...I was diagnosed with a stress in my pelvis after an MRI. The doc said it wasn't an awful one but I had one. I had been training for the Chicago Marathon and was up to 15 mile weekend runs. My doc said take 3-4 off weeks with no running, I could bike or swim. After 4 weeks or so he said if I felt absolutely zero pain I could try running gradually. Here is my question - the Chgo marathon is Oct 9 - about 3.5 weeks after I am cleared to start running assuming no pain, do you think I can give the marathon a shot? Its my first one and while I dont want to further injur myself i would hate to see all my time traning go to waste. Thoughts???

runner-grrl said...

Phil,

You basically have two questions. One, can I run the Chicago marathon if I am feeling ok in 5 weeks, and two, will I possibly be doing further injury to myself if I do.

I can answer both questions for you, but I do need more information. Generally speaking my main questions are: first, what are your goals for the marathon? And two, why did you get the fracture in the first place?

I need some of your history, age, diet, weight, training, tests / dates around the fracture (e.g., bone mineral density, etc.) and any other relevant information.

Then tell me what would make you happy in Chicago--e.g., "crossing the finish line in 6 hours mostly walking is ok with me." Or, "I really need to break 4 hours."

My email is fongrrl at gmail.com.

Best, --Alex

p.s. I am running Chi also (ran it last year too)

Anonymous said...

What a great blog... I'm 8 weeks in to being diagnosed with an early tibial stress fracture. Been deep water running, cycling and swimming which has really kept my fitness up. I've had a couple of short runs on soft grass, and a go running slow on the treadmill over the last couple of weeks. I feel no pain where the SF was but am getting some tight weird feelings just below in my ankle when I do run. It just doesn't feel normal. Any idea what this might be? I'm scared to keep running if this is doing me more harm than good? it really plays on my mind.
Karen

runner-grrl said...

Karen,

So sorry to hear that you have had to deal with a TSF. I'm glad you caught it early. It sounds like you've done a great job of keeping ready to run while you were out (such a long and frustrating process, I know). You are also really listening to your body--which is critical in these early months of recovery. It is hard to say what the ankle problem is, but the fact that "pain" isn't part of your description is a good sign.

Three thoughts for you. First, do you know / understand what led to your stress fracture? And have you addressed the underlying issue(s)? I'd love to help you think through this if you're not sure. Please feel free to write me, fongrrl at gmail dot com. I want to be sure there isn't anything like osteopenia going on and also that this won't happen again.

Second, what could the ankle problem be? You might be using a different foot strike (or changed shoes for that matter) and that is causing some different alignment and the ankle is reacting to that. I know my stride changed a bit during comeback (more outside foot / heel striking instead of midfoot pronation), as I was afraid to put impact in the same spot that caused my TSF in the first place. I can also tell you that for several months I had odd tingly / tight sensations near my TSF. The tibia is one of the largest bones in your body--it takes a long time to lay down all the bone necessary to be completely healed and stronger than before. It is likely this is nothing to worry about (but I do want to hear about the root cause of the TSF).

Third, you are returning to running very early if you've been doing a few runs for a couple of weeks already at the 8 week point. Be very careful and cautious and keep listening to your body. I know you are dying to get back to where you were, but coming back too fast might lead to a reinjured SF and a very prolonged healing process. I'm not suggesting it isn't possible, but you are about two weeks ahead of what I would consider an aggressive return for this injury. Keep pain as your guide, and write to let me know how you are doing.

Best wishes for a continued successful comeback! --Alex

Quick Recovery said...

Thank you. There is another important therapy you could add to your very helpful list of recomendations. As described by this post from a doctor who had a tibia stress fracture and was able to compete in a marathon with no pain in 6 weeks! Quite remarkable, he used a device called Q magnets and there was a published study by Constantino et al called "Treatment of wrist and hand fractures with natural
magnets" that provides scientific evidence. You can see it at qmagnets dot com under published research.

Anyway, I hope this can help someone else.

Anonymous said...

Hi,

I just read all the blogs and am open to any advice I have had four stess fracture in 6 years I am currently midway through recovering from my second one this year. I missed running Boston last year cuz I had a femur fracture and now it's another tibia Boston is out again! I'm 59 tiny and have Osteopenia I pool run initially then spin then go back slowly after 10-12 weeks

There doesn't seem to be any consistent pattern I take supplements medication and eat well

I'm very frustrated again

Jackie

runner-grrl said...
This comment has been removed by the author.
runner-grrl said...

Jackie, I'm glad you wrote. I think I can help you break your pattern, but we need to talk through a lot of details. It's clear that your osteopenia is an aggravating factor, but I still believe you can overcome this. Please write me at fongrrl at gmail dot com, and tell me about your diet, what supplements you are taking, the amounts, the times of day, and your meds. Also, want to know your running mileage and a bit more about your training and each of your SFs (you mention the femur and tibia this year, where exactly were they and what were the two others). Don't lose hope, --Alex

Anonymous said...

Hi - very informative post. I had/have a pelvic stress fracture (inferior ramus) that was misdiagnosed as an adductor strain. I did 4 weeks of P/T before learning that I had a stress fracture. Because cross-training was causing shooting pains, my ortho advised me to take a full 6 weeks off. I did it, and it sucked (I just kept telling myself that if I took time off now, maybe I'd be back to running more quickly). A follow-up MRI revealed that I was healing, but not fully healed. My ortho said to start walking, and once I could walk comfortably (no pain) at a fast pace for 3 miles that I could then try running. So I did test walks every-other-day for 2 weeks, then I did my first "baby-steps" run (after a full 12 weeks of no running). My first run was just two 1/4 mile slow intervals with walking before/between/after. My 2nd test run was today, and I did 1/4 mile, 1/2 mile, 1/2 mile with walking between. It's just hard to tell if I feel "pain" or just my body getting used to moving again. Pelvic stress fractures tend to present with groin irritation/tightness, so I had no idea I was running on a sfx. In my 6 weeks off, I had a DEXA scan (results were normal range), and took additional calcium with vitamins D and K. In hindsight, I built up mileage too quickly (went from 20 mpw to 40 mpw in about a month), so I won't make that mistake again. I'm just feeling very much like I'm in limbo right now... I know I need to take it slow and easy. Anyway, just wanted to say thanks for your post/info!
Tracy

Sarah said...

Thanks for your Post. I was diagnosed 2 weeks ago with a lower left Tibia stress fracture by a Bone Scan. I was Training for a marathon on Dec 20 and was peaking at 50mls a week. I have 4 more weeks of road rest, but have been swimming and biking A LOT. My question is this, If I keep my cardio health in check (somewhat) Can I run in a marathon on Feb 21 or is this too soon to ramp up that many miles just a few months afters a Stress Fracture.
Thanks!

runner-grrl said...

Tracy, So sorry to hear about your pelvic stress fracture! Sounds like you've identified a few key areas that probably led to your fracture. I do think some of the sensations you are experiencing even now are completely normal. But, you are in the healing process (still), so be cautious and let pain be your guide. I'd also recommend using an Active Isolated Stretching program (such as the one Phil and Tim Wharton do). If you'd like to chat more about workouts to restore you to where you were (or additional explanation on why the stretching is important for your type of injury), please feel free to email me at fongrrl at gmail dot com. Wishing you a speedy recovery! --Alex

runner-grrl said...

Sarah, I'm really sorry about the tibial stress fracture right as you were getting ready for a marathon in a few weeks. Four more weeks will only put you out six weeks from the TSF. That is a very aggressive timeline--not to say it can't be done, but best case, you are looking at early January before you can begin walking / running for training. Since you will need to have time to build up and then taper some from the marathon, my general advice would be to plan on a marathon in late Spring or early Fall. But, there are some circumstances you could do it, depending on your goals. Email me at fongrrl at gmail dot com if you'd like to talk more about your recovery and next marathon plans. Best wishes, and a speedy recovery! --Alex

Anonymous said...

Hi! I am a friend of Rick's and just qualified for Boston this past October. Have never had any real significant injuries. Was training for Disney and did a 16 miler four weeks ago. Had a great run and stayed active with my family all day that day. The next day I stepped out of bed and had a pain in my foot. I isolated it to the second metatarsal. Have been told it is a stress fracture and am in a special shoe. Waited about 10 days to find the right doctor. Have been lifting and riding the bike and doing a little elliptical. Am entered in the Boston Marathon this April. It will be 4 weeks this Sunday since I have run. I can still feel a little pain and tenderness in the area. I am taking a 600mg Calcium supplement two times per day as well as a multivitamin. I am a 47 year old female by the way. The vitamin also has Vit D in it. Do I need additional Vit. D? I am so sad...going to Disney next week and not running for the first time in 6 years! What is your advice on my injury? Is Boston still a possibilty? Thanks for your help! Terri

lauratwinrunner said...

This is a great post! Thank you so much for the detailed information about active recovery... I have an orthopaedic specialist appt tomorrow, about a possible tibia stress fracture (perhaps a tibia stress reaction). I was wondering about the earliest symptoms people experience. I was in peak shape.. and, coming to indoor 200 m track (tight and round - no straight aways) gave it my all and in the process had calf pain for maybe 4 days. After that, resumed easy-ish running for a few days.. and even ran (and won a master's 1st place) at a 10 miler. The following week I started experiencing what I thought was ankle discomfort - a strange stress almost 'scratching' irritation just above the inner ankle bone (above the left medial malleolous) that seemed to happen somewhere after the 5th mile of 6, in two successive training runs. After reading and poking around it really seems consistent with a tibia stress reaction or fracture. The great news is that I think I've caught it super early.. and was wondering if other people have felt this strange, mild irritation, and minor 'pain' if you could call it that - and not the deep bone pain that some describe. Again, I have an appt. tomorrow with the Orthopaedist...
Thank you!

runner-grrl said...

Lauratwinrunner, Sorry to hear that you are having what sounds like a stress fracture! For me, it did come on as calf pain first (I didn't recognize it immediately). It is not even unusual for athletes to not have much pain at all in the beginning. It's good you are going to be evaluated tomorrow. Catching it early is best, but will still require a few non-running weeks of recovery. Be sure to insist on a bone scan or an MRI for an accurate diagnosis. Write me back and let me know how it goes! fongrrl at gmail dot com. --Alex

runner-grrl said...

Terri, As I was here responding to Laura, I noticed my lengthy response to you wasn't posted here :-( Drop me a note at fongrrl at gmail dot com. I do think you can have a great Boston--I'll share with you a few reasons why I believe that. I also think you need to up your Vit. D (to 2,000 IU / day if you can). Your body likely can't process more than 500 mg of Calcium at one time. You might consider a third dose for awhile. --Alex

Meghan said...

Great Post Alex!! I was just diagnosed with a 2nd metatarsal head stress fracture of the right foot this past Monday. I'm training for Boston, and recently added a bunch of plyometrics classes to my training ( big mistake- too much pounding combined with the running). It hasn't shown up on xray yet ( too soon) but the Dr. is 95% sure its a stress fracture. I was pain free until Saturday morning when I went for a group run and it flared up around mile 6 or so. I have had stress fractures in the past, and they have come on more gradually. I was really hoping this was extensor tendonitis, and I could take 2 weeks off from running and then jump back into Boston training. The pain is the classic "push on the bone and elicit pain" type though :-( Do with the typical 6-8 weeks off, do you think Boston 2010 is totally out of the question and I should go ahead and defer to 2011? I will swim and bike these next few weeks to keep my cardio up.... but running is really what keeps me sane :-( Thanks!

runner-grrl said...

Meghan, Sorry to hear about your stress fracture... :-( If caught early enough--it can heal fairly quickly. The metatarsal is a fairly small bone (faster than a tibia and much faster than the pelvis). If you heal well, you can be running in 3-4 weeks. That won't set you up for your ideal Boston. You could still run it with slightly lesser goals, and do a lot of cross training (esp. pool running) in 2010. If your qualification window is wide enough, maybe you run both. Enjoy 2010, and then make sure you PR in 2011!
I've had extensor tendonitis, and that is quite painful, but is usually pretty resolved in about two weeks. If you can get a bone scan to be sure.. that might be helpful in this case to know when you can resume training.
Write to me if you want to talk more. Best wishes for Boston! fongrrl at gmail dot com --Alex

Sam said...

Help! I am training for Boston and was in the best running shape of my life when one day, after 29k, I suddenly had severe pain on my medial tibia. If I'm completely honest, I was treating for shin splints for about 3 or 4 weeks and had started to require advil prior to my long runs. Stairs weren't even possible and attempting the hop test was a joke. I couldn't even get off the ground. I was on crutches for a week, started with elliptical and pool and continued weight training. My last long run was 4 weeks ago. Xray was negative and still waiting on results of bone scan. I have been icing and doing acupuncture once a week. I tried running last week and it brought me to tears. I experienced a tib SF about 10 years ago in the same place. I am so frustrated!! I did 5 K today with my leg wrapped. The pain was fairly constant throughout but at times so bad I had to stop and take a break. I am bound and determined to complete Boston. I know my goal is out the window but is there ANYTHING I can do to just get through these next few weeks???? I realize I will have to take the summer off after Boston but I have a high tolerance for pain.

runner-grrl said...

Sam, I'm really sorry to hear about your predicament. There are some immediate steps you need to take to stop doing further damage to the tibia, or your injury will end up being far more severe than a stress fracture. Write me at fongrrl at gmail dot com, and let's talk about a plan for letting your leg heal a bit and how to get through Boston. --Alex

Anonymous said...

Hi,
just wondering if anyone knew what activities are best for a tibial stress reaction. I was diagnosed in december, did an hour of aqua jogging 6days a week, took a month off running and started back to find that it's still there. I now face another month off and it's really getting me down. I'm wearing the space boot thing when going for medium walks shopping etc, and using an exogen bone stimulator also, but am currently not x-training at all. Is awua jogging okay with this? Doc said something about any flexion of foor/ankle makes the calf muscles pull on the shin, so REALLY don't want to delay healing this time, but at the same time, would like to stay active, for mental health is nothing else! Many thanks,
Paul

runner-grrl said...

Hey, Paul, I completely understand the mental part of it. The Aqua Jogging is a great method for cross training, but there are other things you can do. You indicate you have a stress reaction as opposed to a fracture. Write to me and tell me about your diagnostic test (which one) and date of test, training when you discovered the problem and your diet. I'd expect you to be a bit ahead of where you are now in the healing process. Let's try to figure out why. My email is fongrrl at gmail dot com. --Alex

Anonymous said...

Today I was diagnosed with a tibial stress fracture. The last two months have left me feeling bruised to the soul. When 2010 began, I believed it'd be the best year of my life. I was training for Boston (my first time and it took me three years to qualify).

It started as a tightness in my calf and gradually grew worse. I cut back on running and went for active release. When the injury did not seem to be getting better, I asked my chiropractor if he thought it could be a stress fracture. He said no, yet it kept getting worse and I kept trying to run off and on for another month.

I'd go through this horrible mental/emotional thing where I'd build up my courage to try running, only to have to back down when it started to hurt. All the while I felt in my body that there was something horrible wrong ... it couldn't be soft tissue.

Eventually, I took matters into my own hands and asked my family doctor for a MRI. Thank god I did or I might be contemplating yet another attempt at running only to make a bad situation worse.

I think I've had a stress fracture for two months. I've done very little running in the last three weeks.

I posted to your blog just to vent some steam and not feel alone.

Thank you.

runner-grrl said...

Anonymous, Sorry to hear about your stress fracture.. your story doesn't sound so different from mine. I didn't get great guidance early on either, which kept me running for a few months with an obvious stress fracture. I had the same feelings in my calf, and had assumed it was soft tissue as well. I've been where you are, and I know how hard it is. I hope that reading through some of these stories indeed has helped you to not feel so alone. There is hope, and you can recover well if you put your mind to it. If you'd like, drop me an email and let me know how your recovery is going. fongrrl at gmail dot com. --Alex

Anonymous said...

Ugh, read alot of these posts...I too was just diagnosed with a TSF. Thought it was a knee injury because of the location. I had an MRI but was never told the severity of the SF. Was just told to do light workouts. I injured it about a month ago so figured it started healing. I still have alot of pain if I try to run. I can do a moderate stairmaster workout with very little pain. Wondering if this type of cardio is suggested or not?
I also was diagnosed with osteoporosis @ 35 but refuse to take fozomax.
Really just want some advice on keeping the stairmaster a part of my cardio if only little pain - and really only after the workout not during.
Thanks...Jennifer

runner-grrl said...

Jennifer,

So sorry about the stress fracture, and osteoporosis. Be sure you are getting enough Vitamin D (2,000 IU / day) and Calcium (500 mg 3x day).

Pain should be your guide here. Cardio workouts are good, but if you are still experiencing pain (even AFTER the workout), you may not only significantly delay recovery, you may prevent it. You might want to try aqua jogging, spin class or elliptical for a few weeks until you no longer feel ANY pain, then work the stairmaster back in. Only after you've been pain free for about two weeks should you begin walking or running for exercise.

Best wishes for a speedy recovery! --Alex

Maegen said...

I've been recovering from a tibial stress fracture for quite awhile now and was just wondering if you can wear the aircast with tibial support while running?

runner-grrl said...

Maegen, Yes you can wear the cast while running. Also, you could take the tibial plate out and slip it into one of those heavy compression socks. Make sure you've had at least 3-4 weeks of non-running rest before you attempt this though. --Alex

Mari said...

Alex - thank you, thank you, thank you for this! I was diagnosed with what my orthopedic surgeon calls a mild pelvic stress fracture two weeks ago, at the height of my training for the San Diego marathon. He said I can continue to work out without pain, and I am continuing to do 5 workouts (pool running and stationary bike) a week, but I am concerned about a) my fitness for the marathon, and b), what the recovery will be after the marathon. (I plan to go ahead and do it as a run/walk if I have to - I'm doing this through Team in Training and really want to finish this). Could you give me some idea of what to expect?

runner-grrl said...

Mari, So sorry about the pelvic stress fracture.. glad it's minor. San Diego is June 6, so about two and a half weeks away. You were diagnosed about two weeks ago, which means you won't have done any serious running for about a month. You didn't say--but I'm going to assume that this is your first marathon and that you will be happy to finish :-) Stay on top of the recovery, don't push it too hard. Not sure what your goal pace was, but think about planning a run / walk strategy from the beginning (such as 5 min. run / 5 min walk) if that doesn't bother you. If it does, then just plan on walking. Take it easy, though, it's not much time to heal. If the injury feels painful during the marathon, I'd take a DNF and live to run another marathon another day. Feel free to write me directly, fongrrl at gmail dot com. Best wishes! --Alex

Anonymous said...

Your post is now my bible as I suffer through my 8th week of a tibial stress fracture. I am stubborn as can be and refuse to admit that I haven't healed yet. I love biking, so I was so happy to read your view on active recovery. My orthopedic has also given me the okay to bike. I have another recheck in 6 weeks.

I haven't done your suggestion of a week of "nothing". I really can't... single mom, so I don't have an option of not grocery shopping, etc... But I walk with compression sleeves on my injured leg and that does help.

As much as it hurts to read 4+ months until returning to running, it does give me a concrete timeline to shoot for.

runner-grrl said...

Anonymous, So sorry to hear you are still out eight weeks with the TSF. I know how difficult that is.. If you can get the boot that I mention with the tibial plate, you can slip that into the compression sock as well, and that offers a LOT of protection as you do the musts of grocery shopping, etc. I don't think you'll need to be out 4 months unless you have an extremely aggravated fracture or other complications (such as osteopenia). Please feel free to write me with how you are doing at fongrrl at gmail dot com. Hope you are back to running soon! --Alex

Robin said...

I'm SO glad I stumbled across this. I have a pelvic stress fracture, but thankfully it was caught very early (I had some minor pain that went away, then severe pain when I ran on it, so I got an MRI just days later; my sports medicine doc is a GOD). It's been two weeks and I'm hoping I can handle deep-water running starting this weekend. I have a destination 5K in three more weeks (I'm hoping to at least WALK it) and I'm supposed to do my first half in 16 weeks (I'd be happy to run/walk it, which is all I was going to be able to manage even before the injury). Several well-meaning friends have suggested that maybe I'm just not meant to run. Sigh. But you confirmed a lot of what my doc said. He's checking my vitamin D levels (I take supplements) and finally addressing my chronic anemia, so hopefully this will heal quickly and never happen again. Thanks again for all the info!

runner-grrl said...

Robin, Glad you left some comments! Sorry to hear about your pelvic stress fracture, but definitely don't give up. Find out the root cause of the problem and fix it and get out there again :) You'll be surprised how fit you can stay in the water. And it's good you caught it so early. Best wishes for a speedy recovery! --Alex

Anonymous said...

Thank you so much for your post. I am recently back to training after a tibial stress fracture, and boy am I'm afraid to reinjure myself. I'll be 55 in September and the Chicago Marathon on 10-10-10 is on my bucket list. However , I'm trying to stay optimistic for the event. I was up to 35 miles a week when I got injured due to wrong shoes no rest days and increased intensity. I'm a flat footed person that SUPINATES. So the motion control shoes recommended by Runners Edge exacerbated my problem. Not to indict Runners Edge, but every runner should use due dilligence when buying the most important piece of equipment you'll need. With only 7 weeks to go I wonder if I can still make Chicago. I am currently running pain free every other day for 3-4 miles. I did keep my cardio up with the dreaded elliptical and stationary bike. Any thoughts?

runner-grrl said...

Anonymous, Feel free to write me at fongrrl at gmail dot com. Generally speaking, if you have adjusted your goals accordingly, you can probably do your 10-10-10 Chicago (I'm planning on being there also!). Your mileage isn't very high, and you also express some concern about re-injury. I'd like to explore those a little bit with you, so write me an email if you'd like. Also include information about your diet, method of diagnosis, date of diagnosis and how long you didn't run. Hope to hear from you, and if not, best wishes for Chicago! --Alex

Riley said...

I am fifteen and was disagnosed with a pelvic stress fracture five weeks ago. I have about five or so more weeks to go until I'm expected to be able to join my team again. I'm bummed because I'm going to miss the entire cross country season where I am a top runner. However, I'm really skeptical about having it only take 10 weeks to recoverer, because many online things I've read say that these types of stress fractures can take 6+ months to heal! I also had mine for three months before it was diagnosed. I never felt the pain unless I was running, and I've been swimming about a mile a day to keep in shape, also with no pain. I really want to aqua jog, but I'm scared that I shouldn't. My doc. said that if there is no pain, it is fine. WHenever I do it I feel extreme tightness in my upper hamstring/butt, but not neccesarily pain. Can anyone give me advice, specifcally about my healing time? Another detail, I was on crutches/a crutch for four full weeks and will be on and off the next two. Thanks, anyone!

runner-grrl said...

Riley, I am so bummed to hear about your pelvic stress fracture and it preventing you from competing this season. You are right--these fractures can take up to six months to heal. But, it could be less, depending on how severe, the location and healing speed. The good news is you are very young and your body should heal more quickly than an adult's. Make sure you are taking all the minerals your body needs. You'll want to take it slowly back, especially now that you are only off / on crutches now. It's a vulnerable time. Wait until you are off crutches and walking comfortably for a few days, then try aqua jogging for 10 minutes one day. If it goes well, try 15 the next, then 20 > 30 > 45 > 60 minutes. Be sure to back off if you do feel pain. I would highly recommend an active isolated stretching program daily to resolve some of that tightness. Wharton Performance has an excellent one for runners (do NOT static stretch). Best wishes for a speedy healing! --Alex

Riley said...

thanks runner-grrl..one more question: do you think I will be able to run in five weeks or so?

runner-grrl said...

Riley, It looks good, since you are already pain free. You'll want to have a few successful 60-minute walk tests, and then test running out for shorter distances. You have a very good chance at being back to running at the end of the 12-week healing. --Alex

Riley said...

thank you soo much!! it would be suppperr awesome if you could check out my blog!! please comment on ittt

Cynthia said...

I was diagnosed with a cortical stress fracture on my left leg (via MRI). My Dr said it was small. I ran 9 miles yesterday and 5 the day before. My left leg, but not so much that I can't run. My Dr says NOT to run 18 miles tomorrow (which would be the longest run before my marathon on 10/31. Does it matter how small the stress fracture is?

runner-grrl said...

Cynthia, You didn't mention where your cortical stress fracture was, but I'll guess the tibia. Not that it really matters. There are a few injuries that you should not run through at all until there is some healing. Unfortunately, a stress fracture is one of the few. For many injuries, you can try to shorten your runs by distance or time and / or stay fairly active. This one, even if minor, is probably not going to heal and will most likely worsen if you continue to run on it. I know that's not what you want to hear four weeks out from your goal race, but this close out, I would start looking for a back-up plan. Your alternative is to show up really undertrained and not do much between now and then, but you'll have a better experience if you take a couple of weeks off to heal. One more thing this is a nice, finite injury--and if you treat it well, it will heal quickly and nicely and you probably won't be troubled by it again. --Alex

prolango-boot-camp said...

Hi, Alex. Great blog - thank you. My son is 14 and nationally competitive XC runner. He loves to run and is susceptible to over-training - he's a teenager after all ;). Two days ago after his 6th straight day of hard training or races, he developed a sharp pain in the upper-third of the outside of his lower leg after a 5-mile "easy" run on pavement. After a quick exam, his team PT is fearful of a fibular SF. We're going to the doc ASAP, so we've caught this early. I've seen lots of TSF's and pelvics in this blog, but not fibula. I understand your regimen and diet reco's which sound great. Two q's here: 1) Because fibulas are smaller, if indeed this is a FSF, could recovery legitimately be shorter? Nat'l qualifiers start in 4-5 weeks. 2) Would an aircast and/or complete rest (crutches) help quicken recovery? Thank you very much.
Wayne

Piero said...

Hi from Italy, Alex!
Thank you very much for this post! I found very useful to see that I am ot the only one to have a TSF. I've beed training fo the NY Marathon since january, I was in a quite good shape but from August 5th I had to rest for nearly 2 months. Now I can run for 10k without almost any pain at all or maybe some stiffness for the following 24 hours.
Since I am definite about "running the risk" of participating, I have two questions for you:
1) What kind of training would be best for the rest of the days? increasing the lenght every other day or keeping shorter daily runs? Before this I could easily run a half marathon!
2) Can you suggest me some pain reliefs methods (apart from drugs)?
Thank you in advance for your reply.
Piero

runner-grrl said...

Piero, Thanks for writing! Sorry to hear about your TSF. I would recommend water workouts as a good rest day workout / cross training for a TSF. Once you get a good rhythm, you'd be surprised how good a workout it is. It sounds like you are on the edge being healed, so you might want to alternate runs with water workouts until the tibia settles down a little bit more. For pain relief, actually ibuprofen can delay bone healing...so your idea of no drugs is a good one. You might find some relief in arnica gel for the muscle soreness / stiffness you mention. Otherwise taking the stress off the tibia a little (from a compression sock to a light weight aircast) should help the pain a bit. Best wishes! --Alex

Tennis Girl said...

R. Grrrl, your comments were positive and encouraging. Thank you for your suggestions. Been to Foot and ankle orth. to get x-rays on my foot. I feel that I've got a 5th metatarsal stress fracture. X-rays showed nothing. I've had progressive pain for 6 mos. now, and it has not or will not go away. The pain is tolerable but annoying with everyday activities. However, when I run or carry heavy items, the pain is intense. If it is not a stress fracture, what else could this lingering pain be? Any suggestions? Is it worth me forking out the 500.00 deductible for the MRI?

runner-grrl said...
This comment has been removed by the author.
runner-grrl said...

Tennis Girl, The fifth metatarsal is a likely candidate for a stress fracture in a runner. However, being a small bone, it's unlikely to still be causing you problems sixth months later unless you didn't rest at all (and did nothing to supply your body with what it needed to heal). That being said, if the x-ray was recent, and you've had progressive pain (and a progressive injury), one might expect something to show up on the x-ray by now. At this point, though, my recommendation is absolutely to have the MRI. This has impacted not only your running but your day-to-day activities for an extended period of time and you need to get some answers. It's highly possible there is something else going on, and this is not a SF. The good news is, if it is a SF, take the 3-4 weeks to heal it (small bone, rest it, make sure your diet is adequate), and move on. Hope this helps! --Alex

Duckie said...

Hi from Australia,
I was diagnosed with an anterior midshaft tibia stress fracture of the left leg. Came about from increasing training and not allowing adequate rest periods. Im wondering about the splints you talked about. Unfortunately due to life circumstances im not getting much of a chance to keep off the leg. Will the splint help in the healing process?
Thanks
Sue

runner-grrl said...

Sue, Especially if you cannot rest the tibia normally, you will certainly want to get an aircast / splint that will help rest the tibia while you walk around on it. A tibial plate is essential. Yes, that will improve the healing rate. Be sure also to keep your diet healthy, and maintain adequate calcium, Vitamin D and Vitamin K during the healing process (and after as well). Best wishes for a speedy recovery! -Alex

itchin to run said...

Hi, I stumbled upon your blog when looking for anything on a femoral stress fracture. I have not run since Sept 19th when my leg gave out on at mile 12 during the 18 mile NYC tuneup. I thought it was my knee. After seeing many different MD's, having many different diagnoses, 2 MRIs, a bone scan finally diagnosed my stress fracture in the back of my femoral shaft, midway. I was told it usually takes about 12 weeks of no running to recover. It was 12 weeks yesterday and I know it is approximate, but I still have alot of pain just sitting in a chair. I don't see any end in sight. I have been doing PT, weight training, the elliptical with no pain, pilates, etc. I go to gym 5 days a week to keep my cardio up. Do you see any point in still trying to run Boston this year? How bad is a femoral shaft SF ? All I find info on is pelvic stress fractures. Thanks

runner-grrl said...

itchin to run, I'm really sorry to hear about your situation, and your worry about whether you can run Boston. You've worked very hard to stay in shape, but after awhile (and I know...) that gets old, you just want to run again. I've been thinking about your injury today, and I definitely have some questions. You really shouldn't be having pain when sitting 12 weeks out, especially when you've been able to do cross training with no pain. Please feel free to email me with some details: age, gender, have you had any stress fractures before, why you think the MRIs didn't show this injury at first. I'd like to try to help. The good news is, you have plenty of time to get back on track for a solid Boston--if you can start running soon. My email is fongrrl at gmail dot com. -Alex

Anonymous said...

This is a great blog and wondered if someone can give me advice. I've had right foot pain on/off for last 3 months. Started on outside of foot (tendinitis there I believe) but last few weeks in arch and under ball of foot near big toe.

Cut my running way back (from 30 mi week to around 12)...running every 3 days. 2 hard 5 mi runs this week. Foot feels ok during run but afterward very stiff and a lot of discomfort. Can walk ok but there is some pain/discomfort. Been icing too.

Got x-ray from orthopedist a month ago....no fracture showed up.
Should I get an MRI (going to cost me $600 deductible minimum out of pocket) to see if I truly have a stress fracture?
Thanks,
Howie

runner-grrl said...

Anonymous, Glad you wrote, and sorry about your foot pain. Two things that you mention are uncommon in stress fractures of the foot from running. First, you mention pain on the bottom of your foot. This could be a lot of things (plantar faciitis?), but usually running foot stress fracture pain manifests itself on the top of the foot (often with swelling and sometimes bruising). The other thing is you mention pain near your big toe. If you mean in-line with your first metatarsal (big toe bone), it most likely isn't a stress fracture from running. It's nearly impossible to stress fracture that bone (from running alone); its simply too big in comparison with your other metatarsals (which will give earlier). Have you tried new / different shoes? You might pronate (or, more rarely, supinate) in such a way it's causing some problems. Also, not sure if you are using inserts (generally speaking, I don't recommend them). If you are, you might give it a try running without. Also, give your local consultative running store a visit and have someone who is very knowledgeable watch you run and make some recommendations. Be sure to bring your existing, well-worn running shoes for examination. Hope that helps. Oh, and I'd skip the MRI for now. In your case, I don't immediately suspect a stress fracture. If you are still having run-restricting problems in a few weeks after making some of the other changes, then consider it. --Alex

Anonymous said...

Hi I really appreciated this blog. 2 weeks before the NY Marathon I had to stop running...I found out I had Morton's neuroma and had to have surgery. I was recovering from that finally and this last month --before I even started running again-- I got diagnosed with a stress fracture. I'm not sure how my doctor knew, he didn't even take an ex-ray. But I am in a LOT of pain. I cannot wait to run again. I taught myself to swim the last month but it doesn't fill the need for running. It feels like it will never happen. I have been walking too much on the foot, as a NYer it is difficult not to, but I see now I should really really rest. Thanks. nicole

runner-grrl said...

Nicole, It sounds like you will have to rest anyway. But if the stress fracture is suspected in your foot and the pain doesn't clear up with a couple of weeks of rest, be sure to pursue it (get an MRI to find out what's really going on). One good thing about stress fractures is the bones usually heal completely, and as long as you've addressed the root cause, you probably won't suffer from it again. Best wishes for you, I'm hoping to qualify for New York here myself shortly! --Alex

Weight Loss Pills said...

I've really enjoyed having a look around your blog today, keep up the good work!

Anonymous said...

I was diagnosed (MRI) with a tibial stress fracture. I have been told by my doctor that I can start to slowly run again. I went this past Sunday night (10 mins) then last night (15 mins) walking in between the 5 min incriments. There was no "pain" but a burning, itching, and feeling like I had a compression garment around my leg. Is this normal

runner-grrl said...

Anonymous, Yes, I had that exact same sensation. I described it as "pressure" or a "bubble" with a "buzzy / tingling" feeling. Make sure you don't push through any pain at this point, but what you are feeling is completely normal. --Alex

Anonymous said...

Runner girl, Thanks for responding. I am glad to hear you felt the same sensations. It is hard to say what is "pain" and what is just "sensations". Today I swam and did weights, no problems at all, so I am hoping the sensation of tingiling, burning, and compression was just my leg getting use to running again. I am sched to run tomorrow night so we will see.

runner-grrl said...

Anonymous, You didn't mention how far out you were from the fracture, but you did say your doctor had given you clearance to run. You'll notice some sensations in the area for weeks to come, just be sure it isn't pain during--or even in the 24 hours after--the run. If it is, back off for a few days and don't push through anything. You'll probably deal with more worry that pain might be coming than anything (particularly as you do things that you suddenly recall were very painful). Best wishes to you, and I hope your run goes well tonight. --Alex

ceecee said...

hi i stumbled accross your site and i m inspired.i am not a runner but i would love your help.in sept 10 i was having trouble with my left shin.pain....because i had full body bone scan in nov 10 they stumbled on to something on both tibias.results sent to ortho to identify.at this time no pain in left tibia.the ortho took my symptoms and disregarded what the radiologist had docummented and said to me if you came in here and you had one low grade stress fracture i would say yes but the bone scan is showing one in each leg and in the same spots so i think this is connected to your graves disease/which he knew i was very sick with/ so we will take another bone scan in dec and you can take the disks to your endo in feb 11.by the way the second bone scan had the same results.my gp agreed with him in dec and i was suffering more by now still on left tibia only.so i took naproxen like candy and kept going....then it hit first week of jan detiorating by the week ..days...hours..in both legs.jan17 seen gp and could only walk for less than 1 hour a day and she just offered to double dose of naproxen and sent home so confused as to what was happening.3 days in emerg totally depleted.everything shot in both legs from the knee down.the er doctor pulled up both bone scans and said you have 2 fractured tibia.i m in 2 boot cast,in a wheelchair,on fetanyl patch with a referal to a new ortho whom i wont see till feb 8.in er they did not take ex rays for they used the scan from dec 5.i know that i ve suffered so much damage since then and i m very scared for what they will see on feb 8. i m not healthy like the people on this blog so ask for your kindness and offer me any advice you can. i live alone and struggling to stay strong.thank you for taking the time to read this.

runner-grrl said...

Ceecee, Your story is heart-breaking, and I'm really sorry to hear about your suffering with this. Please email me directly at fongrrl dot gmail dot com. Tell me a little bit more about yourself when you write: your age, how long you've been diagnosed with graves (since childhood?), what they are doing about your thyroid, what kind of activity (if any) led up to the stress fractures, your diet. I hope to hear from you soon, Best, --Alex

Anonymous said...

Hi Alex. I am a 15 yr old girl and during this past XC season I was diagnosed with two stress fractures. One in my left tibia and the other in my right femur. I didnt even have any pain in the tibia before I got my bone scan. I was on crutches for 6 weeks (no cast) and then once I got off I eased back into running I haven't gone for more than a five mile run. Now my shin is really hurting in the same spot as where the SF was. I really hope I didn't move to fast b/c track is starting. My coach has me on a stationary bike. Is it possible that my SF has returned?

runner-grrl said...

Anonymous, I'm really sorry to hear about your double stress fracture! First, be sure you are getting adequate nutrition (calcium, Vitamin D) to keep your skeletal structure strong. It's unusual to have two stress fractures at once--you must be running very hard! Unfortunately, it is possible to re-fracture in the same spot. You didn't give timelines, but I'll assume track ended sometime in the late fall 2010, and you took six weeks off and have been running for approx 4-6 weeks (so that is a guess). The tibia (and femur for that matter) are large bones that require some time to heal. Six weeks of no running isn't very long, esp. if the stress fracture was moderate or severe. It is likely you may have come back too soon to running. For the record, I re-fractured my tibia in exactly the same spot two years later (but caught it very very early, and was out for four weeks instead of eight). Certainly, at this point, don't run on it until its not hurting. This may be a passing pain--or it may not be. If you can get another bone scan to find out, that would be helpful in your planning the next track season. If at all possible, try to get in some pool workouts to stay fit. Best wishes to you, and I hope you are back running very very soon! --Alex

ceecee said...

hi it s ceecee again.i went to another ortho and he took exray and even though the 2 bone scans shows low grade stress fracture,he says to take my boot casts off.to my shock he said your feet show a muscle wasting disease and you need to see a neurologist.so i m waiting for that appointment and still in wheechair with little walking due to pain.confused.....and scared

runner-grrl said...

Ceecee, I'm so sorry to hear about your ongoing struggles. Please email me directly at fongrrl at gmail dot com. I had a few questions from your last post (see above), if you can provide some additional detail. Your case sounds quite complex and it sounds like you could use some encouragement. I'll look forward to hearing from you, --Alex

Anonymous said...

Thank you for the info. I also have suffered from multiple stress fractures. Both tibias and left femur at once. Ouch it took about a year to recover but I did. Patience is important and rest, but there is always a way to keep your body moving while you recover.

runner-grrl said...

Anonymous, Three stress fractures at once is no joke :(. But, now you are on the other side of it. I bet you have quite a story to tell, with a full year of recovery. It is so hard to be patient for even 8-10 weeks, but a year seems like a death sentence to your running career. You point out there is always a way to keep the body moving, and that is one of the most important things to remember. You may give up running for a couple (or more, as in your case) of months, but there are so many things you can do for fitness. I explored and did many of them--it keeps you fit and sane while you wait. Best wishes, and congratulations on completing such an extensive recovery so well! --Alex

Anonymous said...

Hey, I posted a comment a few weeks ago about having one stress fracture in my femur and another in my tibia. I said the tibia pain was coming back. I did end up re-fracturing my tibia. My doc said i could never run again :( I am in a walking boot for 4 weeks and no activity for 8. My dad said i could run track next year. Do you think a full year is long enough to recover and what do you suggest to do to stay in shape when i can't run? I will be playing HS tennis next fall, but i don't want to get "fat".

Anonymous said...

So glad to see this is still going and you're responding!

I'm a 27yr-old female recovering from stress fractures in my tibia, fibula, and heel (I was training for the Disney Marathon and was diagnosed on 12/20/10 so I didn't run). I'm just getting back into training now, but can't find a good schedule. I know you said start out running 2 miles or so (I'm passed the 60 min walk test) but at what pace did you start? Do you happen to have a log of exactly what you did to recover and get back to running? I feel lost as to what distance to start at and what pace to start at (I was running 9-9:30min miles), and at what rate and when to increase. Any help would be great!! Thank you =)

runner-grrl said...

Anonymous (who refractured your tibia while running track). I know how doctor's can be. When I refractured my tibia, the first words out of my doctor's mouth were, "Well, running must not agree with you. You should stop running." Not exactly the support and encouragement I needed! (And I have safely returned to running and racing.)

However, No running for 8 weeks is going to be critical at this point. If you have a removable boot, you should immediately start pool workouts. Swimming is great, but also aqua jogging is even better (I have put in my hours in the pool). You can even design fartlek and threshold workouts. Also, work your core as much as you can. You will want to get out of the boot as soon as possible so that your muscles don't atrophy.

When you can safely bear weight, do spin classes. Walk. Do other strength training. You'll especially want to do calf lifts (it will help support the area and prevent fractures in the future). You can probably do those around the 8 week point, or possibly earlier.

And, most of all, be sure you are getting a full 2,000 IU of Vitamin D and taking calcium and Vitamin K (and that your diet is rich in calcium if possible). You will want to work up weight bearing after the 8-12 week point to help your bones get stronger.

Finally, (when you are out of your boot of course) you might want to go to your local professional running store and have some gait analysis. From the sounds of it, you may pronate more than you think, and you may want to have an expert evaluate your stride. Be sure to bring one or two of your favorite, well-worn shoes so they can also be examined.

Anyway, if you'd like some other "get fit, stay fit" ideas during your recovery (and how to come back), feel free to email me at fongrrl dot gmail dot com. Hang in there! --Alex

runner-grrl said...

Anonymous 27yr-old female, Glad you wrote, and I'm happy to hear you are past your 60 minute walk test! My third run back was December 1, 2008, and you can see my entire training history on Buckeye Outdoors here (just change the year to 2008, and month to December). http://buckeyeoutdoors.com/training/traininglog?viewid=5565

You can also get there from the sidebar on my blog.

That may or may not be the best comeback plan for you. Take a look, and see what you can use. If you want any additional guidance, I've put together several plans for people and helped them get back to where they were, just email me at fongrrl dot gmail dot com. --Alex

Anonymous said...

Hi Alex ~ great blog! I am wondering if you would be able to provide some hope for me. I have been training for Boston and about one month ago after a 10-mile mid-week run, I noticed something was very wrong with my right foot, i.e., after my run, though, not while running. Long story short, a week later I had negative X-rays (on March 3). Thereafter, I skipped all my mid-week-runs and kept doing my long-runs on Sundays, a 20-miler on March 6, a 15-miler on March 13, a half-marathon on March 20. With zero improvement, I went to see a sports medicine MD on Thursday, March 24. By the next day, a 3rd metatarsal SF in my right foot was confirmed, i.e., this past Friday (via bone scan). Devastated is about where I am with this news; and I only found out today that this is the first year that the B.A.A. will not defer numbers to 2012. Anyway, deferring is not my first choice. I want to run it...even if it hurts at the end. Because I have a 2012 BQT, a time-goal is not a concern anymore for this Boston. My main concern is the bone will break. In terms of exercise, I found a local pool yesterday and my plan is to water-jog for an hour every other day. My other cross-training option would be spinning, however, I have yet to find a class and sort it out. Today, I saw my Dr. -- to ask for -- and got a blood-work done to test for Vit D deficiency and to discuss every possible effort I can make, nutritionally and/or otherwise, to enhance SF-healing. Any ideas, comments, advice from you would be gratefully appreciated. Ciao, Linda Marie

definition of stress said...

Indeed this is a very great post. I have a friend who has this kind of stress and I am just so thankful that she already surpasses it. She needs to see this post.

stressed tibia said...

Thanks so much for this blog post runner-grrl! I just got diagnosed with a tibial stress fracture. I totally agree with what's been said by others - the physical pain is nothing - the real pain comes from seeing the sun coming out and the warmer temperatures returning and desperately wishing I could be out there running in shorts for the first time this season (always my favourite thing). It's also painful to see my running buddies in the home stretch in their training for the May marathon I was planning to run. Argh.
These days I'm concentrating on doing everything I can to speed healing (nutrition, supplements, acupuncture, etc. etc.) My greatest challenge is refraining from doing any cross training that seems to aggravate things... I tried spinning the other day (in the saddle) and even that seemed to cause a bit of stress on the tibia. I may have to follow your advice and take two weeks off from everything before I can get into an active recovery phase.

runner-grrl said...

Stressed Tibia, Bummer on the May marathon, I have totally been there :(. Take the two weeks--or however it takes for the pain to settle down. Two weeks is pretty typical in the healing phases of this particular stress fracture (all things being equal). Hit the pool / water all you like now and when you are ready, gradually add in the other cross training (first, stationary bike with little resistance before working up to a spin class as you test things out a bit). Email me directly if you need some additional help, fongrrl at gmail dot com. Best wishes for speedy healing! --Alex

vicky1970 said...

Hi there, thanks for the advice on this blog for TSF. I thought I had a shin splint and kept running on what ended up being a bad TSF. In fact Dr. said it's the worse one he's seen in 4 years. He put me in a cast...which is probably good because I'm a first grade teacher so it forces me to do my best to stay off my feet ( not boot...crutches..:o( Anyway had to drop out of the S. Diego R n R in JUne. I'm actually a swimmer by nature - I competed growing up so the pool is my friend and when I get this cast off that is the first place I''m headed. He said no running for 4-6 months...do you really think I'll have to wait that long? So bummed, but appreciate any encouragement you have for me. Take care and thank you again for any input.

runner-grrl said...

Vicky, So sorry to hear about your TSF :( The tibia can take a long time to heal, particularly if the fracture is severe and / or unstable. While I haven't seen the MRI / XRays / bone scan myself, it certainly sounds like from what you said that you do not have a stable fracture and it is quite severe. In this case, you will need to take a lot of time off to heal adequately and four months does not sound out of the question. You might want to get a second opinion from a sports medicine specialist who deals with this sort of injury and the athlete, and possibly see if you could switch to a walking boot at the three week point (that would allow you to shower and potentially workout in the pool). In this manner, if you get to a stable but healing fracture, you could at least protect the tibia while having the ability to exercise a little bit. Best wishes for speedy healing! Please write back in a few weeks and let me know how you are doing (fongrrl at gmail dot com). --Alex

Amy said...

Alex,It's nice to see that you are here to offer support to people in similar situations. I just was diagnosed with a fractured medial sesamoid bone in my left foot. I am not a runner, but do pilates, bike, walk and occasionally wear high heels to work. Doctor said it was due to stress put on the ball of my foot repetitively through all my activities. Any advice for healing? I know this bone has low blood supply...

runner-grrl said...

Amy, That's an unusual bone to fracture for a runner, and I know you said you aren't a runner. Certainly, though, the advice of bone healing and recovery here would apply, but I'd ensure that you've had your Vitamin D levels checked, and consider if there are a particular pair of shoes that were causing you more stress than others. Definitely wear flats for a while, if you are not already in a fracture or rocker shoe to remove the stress. Hope you heal quickly! --Alex

Duckie said...

Hi Runner-grrl, Im now 7 month into healing a anterior tibia stress fracture. Its been a long frustrating journey. The bone is now healed but still have tendonitis (medial tibia stress syndrome) which is still keeping me our of any form of running or even power-walking. Luckly im now back to swimming and spin classes.
Any advice on getting this stubborn tendonitis to heal?
Sue

runner-grrl said...

Hi Duckie, Glad you wrote. I'm sorry to hear you are still struggling with remnants seven months later. Have you tried to run at all for ? Have you had any follow-up MRIs? It would be good to be certain it's tendonitis, and nothing else. Do you know why you ended up with a stress fracture in the first place? I'm especially thinking biomechanically, the same thing that caused your SF might be stressing the tendon around it. I would recommend for sure you have your gait analyzed by a skilled sports medical professional, or by a very good gait-analysis person at a running store. You might need to switch the style of shoes. Meanwhile, you should be doing everything you can to reduce the inflammation. But sure to stretch that part of your shin (not just your calves, but pulling your toes down), take fish oil, and try arnica gel 3x / day for a couple of weeks. Icing might help as well. Feel free to email me for follow-up discussion at fongrrl at gmail dot com. Best wishes for speedy resolution! --Alex

Wes said...

Thanks for the info - I read this when I had a sacral stress fracture...now I started my own blog to document my stress fracture research and experiences www.stressfracturehealing.com

Anonymous said...

I really appreciate this information. I am in a boot with a 4th metatarsal stress fracture after intense training for my fifth marathon and first attempt at Boston qualification. It looks as though I will miss my fall marathon, as well. The emotional pain from this is difficult. Your blog gives me practical information and hope. Thanks so much.

runner-grrl said...

Wes, I've enjoyed reading your blog. You have a lot of practical info out there! I've thought a few times of doing something like that (an entire blog devoted to stress fracture healing). You've done well! Thanks for sharing your link here, as I know everyone suffering from a stress fracture really benefits in hearing from others and getting as much information as possible! --Alex

runner-grrl said...

Anonymous, I'm glad you wrote to share your experience a little bit :) I'm sorry to hear about your 4th metatarsal stress fracture. Depending on when your fall marathon is, you really may still be able to do it. I don't know when your fracture was diagnosed and how long you've been in the boot, but the metatarsal fractures generally heal quickly, and you have many cross training options available to stay fit in the meantime. --Alex

Anonymous said...

Thanks for the reply, Alex!

The fracture happened on March 26th at mile 13 of a 20 mile run. I completed the run as I thought it was a cramp. I haven't run since. I live in a rural area and am a busy mom of four kids, so water running is logistically not a regular option for me. (I used to run before they got up.) I cross train on a stationary bike following interval / tempo / endurance with my HR monitor. I also lift free weights, though they have now said no more squats (I always had to stop the lunges, but I had doubled the squats). The boot is relatively new, about two weeks. I found I was so often feeling great and then would re aggravate the whole thing with a simple step at work. I was in orthopedic sandals for quite a while before the boot.

The fall race is October 2. Would love to run it as my husband is doing so!!

I went for a bone scan last week, though I won't get the results for until the first week in July, where I will have another of what seem to be about three minute appointments with the sports doctor, as they fly by to each patient.

It's a true test mentally for me not to be running - I was nearly in tears as they gave me the boot. And it is hard not to have the "training body" I am used to this time of year, as you mention in your article, about that special vein, etc..

All the best.

Anonymous said...

PS Do you consider caffeine consumption in the mix as an athlete? I think I drink way too much coffee.

runner-grrl said...

Anonymous, Wow, that is a long time for a SF of the metatarsal. You must have continued to aggravate it--or it broke all the way through. The bone scans is going to be very important to understand where you are in the healing process. If it's possible for you to get results before the first week of July, it would be good for you to do that (even if it means going to another doctor--doesn't sound like this one is really managing your care anyway with such quick drive by's).
Generally speaking, of all the running SFs, these usually heal the quickest, so I'm really hopeful that you'll be back sooner than you think. But, it will be important to get those results.
I understand about the four kids part. I also live in a rural area, only three kids, but I totally get it. I was fortunate enough to be able to take my kids to the gym with me and they had a great care program. It wasn't convenient--but sustainable for the short period of time that I needed it.
Be sure to mind the details of your recovery. Try to think positive thoughts (very hard in this situation, believe me, i know first hand and I so feel for you). Stress hormones which come from being upset will not allow your body to heal at its very best. Take care of your diet--the whole diet--not just calcium and vitamin D, but be sure to include lots of wholesome food sources for both of them.
Feel free to write me at fongrrl at gmail dot com if you'd like to talk more. Hang in there, it's very tough what you are going through. I have been there, but you have a very good prognosis, and that Oct. 2. marathon might be possible if you scale your goals appropriately. Best, --Alex

runner-grrl said...

Anonymous, and p.s., i'd actually perish without a strong cup of black coffee in the mornings. And if i go out, i throw on a cafe mocha to boot in any starbucks drive by. So, the only thing i consider is when, where, and how possibly i can frequently imbibe my caffeine. --Alex

Anita said...

Hi,

I developed a tibial stress fracture about 4-5 weeks ago. Well I haven't actually had an MRI scan, because at the moment I'm away in China and it's too hard to do with limited language. At the time I was only 10 days away from a half-marathon overseas in the Gold Coast. Desperate as I was to do it, I didn't run up till the race and then I took painkillers for the race. (I didn't think it was a stress fracture at the time!) Luckily I got through well and it didn't seem to make it any worse. After e-mailling my physio though we've concluded it most likely is a stress fracture as it still hurts a bit when I walk. I have been trying some acupuncture here, I'm halfway through 10 days of treatment, and although I haven't felt a great improvement yet it does always feel good when I've just had it done. I think I will finish the treatment. I was really hoping to do my first full marathon in early Dec this year, but I've concluded, sadly, that this is probably out. I should still be able to do the half then though? Otherwise there's another marathon that I could do in Feb next year, would that be possible? It's so dissapointing, as I was training for my first full for my July race, but low iron and subsequently constant injuries meant I had to change my plans. This seems to be my second marathon that I can't do. Any advice?

runner-grrl said...

Anita, Sorry to hear about your TSF.. and that you are far enough away from home that an MRI isn't practical. Since it was probably only ~30 days since you suspected you had the TSF, and then you ran the half marathon probably 2-3 weeks ago, I'd say you've only given yourself about 3 weeks to truly heal (no running). An "average" TSF (if there were such an animal!) would take about eight weeks to heal before one should start running again. Of course there are a few things that could make that healing a little shorter, and plenty that can make it longer. You should be thinking of another month of no running. That makes December OK for a half and you could roll that into a full in February if you wanted to. Definitely keep up the acupuncture if you feel that it is helping. There are a few ways to stimulate bone healing--but it still doesn't happen over night. Best wishes! --Alex

Ohio Realtor said...

Hi! Thanks for your post! I am about 7+ weeks into a SF of the femur. Only recently confirmed, and now presents as a "healing SF" per orthopedic doc. I thought I was ready to run again soon, now with the correct diagnosis, the doc says crutches for three weeks! I am so much improved since the early onset of symptoms. My pain is nearly nothing, unless I over do it. My gait is nealy normal. Again, doc still says crutches for the next 3 weeks. PT says no need for crutches at this point, as I am well on my way to healing. (Working with PT over last 4 weeks). I am totally confused. I want to do what is best in the long run. Any thoughts or comments on this? Long range prognosis for healing? Doc said 6-9 months. PT again disagrees. I will need medication for my head if this goes on too long. LOL Your post gave me hope. Thank you!!

Ohio Realtor said...

Ooops....a few more bits of info: I have been water running, lap swimming, biking and spinning as tolerated. No running since June 7th. Injury date May 28th. Thanks again!

runner-grrl said...

Ohio Realtor, I'm glad you've gotten a correct diagnosis and seem to be healing well. It sounds like your doctor is probably not a runner and is giving you the most conservative answer possible. Unless there are aggravating conditions, you should be able to start running again soon (roughly the eight week mark from not running--next weekend). The femur, of course, is a large bone, and can take a little longer to heal. It also depends where on the femur the fracture is (which can make the fracture considerably more dangerous than other fractures as it approaches the femoral neck). If your stress fracture is uncomplicated, next weekend (~Aug. 7) you should try your first of the 60-minute brisk walk tests to see if you remain pain free not only during, but also the morning after the test. Repeat every other day for three passing tests. Once you've hit that milestone, you can gradually begin adding very easy, light running for up to 30 minutes. Don't convert over completely right away--continue other days with the aqua jogging, biking, etc. replacing a workout here or there with some actual running.
If the fracture is on the femoral neck, you would be better served by the crutches for a few weeks and treating it a bit differently. If that's the case or if you have any other questions, please feel free to write me directly at fongrrl at gmail dot com. Hope you're out running in a couple weeks! --Alex

Stress said...

You make a great point. Thanks for sharing knowledge with us. It's an interesting post, thanks.

Anxiety Treatments | Coping with Stress Strategies

Anonymous said...

Thank you for this wonderful post!

I was diagnosed with stress fractures in both knees and shins, due to marching band, after having my tibias surgically corrected. They did a bone scan to verify my diagnoses. My doctor was a sports medicine doctor and didn't inform me on how to get back on my feet again. I was only told to stay off of my feet or my knee caps/tibias would break. This ultimately led to me dropping out of high school. Hard to go to school when you can't walk to class.

It's hard to find stress fracture blogs that don't deal with running. It's quite embarrassing that I seem to be the only one out there with marching-band related stress fractures.

It's been three years since I was diagnosed and the pain still flares up if I walk too much.

runner-grrl said...

Anonymous, Wow, I'm so sorry to hear you are still dealing with lingering pains from your marching stress fractures and that it has affected your life so deeply. I don't know much about your story, but stress fractures are also common in soldiers who march for distances. It is too bad that not all of the medical community is not focusing on helping us get back on our feet--literally (my primary care doctor was the same way, but I have found a sport medical facility that is focused on managing injury recovery and helping people get back to their normal lives).
If you haven't already, I would hope that you would go back to a doctor and have a rescan done if nothing other than to assure yourself of the healing that has taken place. Since you are still searching for answers, you deserve this closure on your own body healing process.
It's normal to have some twinges after a pick-up in activity (but the pain shouldn't linger for more than a day or two). I would encourage you to go back to finish your high school diploma if you haven't already done that too, but that is another topic altogether! --Alex

Ohio Realtor said...

Alex, green light from the doc yesterday, although back to walk/run/walks about a week ago. Slowly but surely, aiming for a comeback! I am surprised how much "wind" I've lost, even keeping up with spinning, lap swimming and water running. After 11 weeks of no running, guess it is all to be expected. One thing I have learned, especially for the ladies out there in their 40s, watch your calcium and Vitamin D intake. Mine was too low. Might have avoided this whole injury otherwise. Good news is that I am back at it!! Just in time for snow!

runner-grrl said...

Ohio Realtor, Glad even your doctor has cleared you--but most importantly that you're successfully getting back out there :) I know what you mean, the cardio sure does go quickly, doesn't it? It does come back, and comes back faster if you have tried to stay fit in other ways (which you've really done well!). Your point on the calcium and Vitamin D is so important. We almost cannot get enough in our diet. Glad you got your blood levels checked--it should go hand-in-hand with any SF diagnosis. Even when you think you are taking enough in--your blood levels may show differently, as you may not be absorbing as much as you think you are. Thanks for the good news follow-up! Your story will be much encouragement for others :) --Alex

Ohio Realtor said...

Well, I have been back running for about a month. I have been using a your suggestions Alex as welllas the training plan in this link: (http://pfitzinger.com/labreports/stressfracture.shtml) On Wednesday I ran 12, walked 2, ran 12 walked 2...as in minutes. My leg does NOT hurt when I run. It aches hours later. Sometimes aching well into the next day. Any comments? I don't want to go backwards in my rehab! :-(

runner-grrl said...

Ohio Realtor, It sounds like you may be getting some warning signals to back off the running a bit. If you are feeling pain after you run each and every time, and it throbs into the next day, give yourself another week or two of less "running-like" activity. Some suggestions: 1) You might swap out a running day with an incline walk (3.5 to 4.0 mph, up to 13% you'd be surprised what a good workout that is) 2) Some other cardio, I know you were doing pool workouts, among other cross training. I wouldn't stop weight bearing activity completely, though, just tone it down until you are able to complete a few workouts in a row with no persistent pain during or after. That will ensure you can consistently move forward. Hope that helps, --Alex

Shawna said...

I am so happy to have found your blog! I fractured my heel bone during the 20 mile training run for Chicago (my first marathon)just 3 weeks shy of the race. I think it may have been coming for a while, but the 20 mile run just exacerbated it. I have been in a walking boot and received laser and ultrasound therapy to heal faster. The pain is subsiding and the race is next Sunday. Though I would have preferred to run (I had qualified for a seeded corral), I am willing to walk/run it just to finish what I have been training for all summer. I was wondering what your thoughts were...

runner-grrl said...

Shawna, I have been where you are.. with a seeded corral bib for Chicago and wondering what to do. My advice to you is 1) if the fracture is very stable, and 2) if you can be happy with the resulting finish time of walking / jogging through it, you should go for it. Be sure you visualize your likely finishing times, and your expectations of the race. Chicago is one of the most fun, exciting marathons I've ever done. Just being there is a joy. If you can be happy with the experience of the day, even though your time isn't near want you wanted and you are safe from a more dangerous injury, do it. You should then plan to take the needed time off to finish healing. Hope that helps, --Alex

Ohio Realtor said...

Alex-ran my comeback race today! 18 weeks since my injury date. A local 5K, won my age division. Happy happy! Thanks for the support and encouragement!

Shawna said...

Thanks so much Alex! I really think I am partially healed and at this juncture am not worried about the time. I just want to do the darn race period. I have registered for another marathon in April when I can concentrate on time. I really appreciate your thoughts and encouragement.

runner-grrl said...

Ohio, That is just awesome! I'm so happy to read that, and you've encouraged many others who might stumble on your story. It's great news, and you made my day brighter :) Congratulations! --Alex

runner-grrl said...

Shawna, It sounds like you will enjoy the race! Which April marathon? Best wishes for Chi, and write back and let us know how you did :) Just a few more days! --Alex

Shawna said...

The Illinois Marathon in Champaign-Urbana (my hometown). When is your next race?

runner-grrl said...

Shawna, That's great! Do you have a time goal yet? My next race is at the end of January, so I am in the get strong and get fit stage :) I'm looking forward to a nice, solid PR. --Alex

Shawna said...

My time goal for the April Marathon is 3:55, but I'd be happy with sub 4:00. I would then like to concentrate on BQing by the time I reach 40 (i.e. several years from now when I move up 2 age categories, lol). What distance is your race and goal?

runner-grrl said...

Shawna, Anything sub-4 is an awesome goal :) Sounds like a good short term and long term plan ;). I'm looking for the "right" goal for myself for 2012. I met my 2011 goal (qualifying for New York guaranteed starting position) in April. The January race is just something to get me going (5K or 10K), and maybe run with my twins. Dying to hear how Chicago went for you! Hope you are enjoying a good rest now :) --AG

Shawna said...

The Chicago Marathon was a BLAST! I kept in mind that finishing was the most important goal since I was healing and not running at my full potential. I am really proud of the accomplishment and am looking forward to a 15K in November to end the season before January training starts for my goal marathon.My 11 year-old is now thinking of doing a 5K. Thanks again for all of your support:)

Ohio Realtor said...

Hi Alex, one more quick comment. Yesterday, I accomplished something I never thought possible in July of this year. (Post SF diagnosis). I ran my first half marathon. Well, ran-walked it. I did the Jeff Galloway method, run 5 minutes, walk 1 minute. My finish was 2:17 - I was simply happy to be there. Lesson learned in May, I am now taking time OFF to allow myself to RECOVER! Lisa

Megan said...

Inspirational post! I am a high school cross country and track runner and was diagnosed with a sacral stress fracture 3 months ago after running 40 mile weeks. I rested completely for 2 weeks in which the pain subsided quite a bit. I have been biking on a spinner bike (usually 6 days a week, 3 days of which were intense) for the next 2 months. I only experienced mild pain sporadically throughout these 2 months. Since my recovery was going well I thought it would be ok to mix it up and start water jogging. Since I had been training intensely on the bike, I thought it would be ok to do an intense workout the first day of water jogging. Immediately after the water-jogging workout and still 2 days later, a nagging pain has returned to the sacral area. I have started up running again very slowly which has not caused any pain. I knew that after an injury, I should take up running again very slowly, but I was not sure if it was the same for activities such as water-jogging in which there is no impact. I'm worried that I have interrupted the healing process and injured my sacrum again. Could water-jogging cause this? Thanks.

runner-grrl said...

Megan,

Thanks so much for writing. I'm sorry to hear about your sacral stress fracture. Generally speaking, this stress fracture would have healed within the three month time frame, especially given that you allowed sufficient time for the bone callous to form and harden before you began picking up activity. One area that you should be thinking about is your diet and hormone levels. Are you eating enough calcium rich foods, getting lots of Vitamin D and protein? Is your weight adequate? Those are the kinds of things that could interfere with expected healing times. Meanwhile, the aqua jogging alone three months out shouldn't re-fracture your injury. However, there may still be a lot of inflammation. In my experience, the pain with the stress fractures only seems to settle "in the fracture area" when healing is pretty well under way, and the prominent pain experienced is one of soft tissue around the fracture. So, you may be experiencing some initial soreness or trauma to the soft tissue and or scar tissue around the re-modeled bone. It seems you are doing well with the slow running and the biking. At this early stage (only a few months out), it's safe to use pain as your guide. Go ahead and back off the things that do seem to cause you pain and continue doing things that don't cause pain during (and especially after--up to 24 hours after). You might try less vigorous aqua jogging and or plain swimming (great aerobic capacity builder). In short, it's highly unlikely you've re-injured yourself this far out if all things are equal (no calcium or vitamin D deficiency, etc.) with what you've done. But--trust the pain as your guide. It is the most important diagnostic tool you have without getting an MRI every day :) Meanwhile, you are certainly due for a "recheck" if you can go back to your doctor and get a follow-up bone scan or MRI to confirm healing progress. Best wishes to you, and congratulations on staying fit despite this set back! --Alex

Megan said...

Thank you so much for the advice! It really puts my mind at ease knowing the pain might just be inflammation. But I am continuing to take it easy. Thanks!

Justine said...

Thank you so much for posting this! I was just diagnosed with a metatarsal stress fracture and was just told that I can not run for 12 weeks and I can't do any sort of cardio activity for two! I was just about to start training for my third marathon coming up in March. Shall I even try to pursue this? I was reading about aqua jogging from your previous posts, could this be an alternative training method?

runner-grrl said...

Justine, Sorry to hear about your metatarsal stress fracture :(. The good news is, being a smaller bone, it should heal relatively fast if treated well. Aqua jogging is a great cross training with cardio benefit that you should be able to do now. However, with only four months to train for a marathon, I'd take a look to see if you can find one a couple of months later as a compromise. This will give you adequate time to heal, and not rush you back to running if you're foot is not ready. You probably don't need to take twelve weeks off-but everyone heals differently. Best case, you could take the sixty minute walk test in five to six weeks and see how you do. Best wishes for a speedy healing! --Alex

Rachel said...

I qualified for the Boston Marathon and have been looking forward to running it FOREVER. Mid-way through training, I started having shin pain - localized and shooting - so I thought it was a stress fracture. An MRI did not reveal a stress fracture, so I kept running. I received treatment from a chiropractor, eliminated short runs in favor of pool running, but kept the long runs. Ran 21 miles this weekend and now can barely walk, the pain in my shin is so bad. Same spot. I have an appt. with a doctor on Wed. (10 days before Boston). If he says I still don't have a stress fracture, should I run? If he confirms a stress fracture, I'll cancel my trip to Boston, but if it is not a stress fracture, I am inclined to give it a try. I have wanted to run Boston my whole life and may never qualify again. To be this close and give up b/c of an injury (esp. if the doctor says it is "just" a shin splint) just makes me sick. On the other hand, the pain after my long runs is terrible and I fear making a bad situation worse just because I am pig-headed and didn't listen to my body....Help, please. I don't know what to do....

runner-grrl said...

Rachel, You are in a tough spot and I completely understand how you feel. It's such a huge accomplishment to qualify for Boston (Congratulations!) And heart-breaking to think you might not be able to run it. A couple of things for you:
1). Your first MRI was negative for a stress fracture. This is the tool of choice, so unless it was missed, you probably have a different issue. Did the MRI reveal anything? Your pain indicates a real issue, and I would hope that the MRI should show something.
2). You might have tendonitis (the pain for this can be pretty severe).
3). You might have a stress fracture anyway, regardless of your earlier MRI.
If I were in your shoes, I'd be doing my best to get another MRI so that you have the best information possible. An X-ray is likely insufficient.
If you do have a stress fracture, you, I would recommend passing on Boston. (Looks like you have already come to that conclusion.)
If you don't have a stress fracture, you may be able to manage the symptoms (at the cost of making them worse later) and tough it out through Boston. You will probably want to re-set your expectations on what your goals are for the race, and tone your effort down a bit. But, celebrate what your effort has brought you! I'm happy to help you think through this a bit more as you have additional information. Feel free to email me directly at fongrrl at gmail dot com.
Best wishes, and I sure hope you can get to Boston this month! --Alex

Rachel said...

Thank you so much! Just returned from doctor visit #2. He said I could have a second MRI "if I wanted it," (which I thought was odd) but since the last one was negative and the symptoms are the same (not a lot worse), he suspects it is still periostitis (i.e. "just" shin splints). He agreed that my description of the pain is text book stress fracture, but he was pretty confident the MRI would have revealed a break. His advice? No running until Boston. Pool train to keep fitness. Go to the start line. Run until there is pain. When/if it hurts - stop. If I finish, great. If not, I got there and I tried, but I won't be injured when it is over. So - I am sadly expecting the slowest Boston time ever, but I am looking forward to the experience. Thanks a ton. Your blog is incredibly helpful.

runner-grrl said...

Rachel, Thanks for writing back and sharing your story! Tell me how Boston goes :) --Alex

Kristy said...

hi i was wondering if you could suggest some adivse for me. last may 2011 i ran a half marathon and got 2nd was fine afterwards but went for my ususal run a couple of days later and i couldnt walk all of a sudden. went to my physio who said it could be a lateral miniscus tear or strain but wasnt sure. i had my honeymoon planned in a months time so we suggestd we will see how it is after that and if no better will get an mri. came back no better so got referral for mri, which took 2 months to get. during this whole time i wore a knee brace and did alot of walking no real running and physio contiuned to work on my knee, quite vigouriosuly at time (even made me bruise alo) got mri which was 5 months after injury which showed nothing, but ortho decided to give me a cortisone shot for the hell of it i guess. after the shot i was in immense pain and went back to him numerous times. got worse and worse then the cortione actually caused some fat loss and loss of pigmentation where it was injection (although they say this shouldnt casue pain) in the end pain was so bad wasnt able to walk again even though i had been doing so before hand, although was advised to get rid of my knee brace which i wore 24/7 before the shot. so maybe that had something to do with it. anyway they decided to send me for bone scan and another mri, bone scan was 7 months after injury and suggested it was a stress fracture of the lateral lip of the lateral tibial plateau. so crutchers were given to me finally and was on them for around 7 weeks. got 2nd mri, showed nothing again. got off crutchers and no better really still am not pain free to even walk yet let alone run, my lifestyle has completly changed, all i wanted to do was run again now all i want to do is have a day without pain. it nearly a year since injury and now a sports med specialiset says it might be nuropathic (is. my injury healed but my brain still thinks it is there) and wants me to take some medication to help with neuropathic pathways of the brain, im not so sure but am at my wits end. i just want to walk. it really affecting my work, health and relationship. have you ever heard of stress fracture going on this long? or could it be a prob with the nerve? i also wonder if i hadnt had the cortione it may have been a different story and may be gone by nows. hope you can help. thanks

runner-grrl said...

Kristy,
I've read through your post a few times now, and I just feel your pain coming through, both the physical and emotional suffering that you've been through in the last year. I'm sorry it has taken such a toll on you, and that you've struggled so hard just to get some answers.
A few things stand out to me about your situation.
1). You never got a definitive diagnosis of a stress fracture or otherwise. Your first bone scan and MRI appear to be inconclusive. Your second MRI showed nothing.
2). You are not imagining your pain, and you've gone to excessive lengths to try to recover from it (not running, lengthy time in knee brace, crutches for 7 weeks). No one who loves running as much as you do would tolerate this without good reason!
3). If you did indeed have a stress fracture, this has healed by now.

There are a few things I'd do at this point, if I were you.
1). Collect your MRIs from both dates and take them for a second opinion. You aren't imagining your pain, and something is definitely wrong. You should get a confirmation on the stress fracture one way or the other. It will be helpful to know if this really was the root cause of all the pain.
2). Get out of the knee brace--at this point, this is not helping and is likely contributing to some atrophy or stiffening in the area.
3). Avoid any massage or 'work' that leaves the area bruised. It sounds like you may have had Graston or something like that.
4). Try some gentle active isolated stretching (not static) to get the area more loose over time. Do not push it.

If you can confirm the stress fracture, there are many reasons you might still have pain, even after it has healed. When your body goes through the process of healing a fracture, the inflammation through remodeling process will affect all surrounding tissues. Tendons, muscles, etc. can get adhesions and scar tissue, which can cause a great deal of pain and stiffness. You can break this cycle, though it will come a little bit at a time.

There is another condition that occurred to me based on what you described, although it is rare--it can occur after nerve damage / post injury. You might want to read a little about it: Reflex Sympathetic Dystrophy. It's unlikely this is what you are experiencing, but something that one of the other runners who commented above ended up with as a diagnosis after her stress fracture and extended period of agonizing pain long after the bone had healed.

I can feel how devastating all of this has been on you. I've love to dialogue with you a bit more in depth. Please feel free to write to me at fongrrl at gmail dot com.

Wishing you the best, --Alex

Kristy said...

hi thanks for your quick response. yes the stress fracture was diganosed. via the bone scan in dec 2011. but didnt show on either of the mri's however, it did say stress fracture on the report of my bone scan. but yes you are right it should be well and truely healed by now

Rachel said...

Alex - Just wanted to report that I finished the Boston marathon. It was painful, slow and genenerally miserable (but I finished!!) and I don't recommend that anyone who has shin pain (of any sort) do it, but it is possible. I survived. However, I had another MRI yesterday to make sure the shin didn't fracture during the race. I should get my results tomorrow. I am pretty sure it is not broken, just inflammed. If not broken, how long should I rest it before I try to run again? I am signed up for a relay marathon on May 20 - my portion is just 5 miles - but I want to be sure to give the shin time to heal completely before I cause it to flare up again....
Thanks for your advice.
Rachel (from prior posts of April 3-5, 2012)

runner-grrl said...

Rachel, Congratulations! I'm so happy you finished. And, wow, was it hot out there from what I read / heard! I hope your MRI comes back negative for a stress fracture. If it is indeed negative, I'd definitely give your body about two to three weeks of absolutely no running and still very light activity. I would hope by that point, your shins should have settled down a little bit, and you might be able to work in some very easy recovery cross-training towards the end of that time. By three weeks, you will want to 'work out' your usual 5-6 days per week, but you might want to just gradually replace some of that time or some of those days with running and wane out the other activity gradually. Example: By week 4 (assuming pain has really settled down), replace two days of cross-training with a short run, by week 5, try three days of short runs.
Let us all know how the MRI results go! Cheering for you, --Alex

Rachel said...

Hi Alex - MRI results should "Bone changes consistent with an early stage stress fracture." Whatever that means. Doctor said - no running at all until there is no pain at all. Total rest for a couple of weeks. Then non-impact exercise (assuming no pain), then - maybe in 8 weeks or whenever it feels 100% - I can try to run a little. I have a relay marathon to run on May 20, so I'll take it day by day to see how it feels until then. At least I got a good story out of it and an excuse for my super slow Boston time...I ran Boston with a "broken leg"!! In a heatwave. So, I got that goin' for me.... Thanks again for all of your advice. So very helpful.

runner-grrl said...

Rachel, Well, the good news is you have a real answer for why you felt the way you did. Also, the 'early stages' is good news--if you mind your healing process, you should be ready to run fairly quickly. 8 weeks is a pretty good rule of thumb for an uncomplicated tibial stress fracture. And, yes, you definitely have a great story! Hope you get to run Boston again with cooler weather and solid legs :) Thanks for writing back! -Alex

Paul Allen said...

Hi Alex, I was wondering if you could talk some sanity into me. I have recovered pretty nicely from two sfx over the last few years. Now I am having constant pain in both my feet. Standing hurts! Walking hurts! Running - love it too much to accept it hurts! I am afraid I have bilateral tarsal sfxs! This is bad! I have a bone scan Tuesday and a 100 miler Saturday. I'll do the bone scan, but I am also strongly considering running it despite the pain. Am I totally nuts??!!??
Paul

runner-grrl said...

Paul, I'm hopeful that the bone scan reveals what is truly happening with your feet so you can make a more informed decision. However, if you are in this much pain, I would defer the 100-miler to another time when you are healthy and not in constant pain--regardless of sfxs or not. What's concerning is that you may make it pretty far before you DNF due to pain, and then you'll be even farther from recovery and your ability to turn around and do a 100-miler again this year. Your pain could be from sfxs or it could be from PF or could be from something else. Couple what you discover from Tuesday with your plan, but I'd recommend against the ultra this coming weekend. Write back and let me know what the bone scans revealed. If sfxs are ruled out, try to get an MRI to see what is happening in the soft tissue. Best, --Alex

aggie11 said...

Hi Alex!
First off I just want to say thank you for the positive post about stress fractures! A little bit about myself. I am a recreational runner. I've never run for competition, but simply as my exercise (for both body and mind :) In college my right IT band kicked in a little, and so I started a running program that was 5minutes walking/2 minutes running for 40 minutes, 6 days a week. Each week I would up the running portion by one minute. When I was up to running 5/5 intervals, I was in the best shape of my life. I was running a fast 5 and feeling great. That's what I would like to get back to. But....I'm mentally terrified to take those first running steps. I was diagnosed with a tibial stress fracture by an MRI on March 9. The doctor took one look and said it was just beginning, and that he would only say take 4 weeks off. At 4 weeks I was still feeling some twinges of pain just walking, so I opted to give it a least another 4 weeks. Here I am almost 14 weeks later and I still haven't run. It doesn't hurt to walk around. I can hop on my leg and it doesn't hurt (although I don't know how many times I am supposed to hop on it to test it). I've gone power-walking about 5 times for 40 minutes with no pain. For my return to running, I was going to start out with my typical 2/5 intervals, but only do it every other day, or depending on any pain. Does that seem like a reasonable starting point? 2. How do you make it mentally through those first few runs? I feel as though I'm so hypersensitive to any pain now, that any little feeling scares me. I hate this feeling because the whole point of running is to feel free. And is adding a minute each week following the 10% rule?

runner-grrl said...

Aggie11, I'm so glad you wrote :) You are in such a good place right now physically, and you are ready to get back out there. The good news about stress fractures is that they do heal. Now you need to focus on that fact--your body has taken care of itself. I am curious, though, if the SF was also on the right side (same as IT band issue). If so, you might want to have some gait / stride analysis and also work in some active isolated stretching. Also, to help prevent Tibial SFs and strengthen this area of your body, you should be doing calf raises a few times per week (3 sets of 10 to 15--you can alternate the direction of the toes, 3 times per week).
Starting out your running in the same way, 5 minutes walking, 2 minutes running for 40 minutes will be an excellent way for you to get back into it. You could alternate days for the first week or two to be cautious, gradually adding a day of running as each week goes by.
Your post brings up a really good point--the mental aspect of the injury is often more difficult than the physical one. I remember so well going back to doing things after my SF healed and remember how some 'every day' task used to hurt, and be in fear of that pain. Not because I was afraid of the pain itself, but of the news that the pain might bear.
it is likely you will have some twinges or odd feelings in that area. There may be some tissue damage around the site, though this is generally less of a prolonged problem for TSFs than some other areas in the body for SFs. Don't let that discourage you.
Enjoy your first few minutes of running :)
Best, --Alex

Anonymous said...

runner girl i am not a runner at all. but i as a professional who is on her feet allot found this very helpful. i have had 2 foot surgeris in last 2 years and went back to work a year ago after being off work 2 years being off again is dishaeartening. but i am determined to get back to where i was before. thanks for the pep talk and real info. bj

runner-grrl said...

Bj, Best wishes to you in your recovery. Hope you are able to get to the bottom of the issue and resolve the root cause, so you can have long lasting recovery and relief! --Alex

Marion said...

I just came across your post and wanted to thank you for being so inspirational. I'm a relatively new runner but I've ran quite a few races in the past two years- I'm in love. I'm signed up to run the Chicago marathon (which will be my first marathon) but I got a tibial stress fracture while training for a half back at the end of April. I took time off, slowly added non-impact activities, added walking, then slowly started running again when I was sure I had no pain. I got overly-excited though and ran too much. Now I'm in pain again.

The part you wrote about psychological issues is an incredibly thoughtful description of my fears after suffering from the stress fracture. I had one last year as well, in the same spot actually, and when I felt the pain again back in April it was like my world shattered. When I started running again three weeks ago my thoughts kept going back and forth between "oh my god I'm running again!" and "please please please oh please pain do not come back". The actual pain of the stress fracture is manageable.. it's the psychological pain of having to stop running when you're been training for a race and having to give it all up for a while.

Thank you for writing this post and giving everyone going through this a little hope. It always feels nice to know that other people have gone through what you're dealing with right now. I haven't given up on running Chicago yet but I'm not sure I'll have enough time to train. You made me think bigger picture though, and that's really the most important thing.

runner-grrl said...

Marion, I'm so glad you wrote and shared your experience. I'm really sorry to hear about the TSF in April. Your struggle really comes through, and I think it's the area that makes an injury like this so difficult. You just want to get back out there and not fear the injury again. I so feel for you.

I don't think Chicago is out of the question for you, but you may want to turn to some vigorous cross training while you tibia finally settles down, and slowly crank up the running. Hope your first marathon dreams can come true this fall!

Would love to hear back on how you are doing. Best, --Alex

PlanningQueen said...

Fabulous info. Thanks for sharing so much. I am having an MRI on Monday for a suspected stress fracture of the inferior pubic ramus.

runner-grrl said...

PlanningQueen, Thanks for writing in! Hope you recover quickly regardless of a positive MRI or not, and wish you the very best! --Alex

Anonymous said...

Thanks so much for your article! I'm also suffering through a tibial stress fracture. I originally had two fractures (in the same leg) one healed after 2 months, the other still stubbornly refuses to heal. I've been out for 5 months, struggling through tough mental and psychological times. Before diagnosis I did run on them for 5 months, resting for several weeks in the middle when I was mis-diagnosed with a calf muscle problem. Any advice you can give would be appreciated. Thanks!

L said...

I just came across your blog; it's 4 am and I can't sleep because I've been so stressed about all I was hearing about pelvic stress fractures from running. I'm 5 weeks out from what I thought was initially a pulled groin, wad running and all the sudden at mile 4 a weird pain/sensation down in my groin region right on the pubis bone. I left it alone for a week but it was getting worse not better and I was completely resting it; could barely even walk slowly without a shooting/burning pain/twinge going up inside. Luckily I was in PT already for something else so my PT said that wasn't normal as they had started to treat it too and it was getting worse not better. Went to my primary care & she blew me off said it'll take time to heal & said continue PT. As someone who's very active normally & has had serversl surguries & broken bones in the past I knew it should not feel worse 2-3 weeks out. Immediately called my ortho & they managed to squeeze me in in week 4 after the day I first felt the pain. In the meantime did PT but was just as bad/worse with just ultrasound/stem so called my primary care to see about Xrays or something. Xrays came back normal but she thought it may be stress fracture so did CT; came back normal. Went to ortho/sports med guy a few days later & he initially thought pubis oestosis & sent for MRI but couldn't get in for a couple of weeks. Left feeling utterly dejected especially because on top of all of this I had surgery that same week to do a decompression of my ulnar nerve on my left arm. Luckily I'm a walking mess:) so I knew about the cancelation list & called later that day. Ended up getting in the next afternoon & the ortho called the next day & said I had a stress fracture in my pelvis & wanted all weight off, i.e. crutches. Only problem I was only a few days out from my elbow surgery so couldn't bare
weight in that elbow... Had to wait a couple of days until my elbow dr okayed me to be on crutches and now I'm over 5 weeks out from when I hurt myself and have been on crutches for 3 days. Did I mention my office is having the elevator replaced & I'm 4 stories up & have a very active job where usually I'm running all over the building and up & down flights? It had actually started to feel a bit better a couple days before I got my crutches. I think due to my pain killers for my elbow. I'm very cautious about taking anything & only took 2 per day for 5 days when I had a script for 2 every 4-6 hrs for a few weeks. Obese off for a few days & wasn't even taking Ibeprofen as there was still pain at times but not with each step up into my I guess you can say girl parts. I don't know if it was the pain pills allowed my body to relax and move a little more easy? Anyway I quit taking them after 5 days because I no longer needed them for my elbow. That was about a were ago. Got my crutches 3 days ago & my first trip up the stairs up to my office I managed to land wrong and the pain has come back even worse than before, pretty sure I undid any healing that was done in the past 5 weeks & put me back to square one. I'm back to having continous pain that icing & Ibephron doesn't help at all. I don't see my ortho for another week, do I continue to use the crutches & just wait to see him as there's probably nothing he can do anyway or do I call? Also has anyone else had it where the pain in their pelvis/pubis bone is there all the time and it hurts to even walk slowly limping along? I'm someone who used to run on my lunches in addition to walking at least another 5 miles throughout the day. I've kept all walking/stairs to an absolute minimum so it's not like I'm trying to run and have the pain coming back only when I run, it's constant and my only relief is when I'm sitting on an ice pack & it's numb. As soon as the icepack cools or I take it off for awhile it cones right back. HELP!!!

runner-grrl said...

L, I identify with so much of what you have written. Further along in life now, but I also went through an undiagnosed pelvic stress fracture--and things got worse, a LOT worse--before they got better. This was 13 months ago. I can honestly say the next three months after that were some of the darkest I can remember, and spent mostly on bed rest then graduating to crutches. I would love to share this experience with you and give you some hope at the end of all of this. 13 months out now (today), I completed Pikes Peak Marathon in August (this year), have run every day for the past eight days (including today) and also just started cross fit (three sessions in the past week). I tell you these things to let you know, it can and does get better. If you'd like to talk more, please write to me at fongrrl at gmail dot com. I'm so sorry for what you are going through, and I so completely understand what it's like. --Alex

Hannah Love said...

I just can across the blog and it has been very helpful to me! I was diagnosed with a tibial stress fracture 5 weeks ago and I was put in a walking boot. I was still having pain so my ortho did a MRI and confirmed that I have a bone bruise in my foot and my stress fracture in my leg. I'm in a cast for 4 weeks then hopefully I can start cross training while I'm in an aircast. Thank you for such an inspiring post :)

Lori Jenner said...

I have to ask, do you regret running the Chicago Marathon with the tibial stress fracture? How far off if any were you of your goal time? Thanks :)

runner-grrl said...

Lori,

Great question. You know, I really don't. But, I wouldn't recommend it to anyone. The risk of more serious damage is too great. Had I known it was a tibial stress fracture, I certainly would not have run it. I was four minutes off my goal time. I did come back the following year, and ran it 16 minutes faster (with a healthy tibia), and that was very satisfying. Thanks for writing!

gumilaro said...

You can run after fixation as you explained. As with any running program, however, I recommend that you progress slowly to running (or back to running). Listen to your body and allow sufficient time to get running the way you hope.
metatarsal stress fracture

gunwan said...

I believe my chiropractor worsened my stress fracture. I have a tibial stress fracture...causing pain I thought was my knee. The chiropractor said my leg was out of alignment, pulled my leg and whacked the sides of my knee to put things back. I told him this was hurting...but he didn't stop. The pain got worse, and I had an MRI from the sports doctor and found a severe stress fracture. No more chiropractor for me.
metatarsal stress fracture

Richard Thomas said...

I'm really bummed right now. I was really getting into a great pace and after running 11 miles last Saturday, I felt it and knew what it was. I have a half marathon next Saturday and it's killing me to know that I may not be able to run it. I am thankful that I saw your blog and I think it may be in my best interest to nurse myself back rather than injure it during the race and risk possible surgery. Thanks again.

runner-grrl said...

Hi, Richard, Ugh... so sorry to hear that. If you can stand it, you are better off resting and trying to come back quickly than facing a much longer recovery. I know what that feels like, and completely empathize. Hope you are back in your running shoes quickly!

Priyanka Suri said...

Nice post.Jhansi Orthopaedic Hospital is renowed name for being the best fracture healing hospital in Jhansi at affordable price. For any query visit website.

jesika55 said...

It is a very beautiful and good site. It’s a helpful. it can our life beutifull and helthfull.
Specialized Running and compression gear for athletes, runners, elderly, nurses High quality Calf compression sleeves, compression socks

compression socks
calf compression sleeves

Wheelchair India said...

Hey, very nice site. I came across this on Google, and I am stoked that I did. I will definitely be coming back here more often. Wish I could add to the conversation and bring a bit more to the table, but am just taking in as much info as I can at the moment. Thanks for sharing.
Aluminum Walking Crutches

Keep Posting:)

Lenay Phillipps said...

I am a cancer survivor and a domestic abuse survivor. I have three sons, two of whom have juvenile diabetes. I have worked in the healthcare industry in some capacity for the past 30 years and as an entrepreneur. I am now combining my passion for both fields in this blog with a goal to provide helpful information on weight loss. My bigger goal is to help fund a cure for juvenile diabetes. I have visited this blog there provided valuable information as you will get better life also I am suggesting more tips, you can Please follow those
natural weight loss
lose weight
weight loss
diet
weight management
losing weight