How Runners Can Prevent Stress Fractures
Sometimes taking a break from running is a great way to recover both mentally and physically. But when you have to take a break against your will, it can be absolutely frustrating. No break from running is as frustrating as the break that is required when a stress fracture is the perpetrator. Typically, a stress fracture will sideline you from running for about 6-8 weeks. That can put a major damper on your training.
Stress fractures are overuse injuries that result in tiny hairline cracking in the bone. Most commonly for runners, these injuries are a consequence of the “too much, too soon” approach to training. Pain with impact is the common complaint of runners with a stress fracture. A proper history is sometimes enough to diagnose this issue but x-rays and MRI are occasionally necessary to visualize the injury.
Treatment for stress fractures usually involves taking a break from the aggravating activity. For runners, that means taking a break from running.
Yes, I said it. No running.
Depending on the extent and location of the stress fracture, elliptical workouts and pool workouts may be permissible. Otherwise, biking may be another option in order to maintain your cardiovascular gains. But what can we do in terms of prevention?
Bone Mass Background
On average, our peak bone mass is reached by 25-30 years of age. This can vary based on genetics, gender, activity, onset of puberty and nutritional variances. Up to the age of 30, our bones are regularly replacing old bone with new bone, also known as remodeling. After age 30, the remodeling process slows significantly. The years between 10-30 years of age are the most significant years of bone development.
What Does Research Suggest?
While improper shoes, muscle weaknesses and sharp increases in mileage/intensity have been implicated in stress fracture causation, research suggests that our activities during the ages of 10-30 may be the primary contributor in stress fracture prevention1-3.
It’s been found that runners who participated in ball sports during their childhood and adolescence are less likely to develop stress fractures as adults1. This is due to the various vectors of mechanical loading that are placed on the lower extremities throughout competition, which is understood using Wolff’s Law. This law explains that when our bones are placed under mechanical load, they will remodel and strengthen in order to adapt to the forces being imposed on them.
Since ball sports require high level impact loading while changing direction on hard surfaces, the variety of force vectors causes the bone to remodel and strengthen more completely than compared to a repetitive low impact sport such as distance running1. Distance running was still shown to have positive effects on bone remodeling but not as significant as the high or odd impact loading sports2. This is due to the impact of running being predominantly one directional.
Nutritional Recommendations to Prevent Stress Fractures
Everyone knows the importance of calcium and its role in bone health in prevention of osteoporosis, but it also plays an important role in the prevention of stress fractures4. A daily intake of at least 1500 mg of calcium demonstrated a decrease in occurrence of stress fractures in female athletes and military recruits4.
Research doesn’t show a correlation between vitamin D intake and a reduction in stress fractures4, but we know it plays an important role in the absorption of calcium for bone densification. If your vitamin D levels are low, which is common in Minnesotans, you won’t sufficiently absorb calcium. So, even though research doesn’t show a connection, we can safely assume it’s important and necessary.
Getting your nutrients through real food is always preferred. But for runners, especially those of us who live in Minnesota, it can sometimes be difficult to maintain adequate levels of these nutrients. That’s when it’s important to add a high quality supplement in order to achieve the necessary levels.
These levels can vary and you should consult with your healthcare provider prior to taking any supplements.
Continuing to preserve proper bone health once you have reached peak bone mass is still important. Weight bearing activity, proper nutrition, and high quality shoes are still important in maintaining bone mass as we age. Our bodies just won’t be as efficient as they once were.
While it may be too late for some of us to make any significant changes in our activities, it’s an important reminder of the benefits of cross training and proper nutrition during the years of peak bone development (10-30 years old). It also serves as an opportunity for parents and coaches of young runners to encourage proper nutrition habits and engagement in ball sports or odd-impact activities.
- Fredericson M, Ngo J, Cobb K. Effects of ball sports on future risk of stress fracture in runners. Clin J Sport Med. 2005;15(3):136-141. http://www.ncbi.nlm.nih.gov/pubmed/15867555. Accessed March 4, 2015.
- Tenforde AS, Fredericson M. Influence of sports participation on bone health in the young athlete: a review of the literature. PM&R. 2011;3(9):861-867. doi: 10.1016/j.pmrj.2011.05.019.
- Weidauer L, Minett M, Negus C, Binkley T, Vukovich M, Wey H, Specker. Odd-impact loading results in increased cortical area and moments of inertia in collegiate athletes. Eur J Appl Physiol. 2014;114(7):1429-1438. doi: 10.1007/s00421-014-2870-5.
- Tenforde AS, Sayres LC, Sainani KL, Fredericson M. Evaluating the relationship of calcium and vitamin D in the prevention of stress fracture injuries in the young athlete: a review of the literature. PM&R. 2010;2(10):945-949. doi: 10.1016/j.pmrj.2010.05.006.