Vincent H., Brownstein M., Vincent K. Injury Prevention, Safe Training Techniques, Rehabilitation, and Return to Sport in Trail Runners. Arthroscopy, Sports Medicine, and Rehabilitation. 2022;4(1): 151-162.

What is a Stress Fracture?

Stress Fractures are tiny cracks in the bone caused by repetitive force and often overuse. Stress fractures are difficult to see on imaging and often are undiagnosed if you go right when your pain begins.

Why is this? The stress fracture is better seen after it has started healing as the re-ossification is where you can begin to see the fine line in the image.

Can you find the stress fracture in the image below?

Stress fractures often occur in the tibia (shin bone), knee, ankle and metatarsals (feet bones) but they can occur anywhere.

How can I tell if I have a stress fracture?

Common Physical Symptoms are:

low level localized pain or a dull aching pain
Pain that worsens wit movement and can last for more than 24 hours post activity
pain when weight bearing, especially when hopping on the affected leg
swelling and tenderness over the area may be evident depending on the location

What is the best way to diagnose a Stress Fracture?

Early detection and diagnosis is important to allow for successful healing and quicker recovery. Physical Therapist and MD’s use special tests like the hop test, percussion test or a metatarsal loading test to help diagnose. However, the best way to diagnose is through an MRI because it has the most sensitive image that can be used to differentiate between soft tissue and bone images.

What Causes a Stress Fracture?

Chronic/overuse
Loading and Loading impact
Running through fatigue
Abnormal joint motion
Running through non-critical, chronic pain

Key Mechanical Stresses to the musculoskeletal system during running and motion strategies required to reduce risk

Core and pelvis muscle activation for stability
Eccentric and concentric leg strength
Quadricep and hamstring coactivation and stiffness
Fatigue resistance
Plantar Flexor and dorsiflexor strength
Trunk Control, avoidance of excessive forward lean
Core muscle coactivation prevention of pelvic drop and obliquity
Knee flexion and neutral alignment
Intrinsic foot strength
Ankle strength, reactivity and neuromotor control
Stable foot landings, non-heel strike with appropriate ankle range of motion.

What are some other risk factors for the development of stress fractures?

Increasing the volume of running too much too soon
Changing your foot wear or running surfaces
insufficient nutrition including reduced vitamin D
Prior stress injury to the bone
menstrual irregularity or low BMI
health conditions that reduce bone density (such as osteoporosis)
poor biomechanics and certain running techniques

Already Diagnosed with a stress Fracture?

If you have already been diagnosed with a stress fracture then stopping the aggravating factor (running/jumping) allows for the bone to heal.

DONT FREAK OUT!!

There are many other things to do like BIKE, ROW, SWIM or STRENGTH TRAINING to add to your training while resting the bone. Rest does not mean do nothing!

My go to BIKE is the Assault Bike, if your want more a road bike feel then I prefer this one the Concept 2 Bike ERG.

If your really trying to build your quads while resting the concept 2 Rower is also a good tool, it has a maximal calorie output of the other two also!

Injury Prevention

The best way to minimize risk of stress fractures is to avoid any sudden changes in your training.

If you are a novice runner, it might be a good idea to chose a running program that includes run-walk intervals such as Couch to 5k.

Avoid running on consecutive days to allow for the body to recovery (REST =REPAIR).

INVEST in a good pair of running shoes.

Shoes:

More cushion is not always better! Remember what I said before it’s about MOTION CONTROL at the foot!

More on this topic later but here are my recommended shoes:

Brooks-they have a great shoe finder tool, if you are not sure you can also see your physical therapist or podiatrist to recommend the correct shoe for you.

Mizuno-

As a general rule of thumb avoid increasing your weekly mileage by more than 15%.

Bone strength and toughness plays a critical role to resist against fatigue damage and development of stress fractures.

Therefore, strength training, core strength, neuromuscular control and rest play a HUGE role in prevention.

Below I have listed some of the BEST exercises for runners to prevent stress fractures and plain ol’ improve your running speed and control! Please click my links to help support me and allow for continuation of writing.

Please see the video for my shortened list of MUST DO exercises with demonstration.

Exercises to prevent Stress Fractures

These are to be done for 8-18 sessions for 2-6 weeks. This is not achieved any other way, it takes this long to build strength and control. If you want it then you have to work for it.

One of my pet peeves, is when someone asks for my help and I spend my time helping them and they do not carry through with my advice. Then they say physical therapy didn’t help. Well darlin’ you didn’t actually do the physical therapy, LOL!

Flexibility

Lunge Stretch forward to to the side
Pigeon Stretch
Hip Swings
Calf stretch (Knee straight, knee bent)
Lower trunk rotations

Strength and Neuromuscular control

Step ups with DB—Click here for a great box
Single leg bridge (Hip thrust) - you can add resistance with bands, no need to load up heavy with a bar!
Doming balancing on one leg—This works the intrinsic muscles of the feet and a MUST DO!-Make it more difficult with an balance pad, click here to view.
Doming with band
Single leg balance on half foam roller with hip 3 way exercise— A must do !! Click here for bands and 1/2 foam roller!
Lateral lunges to Bosu
Quick feet on Bosu or Mat
Single leg calf raises, either body weight or use with bands or DB.

Click below on the images to get your tools for success.

Plyometrics

Scissor jumps either body weight or with bands
lateral skiers- either body weight or wtih bands

All of these exercises address the biomechanical needs to reduce stress fractures in running. One is not more important than the other. If you have difficulty or pain with any of them stop and reach out to me or see your physician. So when looking at these tools/equipment, compare it to the cost of one MRI. There is your justification right there.

I hope I was able to help you and help you smash those goals! If I did please follow me on IG (click below in the footer) and subscribe to my You Tube Channel.

Thanks YALL!

Disclaimer

Amy the PT girl is to be used for educational purposes only. It is not intended to diagnose or treat medical conditions. It is recommended you consult your healthcare provider before beginning any exercise program. If your condition does not improve or worsens, stop exercises and consult your physician right away.

If your looking for one-on-one guidance please feel free to contact me through email or submitting your information in the contact section. You can also find more videos on my You Tube Channel.

How to Prevent Stress Fractures From Running