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| Stress Fractures…Stop them before they stop you!
by Jennifer Malcolm
Stress fractures are one of the most common injuries seen in long distance running, and many runners will be forced to take time away from training over the course their running career due to this type of injury. It is therefore crucial for runners to understand why stress fractures occur and how to prevent them.
Wolff’s Law states that through activities of modeling and remodeling, bone responds to stresses placed on it. Stress fractures occur when excessive stress is applied to normal bone that is unable to adapt, or when normal stress is placed on weakened bone. Its typical presentation is gradual onset of localized pain with tenderness on the bone. There are many factors that contribute to such an injury and each will be discussed in this article.
First, is one’s training regimen. It is critical to have a good relationship with your coach, because at the high school level he or she will be planning your workout intensity and mileage. Every individual differs in how they adapt to certain stressors. One training program may allow for PRs for one runner and cause a stress fracture due to the type of training in another. Be honest with your coach regarding the aches and pains associated with training as well as the amount of training you have done over the summer. It is important to increase your mileage slowly, with some rest days to allow your body to adapt to the additional stress.
 Second, training surfaces are critical in stress fracture prevention. Soft surfaces like grass, track, and trails are ideal. Concrete sidewalks and roads place added stress on the body and even the slightest slopes and inclines experienced can place angular stress on the hips and legs. Over time, these stresses can lead to fractures. If these surfaces cannot be avoided, be sure to switch sides of the road to alternate the angular stresses of road surfaces, utilize cross training (biking, swimming and aqua-jogging) and most importantly, listen to your body.
Footwear is the most important piece of equipment to a runner. Your shoes are your best friend or worst enemy. We have all dealt with blisters, black toenails, and calluses, however a bigger problem often occurs with training shoes. Many of us grow attached to a particular shoe and do not enjoy trying to find a new shoe that fits the way the old one did. For that reason we often hold on to a pair of shoes far past when they should have been retired. A typical running shoe has a life span of 300-400 miles or 3-6 months depending on the runner’s build and style. Also, each runner has different biomechanics or running form, which means that individuals will require different amounts of cushion vs. stability in their shoe. Biomechanical flaws such as over-pronation (flat feet) or supination (high arch) can significantly affect the way bone reacts to stress, resulting in overuse or excessive wear and tear. With the help of the technically evolving running shoe or a pair of orthotics, these flaws can be corrected, lessening your chances of developing a stress fracture. Runners and parents will often ask what is the best brand of running shoe to buy. The answer is the one that fits the best based on foot type and comfort (regardless of name brand). It is also reasonable to use more than one training shoe. Take your time when finding the right shoe and don’t forget to replace them before it’s too late!
Several nutritional factors are involved in bone growth and play an important role in stress fracture prevention. We all nod our heads when mom and dad tell us to finish our milk at dinner and we have all seen the “Got Milk?” ads for a number of years, but are we really taking the message seriously? During adolescence, 60% of peak bone mass and over half of adult bone calcium is acquired. For individuals ranging in age from 9-18 years old, the daily calcium requirement is 1,300 mg and vitamin D is 200 IU. Still, runners may need more than the average teenager (approximately 1500 mg calcium and 800 IU vitamin D) just as they need more calories. The “energy available hypothesis” states that an individual exercises until she is in a negative caloric state and remains in that state for a prolonged period due to inadequate ingestion of calories for the amount she is exercising. Such dietary stress can lead to both problems maintaining normal bone mass and hormonal abnormalities, leading to menstrual irregularities. It is therefore essential to eat enough and eat right. Foods such as milk, yogurt, cheese, tofu, sardines, salmon, broccoli and spinach are rich in calcium. Milk, salt-water fish and eggs are excellent sources of vitamin D. Many foods and drinks are also fortified with both vitamin D and calcium (i.e. orange juice), making your intake even easier. If you are still not maintaining appropriate levels, you can boost your calcium content by adding nonfat powdered dry milk to pudding, cookies, soup, casseroles, etc or by taking calcium supplements. I cannot stress enough how important it is to help your body build bone through nutrition. During your teenage years you reach your peak bone mass and by your late 20s your bone mass will be declining.
Thus, the steps you take now to help maintain a healthy bone mass will help prevent not only stress fractures while running but also osteoporosis later on in life. This brings up another important topic. As you may have read, female distances runners have yet another obstacle in overcoming stress fractures and osteoporosis. As if dealing with cramps, bloating and emotions once a month wasn’t enough! Hormonal changes associated with menstrual irregularities are associated with an increased risk of stress fractures and are tied to both osteoporosis and eating disorders. Athletes with menstrual disturbances have lower estrogen levels than those with normal cycles. This low estrogen concentration correlates with a lower bone mineral density (BMD) making it more difficult to adapt to the stresses of running. Estrogen acts as a bone protector and rises cyclically with each period. Be sure to consult your physician if you are experiencing such irregularities or multiple stress fractures. Also, please be aware that even if one’s period normalizes, it may not mean that the BMD has normalized, so follow up with your doctor. |
