The beautiful weather makes it near impossible not to go out and run. Like the increase in sneezing from the pollen count, there has been an unfortunate increase in injuries of the foot, and in this instance, the prevalence of stress fractures. This article looks to help you understand the pathology, identify training error, target the areas for strengthening and assist you in the management of the symptoms long-term to not only prevent from occurring but to offer suggestion to speeding up recovery following injury.
“A stress fracture is a small crack in the bone, or severe bruising within a bone.”
The foot injury is mainly due to load changes, or the body’s inability to absorb the increased load. The long and short is that the body goes through a natural process where it breaks down and builds back up. The cells are a living thing and go through birth and death on a smaller scale. Stress fractures occur when the stress on the bone is more than its ability to place down new bone and adaptive capacity – and therefore becomes inflamed. The injury develops gradually, normally as an underlying ache, before intensifying as the injury falls further behind in the bone remodelling process until daily activities become painful.
www.medicalxpress.com
The changes in the parameters of a runners training programme i.e the intensity, frequency, duration, terrain, etc can increase the load on the bone too high for it to replenish.
Although experience of running can reduce the likelihood of injury, there is a direct relationship between marathon training with under 18 months running experience and also mileage ranging between 64-100km per week. Some research has shown stress fracture in 25km per week cases and therefore each case is specific to the intrinsic and extrinsic factors relating to the individual runner.
www.therunningclinic.com
There can be multiple sites that are prone to this type of injury, mainly in the lower limb in runners. The most common is the tibial shaft, metatarsals and the tarsal navicular. Other less common are the femoral shaft ( Thigh bone) and the pelvis. The most common that I see in the clinic, but only accounting for between 10%-25% of stress fractures, of late has been the metatarsal (long bone of the toes). The area tends to include the 2nd and 3rd bone shafts which are long and thin like fingers with two areas within the bone, the base and near the far end of the bone.
www.sjsom.org
There are other factors that may contribute to over loading and eventually to stress fractures or stress reactions. These include body weight and existing pathologies ( diabetes, osteoporosis, vitamin-D deficiency, Calcium Deficiency or HRT treatment) can mean that some runners are more susceptible than others.
The most relevant factor contributing to stress fracture from my eyes is strength. Strength is a common overlooked factor involved within the prevention of stress fractures. Burne et al (2004) determined that a calf circumference reduction of 10 millimetres resulted in a 4 fold increase of tibial stress fracture. The role of the muscles to pre-tense to absorb load is a major contributing factor to reducing the likely hood of fracture. It could be suggested further that the strength of the foot muscles – in particular the intrinsic muscles, would protect the metatarsals would have the same effect. Ferris et al. (1995) studied the role of the digital flexor muscles in preventing bending of the metatarsals and found that on relaxing the muscles there was an increased bending which tightens the likelihood of fracture. The strengthening of the digital flexors may prevent stress fracture of the metatarsals by lessening the bony vibration.
www.realbuzz.com
Although the consequences of sustaining a stress reaction are frustrating, understanding the injury and noting signs and symptoms in the early stages is important. There are many factors that influence the injury, but looking closely at your training programme goes a long way to aid prevention. Increasing parameters gradually, building a base and increasing the mileage within 10% of the previous week/month is a rough guide to monitor load.
Running in footwear that has worn out or unsuitable for the terrain and distance you are running, insufficient recovery period following previous injuries and high intense sessions and running on the same terrain and the same pace all can contribute to the injury.
Running is a passion for so many of us, understanding your injury and gaining the knowledge to manage your injury independently is important. It is very important that you discuss the injury and create a strengthening plan for the return to running that accounts for the stage of healing that your injury is at. There is unfortunately no set recipe, but a unique specific strengthening plan, based on your needs is important and imperative to the management of the injury.
One way in which I could help you, is if you look out for the #unlacethebrace programme on PhysioRun Youtube that I am looking to go live with. Following @physiorun on InstaGram or James Cruickshank PhysioRun on Facebook for further details.
If you found this blog post useful, if stress fracture is limiting your running then contact me personally at: james@spearphysiotherapy.co.uk stating “return to run” and I will send you the telephone number to book an appointment at the clinic for assessment and an individualised treatment plan.
Runners want to run, PhysioRun wants to help you do this safely and as efficiently as possible.
Thanks for reading
Run Long and Prosper
James
https://medicalxpress.com/news/2017-03-non-coding-rna-molecule-role-osteoporosis.html
https://www.realbuzz.com/articles-interests/running/article/stress-fractures-diagnosis-and-recovery/
Burne S, Khan K, Boudville P, et al. Risk factors associated with exertional medial tibial pain: a 12-month prospective clinical study. Br J Sports Med, 2004;38:441-445.
Ferris L, Sharkey N, Smith T, et al. In uence of extrinsic plantar exors on forefoot loading during heel rise. Foot Ankle, 1995;16:464-473.