Laura Barreca, PT, DPT
One of the scarier words for runners to hear in the world of injury is stress fracture. A stress fracture is damage to a bone and for our runners, typically found in the leg whether that be the tibia, fibula, femur, or pelvis. As runners, we try to avoid this big bad scary injury that keeps us from doing what we love. Let’s dive into how these things can happen and how we can avoid them.
Stress fractures can form when osteoblasts, or the bone forming cells, are outnumbered by osteoclasts, or the bone degrading cells. This can result in breakdown of bone leading to a stress reaction or a stress fracture. There are varying stages and a stress reaction is the simpler of the two in which the bone is just starting to emit breakdown signals. Stress fractures can be characterized into levels of severity utilizing grades 1 through 4.
So, what can cause these terrible things to happen: too much too soon in terms of training load, sleep deprivation, increased stress levels, and nutritional deficits. Let’s walk through each of these.
- Too much too soon – what does this mean? This is in reference to training load and looks at how much you are running or how hard you are running. Too significant of a mileage increase from week to week, too many hard efforts/workouts in a week’s time span, or not enough rest days to allow the body to recover between efforts can cause a stress fracture to develop. Looking at training in terms of volume, intensity, & frequency can be helpful with this.
- Another factor that can significantly impact bone health is sleep deprivation. Sleep is when the body stimulates regrowth hormones that allow damaged sections of muscle/tissue/bone to be healed. If we are depriving our bodies of sleep, this healing time is impacted. And like Lisbeth said in her blog, it’s free!
- Next up, increased stress levels. And yes, if you live in New York, these are going to be high. This is something that is often out of our control– relationship stress, family stress, job stress, financial stress; there is a lot that can come into play here. Increased stress levels mean increased cortisol which is a hormone that can contribute to bone breakdown. Trying your best to control or manage what you can is only going to help you to be healthy in the future.
- Last up, nutrition. Nutrition is something that can also contribute to the breakdown of bone. Most people think about what you eat when I mention this, but what is also important is how much you are eating. Running is a source of energy depletion and this energy needs to be replaced with nutrients or our body’s energy source. If you are not replacing lost energy after your runs, the body will have to pull from other places and this could be from your bone health.
So with all of this in mind, check in on yourself throughout your training cycle to make sure that you are on the right track. Check with your coach, physical therapist, or another licensed professional to make sure that when life is getting in the way, your training is adjusted to support these changes and avoid injury in the future.