For access to all of our training, gear, and race coverage, plus exclusive training plans, FinisherPix photos, event discounts, and GPS apps, sign up for Outside+.
The very words “stress fracture” invoke intense fear in any athlete’s heart. Months of discipline, thousands of miles of preparation— all that hard work—can seemingly dissipate with a doctor’s unwelcome diagnosis.
In training and racing, we put tremendous amounts of stress on our bodies and sometimes it leads to injuries such as stress fractures, or tiny cracks in a non-displaced bone most often caused by repetitive stress over time, that don’t allow us to train or race.
So how does one weather this challenging storm? Use this expert advice to overcome this unwelcome injury:
1. Get a diagnosis.
The body is incredibly complex and just because your foot hurts before or during a run doesn’t necessarily mean that you have broken a bone. That being said, a mild, localized pain that progresses to acute pain over time may be indicative of a stress fracture.
“Bones are always remodeling based on the stress placed on them,” says exercise physiologist Greg McMillan, founder of the McMillan Running Company. “Weight-bearing activities like running build bone density because the bone adds strength to withstand the stress. If, however, not enough time is given between the stress on the bone and the remodeling to build it stronger, there can become micro fractures in the bone at the site of greatest stress.”
If you suspect you have a stress fracture, don’t delay a proper diagnosis. Get to the doctor, request a series of scans (Note: X-rays won’t always show a stress fracture in its early stages—bone scans or an MRI are usually more accurate) and stop playing the guessing game.
2. Don’t panic.
If you have been diagnosed with a stress fracture, take a deep breath and relax. It’s going to be at least a few weeks until you can run again, and it’s important to accept this fact from the outset. You will need to be disciplined and have a plan in order to safely return to running once the injury is healed.
McMillan says there are three stages to recovering from a stress fracture: 1. Rest; 2. Gentle loading of stress and 3. Return to load-bearing activities. In the first stage—typically one week–you need to do absolutely nothing but rest so that the bone can “calm down.”
The second stage lasts anywhere from 2 to 4 weeks (or longer for more severe cases) and allows for the introduction of cross-training into your workout routine. Depending on the location of your stress fracture—the shins and metatarsals are some of the most common spots for runners, although bigger bones in the the hips, femur and pelvis are also susceptible—you may be wearing a boot on your foot or find yourself on crutches during this period. Two excellent non-impact training options for you in this stage are swimming and water running.
Sarah Crouch, an expert coach from Runners Connect, likes water running, as it simulates good running form in the water and keeps the heart rate high. Specifically, Crouch prescribes a fartlek pyramid. “The athlete will aqua jog easily for 15 minutes before a workout of 1-2-3-4-3-2-1 minutes at a hard effort with 2 minutes easy aqua jogging between, followed by a 15-minute easy cooldown,” advises Crouch.
The third stage, which can several weeks, you can slowly begin to start running again, incorporating walk/runs for the first week and gradually building up to short runs over the course of 2-3 weeks.
3. Keep your eyes on the prize.
The mental challenges of surviving a stress fracture can be more challenging than the physical. It’s important to take the injury one day at a time and seek comfort in the fact that eventually the fracture will heal. “Don’t be frustrated with lost fitness,” says Crouch, “but rather celebrate the little victories that will come week to week like your first truly pain-free run, your first double digit long run, or your first speed workout.”
Crouch suggests taping a note on your refrigerator or mirror to keep things in perspective. “It can be a message to yourself to be patient and focus on the long term goal of healthy training rather than the short term goal of daily pushing for improvement,” Crouch advises.
The best news about a stress fracture? It can make you healthier in the long run. “Bone heals stronger, whereas soft tissue injuries typically leave the area more vulnerable to injury,” says McMillan. “A well-taken-care-of stress fracture and subsequent training error avoidance can actually leave the runner ready for more (and more intense) training.”