"Why do I Keep Getting Stress Fractures?" - common causes of & ways to prevent stress fractures
If you’ve ever suffered from a stress fracture you know all too well just how pesky they can be! As runners, any injury that forces us to take time off from running can not only be physically painful, but the toll it takes on us mentally can be a heavy burden too.
As you may know, one of the most common causes of stress fractures is overuse however there are other causes that should be considered when assessing a stress fracture. But first, let’s talk a little bit about what a stress fracture is and how it presents.
Signs and symptoms of a stress fracture
Stress fractures begin when there is repetitive and excessive stress on the bone. This then causes an acceleration in the normal bone remodeling process, production of microfractures then subsequently a stress injury such as a stress reaction and finally a stress fracture occurs.
Stress fractures most commonly occur in the bones of the leg and foot (tibia, tarsal navicular, metatarsal, fibula, femur etc.) in athletes who participate in sports involving high volumes of running and jumping. A stress fracture presents as localized pain on the affected bone. The pain typically increases with weight bearing activities (such as running, walking, jumping) and repetitive use. There also may be signs of edema or swelling in the area.
If you suspect you have a stress fracture visit your medical doctor to be properly assessed and sent for any necessary imaging.
Your doctor may order an x-ray or MRI to diagnose a stress fracture. However, in the initial stages of a stress fracture, they’re often difficult to see on imaging. Understandably, this can be a frustrating process!
So how can you reduce your chances of getting a stress fracture or decrease the risk of having subsequent stress fractures in the future?
Common causes and risk factors
There are a number of risk factors that can increase your risk of experiencing a stress fracture. Here are some factors that increase the risk of stress fractures that you can modify.
1.High volume of physical activity without proper rest and recovery.
I can’t stress (no pun intended) this point enough! Our body needs time to rest and recover after activity. Think of it like the gas tank in a car. You can’t run on an empty gas tank, you have to stop the car and refill it from time to time. That being said, you should have at least 1 rest day a week. A rest day may include doing no activity or something that has less impact on the bone such as swimming or cycling.
2.Not consuming enough food to meet your body’s energy needs.
In order for your body to properly recover after activity we need to discuss something called energy balance. Energy balance occurs when the energy intake (EI) equals the total energy expenditure (TEE). Basically if you’re in a negative energy balance you aren’t replenishing your body with the energy it used up throughout the day for basic body functions and exercise (again, think of the gas tank analogy). If you have difficulty with eating or want support with proper fuelling as an athlete, please reach out for help! Nutritionists, dieticians and naturopathic doctors can help with eating habits and proper nutrition for athletes.
3.Increasing exercise volume too quickly.
Often when we are new to a sport such as running, it can be easy to get caught up in the excitement and joy of running and increase our mileage too quickly. Do your best to slowly work up to longer runs and take your time increasing your weekly total km’s run too. Think about getting a coach or following a training plan to make sure you are safely increasing your activity. Your muscles and bones need time to adapt and this will help avoid overuse injuries such as stress fractures.
Other things your healthcare provider should consider if you’ve had multiple stress fractures
Our bone health is multifaceted. It includes the balance of several hormones along with many different nutrients (your bone health involves more than just good ‘ol calcium intake).
If you’ve suffered from several stress fractures your healthcare provider should be doing some more extensive diagnostic digging. Things like a complete blood count along with iron (ferrtin) levels should be looked at. Looking into your vitamin D status, your thyroid and parathyroid function may also be indicated as well. They may want to screen you for absorption problems such as celiac disease if you experience digestive symptoms.
If you’re a woman and you’re experiencing changes in your menstrual cycle, other hormones your doctor may want to measure are follicular stimulating hormone, luteinizing hormone and prolactin. Keep in mind though, whether your doctor orders any of these tests mentioned is based on your unique case. But what I’m trying to get at is that it may not always be solely an overuse injury.
Treatment
Firstly, stress fractures should be treated by a multidisciplinary health care team. This might include physiotherapists, chiropractors, medical doctors, endocrinologists, nutritionists/dieticians and naturopathic doctors to name a few. But the number one first line treatment is rest (as a runner, I know how hard this can be but it’s necessary!).
As a naturopathic doctor, my treatment is always targeted at the root cause of your health concerns. Once we uncover why you are getting multiple stress fractures, we can target treatment at the root cause(s). This may include balancing hormones (through herbal medicine and nutrition), supporting digestive health (removal of food sensitivities or intolerances) and supplementing the appropriate nutrients to aid in optimal bone healing (vitamin D3, K2, calcium, magnesium, phosphorus etc.) depending on what the cause may be.
If you’ve experienced multiple stress fractures I encourage you to ask your health care provider(s) to dig deeper and make sure all applicable root causes are accounted for.
Wishing you safe, happy and healthy running!
References
https://www.aafp.org/afp/2003/1015/p1527.html
https://www.aafp.org/afp/2011/0101/p39.html
“Taking the stress out of stress fractures. Deep dive & clinical tips w/ Dr. Kathryn Ackerman - BJSM podcast”
