Running injuries can be at best painful and at worst require physical therapy and time off from running. Stress fractures are often all three, often occurring without the runner even knowing, but potentially causing lots of problems.

Sports scientist and footwear specialist Emma Kirk-Odunubi tells us all about stress fractures, how to treat them and how to avoid getting one in the first place…

Quick stress fracture facts

• Injury name: stress fracture
• Area affected: can be anywhere in the lower limbs of the body. Most notably, they occur in the feet, shins and hips.
• Recovery time: anywhere from 6-12 weeks
• Time off from running: anywhere from 6-12 weeks

What is a stress fracture?

Stress fractures are small breaks in the bones that develop from repetitive impact and ongoing stress. They don’t happen after one specific trauma or fall, but build over a long period of time. The breaks can be known as hairline fractures, rather than clean-cut breaks. They most commonly affect the feet, shins and hips, and can stop you from running altogether.

What are the symptoms of a stress fracture?

The main symptom of a stress fracture is acute pain at a specific point on the bone. The area is isolated and if you move above or below it, there should be no pain when palpated (physically examined). Other symptoms may include bruising around the area, as well as swelling and pain which reduces when you rest.

What causes stress fractures?

Stress fractures come from a build-up of various stressors over time, some of which are more complicated than you would think.

• Running volume
  One of the biggest causes of stress fractures is a sudden spike in training load. A drastic increase in the amount of time spent running can place more stress on your bones than they’re ready to handle.
• Poor footwear
  Wearing incorrect footwear or old, worn-out shoes can lead to fractures. If, for instance, you run in traditional trainers one week and then do barefoot running for same mileage the following week, you are risking a stress fracture. The increase in impact and lack of cushioning will send more force through the shins and feet and increase your injury risk.
• Overstride
  Over-striding is a common running habit that significantly raises impact stress on your body. When the foot lands too far ahead of the body with a slightly straighter leg, it increases ground reaction forces. We all naturally place between two and four times our bodyweight through our feet with every step so this can have large force effects on our joints and bones. By increasing your cadence (taking more steps), you can help to reduce the impact and forces through the lower limbs.
• Diet
  Lack of calcium and vitamin D in our diets can lead to poor bone strength. In the UK, we lack sunlight at some points in the year, especially if we work inside in offices and exercise in gym spaces.
• The Female Athlete Triad
  Don’t worry, we didn’t know what this was either! It refers to a cycle that women can fall into where we end up over-exercising and under-eating. It affects our hormone production, which can lead to menstruation problems and osteoporosis. This drastically increases your chances of fractures.

How can I avoid getting stress fractures?

As with all running injuries, this will depend on the reason why we may be developing one in the first place. Here are some simple things that can help.

• Monitoring your running volume
  Training plans suggest that your weekly mileage should not increase by more than 10-15% on the previous week. By keeping under these boundaries, your body is more likely to manage the volume of work you are taking on.
• Investing in better footwear
  Having a good pair of running shoes is key to preventing injuries such as this. If you have a great pair already, be mindful of how many miles you’ve run in them. Even the foamiest of shoes have an expiry date where they stop offering the support we need.
• Improving your running form
  If you don’t know whether or not you overstride, it may be time to find out. These days, clever running apps such as MapMyRun and Garmin can work out your cadence and stride length.
• Improving your nutrition and bone health
  If you think your vitamin D levels are low, try taking a supplement or working with a nutritionist to ensure that you’re getting enough vitamins to ensure good bone health. Strength training is also important for keeping runners’ bones healthy.
• Seeking medical advice
  If you think you may be experiencing that Female Athlete Triad, head to your doctor to talk about the best way to improve your health.

How do I treat a stress fracture?

First of all, you need to seek medical advice from a doctor, or visit a physiotherapist.

You can only formally diagnose a stress fracture by having an x-ray. It also may not even show up on an x-ray, especially if it is in one of the smaller bones in our lower body. In these cases, a medical professional will still be able to diagnose a stress fracture and treat as such. Experts always pay special attention to any fractures in the fifth metatarsal region as this area has reduced blood flow and can take longer to heal.

Treatment for a stress fracture usually involves complete rest of the affected area with little to no impact for up to 12 weeks. Many doctors will place you in a boot or cast if the injury is on the foot or lower limb, and advise activities like swimming or cycling to help you keep moving without putting more stress on the affected area.

Once the fracture is healed, it’s a good idea to implement some preventative measures for the future, as listed above.

Is there anything I can do while I recover from a stress fracture?

Most stress fractures take about three to four months to heal, and most of this time should be spent avoiding high impact sports. Aqua-jogging, swimming, cycling, strength training, Pilates and yoga are all things you can do while you take a break from running.