5 Phases of Stress Fracture Recovery

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One of the most dreaded running injuries, stress fractures can sideline runners for weeks or months. Stress fractures often result when the athlete makes the mistake of doing too much, too soon; these cracks or fractures in bones typically occur when tendons or ligaments that attach to the bone are repeatedly overloaded by new training stress before they've adapted. Stress fractures tend to occur in runners' pelvic areas, legs or feet.

Stress Reaction Versus Stress Fracture

A stress reaction is the precursor to a stress fracture. While at the stress-reaction stage, the bone structure is breaking down and becoming weaker, but does not actually contain any fracture. 

A stress fracture means the structure of the bone has been compromised by a crack or fracture. 

More: Common Running Injuries

What Causes Stress Fractures

Stress fractures can occur from abnormal force on normal bone (most common in athletes), and with normal force on abnormal or osteopenic bone (more common in older patients or young, very thin females). Routine x-rays rarely show a stress-fracture injury. A bone scan or MRI is needed to confirm the diagnosis. A bone-density scan may be needed if concern for osteopenia exists. 

As long as the bone quality is normal, the following phases will help you get through a stress-fracture diagnosis. 

Phase 1: Injury Period (Usually 4 to 6 weeks)

This period begins at the time of diagnosis, not at the time the athlete started feeling pain. The athlete must stay below their pain threshold throughout this phase. To accomplish this, weight-bearing status is variable for each patient, but can range from being on crutches to use of a special walking boot to being able to swim, aqua jog or even ride a bike. This may be a trial to see what causes pain, but you must be honest! Don't do anything that causes pain, and if you experience pain when walking, you might need to try crutches or a walking boot. Here are more rules to follow:

  • Don't take medications to mask pain. 
  • Understand the way you interact with family, colleagues and training partners. It's not their fault that you are hurt. Be aware of displaced anger. 
  • Use this time to attend physical therapy, seek chiropractic treatments, and/or massage therapy to assist in the healing process. 
  • Yoga (stretching) and core strengthening are essential to the safe return to your pre-stress fracture activities when the time comes. They will also help you maintain your level of fitness while healing.

More: The Key to Overcoming Running Injuries

Phase 2: Stress Fracture Recovery (3 to 4 weeks)

During this time, I assume the athlete has no pain. Continue all strengthening, flexibility and therapy from phase 1. Our goal during this phase is to understand why the stress fracture occurred.

Gait analysis and shoe evaluation are often necessary to make sure all forces are appropriately distributed.

Understand if there was a training error. It is important to know if too much mileage, too much intensity, or a too-quick build-up was the initial culprit. Get a coach to help make a plan for recovery and return to safe training. 

Appropriate run progression is essential. Slow progression of weight bearing from deep water running to running at a certain percent of body weight (Alter-G treadmill) is very beneficial. Check out Pete Pftizinger's plan on aqua jogging to learn how to run in the pool safely. 

Try this run/walk program to progress into running successfully.

More: 5 Ways to Train Through the Pain

Phase 3: Build Phase (3 to 4 weeks)

This is the time to prepare the body for the intensity to come. Do this by slowly increasing running volume, and:

Continue yoga and core exercises

Continue technique focus

More: 5 Core Exercises for Runners

Phase 4: Normal Prep for Race

This is dependent upon the distance of the race, your fitness level and expectations.

More: Are You Ready to Run a Marathon?

Phase 5: Race

We have found that if you follow these phases step by step, you have a great chance of recovery. If you skip a step (or phase), you will fall down to the bottom of the steps, and need to restart at phase 1.

Think About Your Nutrition

Endurance athletes typically have an acidic nature to their blood. This side effect of endurance training, in addition to a poor diet, can lead to acid levels that are high enough to pull calcium out from the bones. Take 1200mg of calcium and 400 IU of Vitamin D per day. Also consider a lactic-acid buffer, such as Extreme Endurance, to make the blood less acidic. (Suggested Reading: The China Study by Colin Campbell and Thomas Campbell, pages 204 to 211.)

Establish what you want to accomplish during this four- to six-week timeframe. For example, do you want to increase flexibility, try other sports such as swimming or biking, spend more quality time with family, etc.?

Volunteer at a race to keep good running karma. Hand out nutrition during a marathon, cheer on your teammates, or volunteer at your favorite event.

More: How Endurance Athletes Can Lower Acid Levels

READ THIS NEXT: You're Not Running Too Much, So Why Are You Injured?

Stress Fracture FAQs


How long does it take a stress fracture to heal?

It typically takes six to eight weeks for a stress fracture to heal completely. It may take longer if you don’t take proper rest and recovery measures.

Can you walk on a stress fracture?

Walking on a stress fracture is not recommended. Doctors may recommend wearing a boot, depending on the severity of the injury.

Do stress fractures show up on x-rays?

Small stress fractures often can’t be seen on an x-ray. Evidence of these fractures may not appear until weeks after the injury. It is important to listen to your body and respond to sharp pain accordingly.

 

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