Stress Fracture - Getting to the root of the problem!

Slightly ironic title as pretty much on the same day I found out I had a stress fracture I had to have root canal and it got me thinking that I needed to get to the bottom of why I got injured.

It is really important that with any injury that you get that you try and figure out the cause. There is no point resting, doing rehab and then cracking on like normal. This will inevitably lead to you getting injured again. I have had a few injuries in my time and have always tried to figure out the cause and build prehab (way better than rehab) into my programme. A couple of injuries I have had over the years:

  1. Patella tendonitis - due to stupidly tight quads. Bring on a shit tonne of stretching and yoga.

  2. A torn calf - Due to very tight calfs. Again bring on a stretching routine (you think I would just stretch everything, now I do ;))

  3. Plantar Fasciitis - This injury is on crack and I have no idea how or why I got it. I had it for two years, some days walking was excruciating, I hobbled when I ran, had to pull out of the Highland Fling because it hurt so much and then one day it just disappeared. Don’t ask!

What can cause a stress fractures?

  1. Overuse

  2. Decrease in Bone Strength e.g. Osteoporosis

  3. Lack of nutrients; usually from an eating disorder

  4. Amenorrhea (Female Athlete Triad)

  5. Biomechanics

Generally the list above is why you tend to get a stress fracture. I am going to go through each one and explain why I think this reason did or did not contribute to my injury.

1. Overuse: I do not think that this was an overuse injury. I have gone back through my training over the past two years (yup two years) and in fact I am doing less running now than I ever have. Here is the total milage I have done each month over the past year (I didn’t want to bore you with two):

Mar 18 - 551km, Apr 18 - 400km, May 18 - 643km, Jun 18 - 432km, Jul 18 - 344km, Aug - 431km, Sep 18 - 304km, Oct 18 - 331km, Nov 18 - 334km, Dec 18 - 289km, Jan 19 - 335km, Feb 19 357km

Keeping a log of the training you have done is really important so you can go back and analyse what you have done should you get injured. It is also really useful to see how much you have progressed!

2. Decrease in Bone Strength: The only real way that you can tell if you have issues with your bones is to have a bone density scan. I didn’t have one of these so I can’t completely rule it out but this is the first issue that I have ever had with a bone, bar falling off a swing and breaking my arm when I was 6, and that fact that I am healthy otherwise we ruled this out as a cause. Should I have any more issues I will get a scan to double check.

As a precaution to strengthen my bones I have started taking a Calcium supplement. If you take a Calcium supplement make sure it has Vitamin K2 in it or take this as an addition. There is evidence to suggest that elevated calcium supplements may raise the risk of heart disease and can be linked with the accelerated deposit of calcium in blood vessels. In contrast K2 is associated with the inhibition of material calcification and arterial sifting. Threfore lowering the risk of vascular damage because it activates matrix GLA protein, which inhibits the deposits of calcium on the walls. Vitamin D is also super important in helping your bones absorb calcium. If you are not getting enough direct sunlight like me at the moment as I am working inside and doing all my exercise inside a gym (kill me now) you may want to think about taking a Vitamin D supplement too.

3. Lack of nutrients (eating disorders): Let’s be honest eating disorders are extremely common in runners, especially girls and it is really sad that girls with so much talent get caught in a horrible whirlwind and can end up with career (the sporting type) ending disorders such as osteoporosis. Take a minute to read Bobby Clays interview about just how real this problem is.

I love food! i don’t cut things out of my diet I eat what I want when I want. If I was a couple of kg lighter would I be faster? Who knows but what I do know is I would be miserable. I have been brought up eating tasty food and it is not something that I am willing to give up or cut down on. Yesterday I noted down what I ate. This is a typical day for me (if i do more training I will also have a bowl of oats with cinnamon, eggs on toast and apples and a protein recovery shake after a hard session). I know that I am getting a balance of all the food groups with a good portion of cake on the side so I have been able to write off this is a cause of my stress fracture.

Breakfast - Yoghurt, honey, nuts and fruit.

Mid morning snack - Scones, homemade I might add and tea. I was slightly upset I didn’t have clotted cream to smother all over them.

Lunch - chicken fajita wrap with peppers, onions, corn, avocados, sour cream and cheese.

Dinner - Steak, homemade chips and peas.

I also had a handful of nuts but threw them in my mouth too quickly to take a picture.

5. Amenorrhea (Female Athlete Triad): Amenorrhea is the absence of menstruation. Women who have missed at least three menstrual periods in a row or girls who haven’t begun mensuration by age 15 are normally diagnosed with amenorrhea. Amenorrhea together with eating disorders and osteoporosis is normally referred to as the Female Athlete Triad. This can be a very real risk in woman who do sports in which a low body weight and lean physique are desired (e.g. dancers, gymnasts, and runners). It is important to note that individuals do not need to show signs of all three components of the female athlete triad simultaneously to be affected by the condition. The female athlete triad is a result of energy imbalance; thus, adjusting the energy expenditure and energy availability is the main intervention, basically eat more! It is important to note that not all athletes with female athlete triad have disordered eating. Some athletes are not aware of their energy needs or do not have the appetite to drive adequate consumption. A session with a Sports Nutritionist will be able to advise on this.

I ruled the Female Athlete Triad out as I have never missed a period, I eat a well rounded balanced diet and I have never had any other issues with my bones but it is an important point to think about for female athletes especially if you get a stress fracture.

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4. Biomechanics: My stress fracture is in the Fibula. This is a pretty rare bone to get a stress fracture in as it doesn’t take a lot of the load that goes through your legs (typically 15%). The main function of the fibula is as a point of attachment for many of the muscles of the lower leg. This results in traction and twisting forces placed on the fibula bone from the surrounding muscles. To add to the forces that already go through your fibula I over-pronate, which makes my peroneal muscles work harder for longer during toe off in the running gait cycle. Everyone needs to have pronation to have a proper running gait as it absorbs the impact from the ground and propels you forward by my over-pronation has been putting additional force on my fibula hence leading to a stress fracture. Luckily over-pronation can be resolved by orthotics. I have had orthotics for many years but like running shoes orthotics take a battering and need to be fixed and upgraded over time. I only had mine re-done last year but turns out they were no longer working for me. Luckily I have had a new pair made so when I am ready to run again I can jump straight into them!

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In summary I am pretty sure (with the help of my Physio; Parys Edwards, Podiatrist; Mark Karam and Radiologist Bev Roos) that the stress fracture was do to my over-pronation and needing a new pair of orthotics.

Annoyingly anything that works the calf muscles is not likely to allow sufficient rest to enable healing to take place so I have had to do exercises that isolate the calf as best as possible. Luckily there is still loads that I can do including; Aqua Jogging, Swimming (pull only), SkiErg, Handbike and a shit tonne of ab, glute and arm exercises!

If you are injured good luck getting to the root of the problem and work on fixing it!

P.s. I am not a doctor and have researched/found out about the above myself. So if you are injured please do not self diagnose go and see a professional. You will get better way quicker that way! If you are a professional and I have got anything wrong in the above blog please let me know!