Stress Fracture Rehabilitation

Don’t Rush Your Stress Fracture Recovery

A stress fracture is a frustrating and serious injury for any athlete. The presence of a stress fracture indicates the athletes needs to examine their training approach, running biomechanics, and their overall health. A basic rule with stress fracture rehabilitation is that any attempt to rush things can cause re-injury and ultimately delay the return to full training. The positive news is cross training through the stress fracture rehabilitation process, where activity that does not cause pain during, or after the session is encouraged. Alternative activities that are considered safe in the management of most stress fractures and considered appropriate during the stages of the healing phase include:

• Swimming
• Pool walking, or deep water running
• Cycling / exercise bike
• Elliptical machine (also referred to as a cross trainer machine)
• The more elite athlete may have access to the use of an anti-gravity treadmill, this treadmill has a harness support system that can support as much as 80 percent body weight and can keep the athlete running during the recovery process.

Not all of the above are necessarily safe to start immediately once given the diagnosis of a stress fracture, the lower load activities like swimming, or deep water jogging normally are OK to begin immediately. However cycling, or the elliptical trainer may need to hold off for a number of weeks as per your sports medicine specialists advice. The golden rule during stress fracture rehabilitation is, ‘if it hurts, don’t do it’.

Stress fracture rehabilitation focus centers on allowing the bone to heal. This bone healing takes around four to six weeks for the majority of stress fractures. The exact time required depends on the fracture site, some bones renowned as having “poorer” blood supply may well require total immobilization, a period of non-weight bearing and allowance of extra time to complete healing. Your physiotherapist and sports medicine specialist will guide you on what is appropriate for your specific situation keeping in mind your fracture and sporting preferences.

Components Of Stress Fracture Management

Managing mileage is not the only thing to consider in stress fracture rehabilitation and the return to running. The goal of stress fracture rehabilitation is that when resting to allow the fracture to heal, the enforced down time is used to come back mentally refreshed, as well as being used to strengthen major muscle groups vital to running, so the athlete can come back stronger than before the injury.

Diet And Stress Fracture Management

Making sure you are “eating well” is important in the preventing and healing of stress fractures. A diet short on calcium will force your body will steal calcium from your bones, which can make them vulnerable to stress reactions and fractures. Worth knowing is that Vitamin D consumed in the diet, or absorbed via natural sunlight helps your body absorb calcium. So a lack of calcium and sunlight could put you at greater risk of developing stress fractures.

The Female Athlete Triad: Osteoporosis, amenorrhea eating disorders all put females at greater risk of suffering stress fractures. The triad is the combination of:

• Osteopenia and osteoporosis, conditions respectively meaning that an individual has a lower than average, or significantly lower than average bone density.
• Amenorrhea, which is the absences of, or infrequent menstrual periods, a situation  associated with decreased estrogen in the body, limiting the bodies ability to process calcium.
• and eating disorders, where there is impaired intake of nutrients (including calcium), coupled with significant weight loss, which itself can bring on amenorrhea is a significant risk factor in stress fractures.

Footwear And Stress Fractures

It is a good idea that a runner, athlete is professionally fitted for their running shoes, to ensure you purchase the “correct” shoe for your foot and running demands. It is false economy trying to save money on running shoes by going for a cheap pair, or buying a pair because they are on sale, if they aren’t the shoe that’s right for you, there is a good chance you will end up spending 10 fold at the physio not to mention you will be dealing with the frustration of injury. Equally, trying to stretch out the life of shoes a couple of extra months, shoes that are obviously worn those “few more runs” may well end up again costing you in medical expenses well beyond what a new pair of shoes is worth.

It is a great idea to regularly check for signs of wear in your shoes, even consider rotating your slightly older and newer running shoes during your weekly training. Doing this allows your feet to experiencing some variation from one run to the next and can reduce the risk of over load to tissues.

Running Form And A Return To Running Following Injury

A couple of factors to consider when returning to running following a stress fracture are, the speed at which you train and the strike frequency (often referred to as cadence).

• Running fast can mean greater forces when your feet hit the ground, consider slowing down the pace once you are clearing to begin your comeback to training.
• Also look at your running stride rate, elite runners generally tend to maintain a stride frequency of around 180 steps per minute, or more. This cadence is even maintained at slower paces, keeping a high cadence will encourage your body to avoid over striding, avoiding which can reduce impact in your feet and legs.

Obviously, changes made to variables such as running speed, or cadence must be made gradually. As is the rule with any changes to a running program/training, as sudden changes to technique, or training are themselves risk factors of injury, which is the very thing we are trying to manage and avoid.

Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Stress Fracture Rehabilitation should consult his or her general practitioner, physiotherapist, sports medicine specialist, orthopedic surgeon or otherwise appropriately skilled practitioner.