Stress Fractures Running And Their Management

Stress Fractures Running And Their Management

How Long Do Stress Fractures Running Take to Heal?

You can group stress fractures running into “high risk” and “low risk” categories. Your high risk stress fractures running are fractures that occur in areas known to heal poorly and tend to require significantly more time off training.
Relatively higher risk stress fractures include:

  • The navicular (small bone positioned in the mid foot).
  • Pelvis stress fractures like the pubic ramus
  • The femur (the long thigh bone) stress fractures in this bone at the neck of the femur knee the hip joint can be slow to heal and problematic.

Stress fractures occurring in sites above the knee should potentially ring alarm bells, as fractures to strong bones like the femur (the strongest bone in the body) may well hint at underlying medical issues such as osteopenia, or osteoporosis (medical condition causing weakening of bones).

Low risk stress fractures running are stress fractures that generally heal well when given the appropriate rest and immobilisation, followed with a gradual return to load and training.

Relatively lower risk stress fractures include:

  • Tibial fractures (your inside shin bone of the lower leg)
  • Fibula (your outside shin bone of the lower leg)
  • Metatarsal stress fractures (the thin long bones of the forefoot common with runners to experience fractures in the 2nd and 3rd metatarsals)

Fortunately, low risk stress fractures are more common than high risk stress fractures, which are relatively rare. As noted above someone suffering a fracture in an area that is considered “higher risk” may need to be treated more holistically than just locally with some relative rest and gradual return to load.

Avoiding Stress Fractures Running

Because generally there isn’t any agreed on best practice treatment for speeding up the healing of stress fractures aside from rest and/or immobilisation, most research efforts are directed at the prevention not treatment of stress fractures. The strategies for prevention of stress fractures focus mostly on reducing stress on your bones along with maintaining, or building their strength.

Obviously within these strategies, training approach management takes a lions share in the role of applied stress to the bones. Any rehabilitation or prevention program that doesn’t address training load is likely destined to fail. Gradual ramping up of training and the inclusion of “down weeks” into a training regime is crucial to allow for your bones to become stronger. There is a loose rule that 70% of running injuries are training errors, and I feel this can be applied to running stress fractures. If as a runner you can get your training loads and rest periods sorted then you are more than half way there.

Low Intensity Pulsed Ultrasound For Bone Healing

The use of low intensity pulsed ultrasound (LIPUS) to aid fracture healing is something that may assist in accelerating healing with fresh fractures, including running stress fractures. LIPUS is sometimes used for assisting the management of fractures with delayed healing, non union, or fractures occurring in elite sporting situations where the need for a rapid return to play is considered crucial. As mentioned earlier there generally isn’t any agreed treatment for speeding up the healing of stress fractures aside from rest, however in saying that LIPUS is some times used and it would be amiss not to mention it here when discussing stress fracture management.  Low intensity pulsed ultrasound and bone healing is a relatively new technology and there are mixed research results. A recent systematic review of randomized controlled trials on LIPUS published in the BMJ 2017 concluded not so flatteringly for the use of low intensity pulsed ultrasound that: “…LIPUS does not improve outcomes important to patients and probably has no effect on radiographic bone healing…”
However the use of such a device under the guidance of a specialist may be suggested, or indicated if return to training time frames are tight, or the running stress fracture is considered a high risk fracture, or is showing signs of delayed healing.

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 Fractures Running And Their Management should consult his or her general practitioner, physiotherapist, sports medicine specialist, orthopedic surgeon or otherwise appropriately skilled practitioner.