Avoid stress fractures

By Gary Droze

Many injuries are associated with specific sports. Rotator cuff tears commonly afflict baseball players, elbow tendonitis torments tennis enthusiasts, and ankle sprains often halt play on soccer fields and basketball courts.

Stress fractures particularly strike distance runners. This should not surprise us, given that they are defined as “fractures, usually of a hairline type, that develop gradually in response to repeated and prolonged stress” (Taber’s Cyclopedic Medical Dictionary). Runners may embellish and effuse in describing the lure of our activity, but the action itself pretty much amounts to “repeated and prolonged stress.”

Having experienced stress fractures in my own running career, and seen them sideline some I’ve coached, I would like to offer what has helped my athletes and me prevent stress fractures (I’ll leave diagnosis of the injury to individuals whose names are appended with the letters “MD”).

Stress fractures are likely to occur in runners who make poor choices in one or more of three areas: footwear, running surface, and training progression.

Many runners do not replace their running shoes often enough. I see high school runners wearing the same shoes after the midsoles have long since broken down (usually about 300 miles). Worse yet, many young runners borrow shoes from friends or family, setting out in footgear that is both excessively worn and ill-fitting. Good running shoes are not cheap, but neither are repeated visits to the orthopedic clinic.

Choosing the softest possible running surface can mitigate the jarring impact that runners experience one thousand or more times per mile of running. The biomechanically superhuman may get away with training on sidewalks daily, but we mortals need to search out wooded trails, soft tracks, and fields at least twice a week. And as tedious as treadmills are, even they offer less impact than concrete.

Prematurely increasing training volume raises the potential for a stress fracture. Those who must drive their mileage up for success may want to gradually ramp up the weekly distance over six months to two years, rather than jump on the “three-month plan” bandwagon. Moreover, reviews of injury statistics reveal that numerous consecutive days of running had a higher correlation with stress fractures than either training speed or weekly volume. In other words, interrupting the stress before it causes injury – with planned days off – can actually allow you to train harder without injury. Simply put: two 10-milers followed by one day off trumps three consecutive 7-mile days.