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Runner Therapy: Stressful Stress Fractures

Posted Apr 14 2011 9:48am

Question: via Twitter follower @EmmyKeane: what kind of low impact exercises are good when dealing with stress fractures??

Runner Therapy says: Stress fractures can be extremely stressful! It is challenging to find a form of exercise that is productive while not slowing down or delaying healing.

Every day, every second, we are generating new bone cells as our movement naturally destroys some as well….just like skin cells. Stress fractures or any stress injury occurs when the rate of bone breakdown exceeds the rate of bone cell production. Its simple math, really.

Although genetics and low calcium or other essential mineral levels can predispose an individual to a stress fracture, generally they occur when we demand more of our body than it wants to accept. Thus we disrupt the balance of production and destruction of bone cells.

Therefore, all you need to do is significantly more than your body is used to doing. So, running a 10 miler when you’ve only done 5 miles in the past, doing your first hill or speed workout, training for your first marathon…or second or third, or simply breaking the 10 percent rule (adding more than 10 percent mileage a week) are all great ways to get a stress fracture! Any deviation from slow, graded increases in your mileage or terrain will set you up.

Low impact exercise during recovery depends on where the injury occurred. Because too much weight bearing can keep the area from healing, it is generally recommended to avoid standing exercise. Although some doctors may allow biking, for a lower extremity, low back or pelvic stress fracture, I do not. I find it is better in the long run (and gets you back to running faster) if you avoid all weight bearing exercise, including partial weight bearing activities like the bike.

It is all about letting the area heal as fast as possible; so with partial weight bearing I find it heals slower because there is still significant force on the area.

That said, you also want to avoid walking and standing long periods. Take a cab instead of the subway. Skip the stairs and opt for an elevator. These little tricks will add up and promote quicker healing.

On the other hand, don’t sit on the couch and not move at all! A little bit of weight bearing from simple walking will encourage the body to make more bone cells. We just can’t overdo it or we will destroy more than we make…and that’s why we got here in the first place!

This is where its time to work on your swimming. I know, you’re a runner…you don’t want to swim. But even think about the potential for a triathlon when you heal…just to give you motivation to swim!

As far as other cardio, there are really no other options that don’t involve at least partial weight bearing…(Even the row machine is partial)…unless you do the upper body ergometer and spin your arms around! Stick to upper body and core workouts that don’t involve the lower extremity. Get yourself ready for when you return…tone and strengthen…and watch your diet.

Eat foods high in calcium, antioxidants and omega-3′s. Try to work on some stubborn body fat in favor of lean muscle. This way you set a new goal, instead of being depressed that you can’t run. Add some balance to your life, you may surprise yourself…although it may not seem like it, there is more to life than running…and you’ve only got 8 weeks or so without!

As someone who has had 3 stress fractures because of low calcium or osteopenia (early osteoporosis), what worked for me was remembering those that never stand up out of a wheelchair, let alone run. I always imagine their life instead of being bummed with mine. Running is a gift we should be honored to have!

Follow a few of these suggestions…and your body and mind will come back to running stronger and fitter!

Do you frequently develop stress fractures?  How have you dealt with them in the past? Are you likely to develop stress fractures during training for a race? Have a question for Runner Therapy, send it here .

- Marisa

(Marisa, a MS PT SCS ATC, is a member of  iRunnerBlog’s team and writes Runner Therapy, she is a physical therapist in private practice in midtown NYC.  She one of a dozen or so therapists  in the state of NY to be board certified in sports.)

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