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Health & Exercise Forum


Mar 3, 2009

Dr. Paul MackareyIt is four weeks away from the 12th Steamtown Marathon. After training all spring and summer for the first 7 Steamtown Marathons, not a Columbus Day Weekend goes by without my thoughts of this great event. I am writing this column on a plane to Greece, where I plan to visit (and run) the original road from the town of Marathon to Athens. This will be the first of four columns dedicated to those dedicated runners preparing for the big day.

I would like to introduce this topic with some marathon history. In 490 B.C. Athens was under attack by the Persians and was outnumbered more than two to one. The Athenians fought bravely and defeated the enemy in the town of Marathon to keep the intruders 26 miles away from their families in Athens. To keep the anxious citizens of Athens calm, leaders immediately ordered a foot soldier, Phedippides, to the capital to share the news. Phedippides ran, in full armor, for 26 miles from Marathon to Athens, delivered the message and died immediately. Now, people do the same thing of their own free will!

Each year at this time, dozens of runners preparing for the Steamtown Marathon come to my office with severe shin pain known as shin splints. Unfortunately, in many of these athletes, this problem can lead to a much more severe and advanced problem with shin splints called a stress fracture. Some very good athletes have been hindered by this problem.

What is a stress fracture?

A stress fracture is fatigue damage to bone with partial or complete disruption of the cortex of the bone from repetitive loading. While standard x-rays may not reveal the problem, a bone scan, and MRI will. It usually occurs in the long bones of the leg, mostly the tibia but also the femur (thigh) and foot. Occasionally, it occurs in the arm.

Who is at risk?

10-21% of all competitive athletes are at risk for stress fractures. Track, cross country and military recruits are at greatest risk. Females are twice as likely as males to have a stress fracture. Other athletes at risk are: sprinters, soccer and basketball players, jumpers, ballet dancers are at risk in the leg and foot. Gymnasts are also vulnerable in the spine while rowers, baseball pitchers, golfers and tennis players can experience the fracture with much less frequency in the ribs & arm.

The problem is much more prevalent in weight bearing repetitive, loading sports in which leanness is emphasized (ballet, cheerleading) or provides an advantage (distance running, gymnastics).

Stress fractures usually begin with a manageable, poorly localized pain with or immediately after activity such as a shin splint. Over time, pain becomes more localized and tender during activity and then progresses to pain with daily activity and at rest.

Causes of stress fractures

  • Overuse, Overload, Over training – is the number one cause. Running too many miles with too much intensity with too much frequency is the perfect formula.
  • Inadequate Fitness Level – or activity level prior to the stress fracture. For example, the high school runner takes the summer off and then quickly accelerates his/her program to quickly for cross-country in August/September.
  • Poor Biomechanics – when your feet hit the ground the forces are absorbed and transferred to the rest of the body. If the biomechanics of feet are not perfect, then the forces are not absorbed and another body part bears too much force. For example, flat or pronated feet poorly absorb the shock and pull the tendons of the foot and shin.
  • Recent Change in Training Schedule – sudden increased intensity or speed
  • Recent Change in Running Surface – sudden change to a hard or soft surface
  • Recent Change in Footwear – shoes too hard or too soft, too much control or too little control, too much pronation or too much supination
  • Overweight – running with an extra 10 pounds and attempting to return to running as a method of weight loss
  • Underweight – the underweight female athlete is at high risk for stress fractures. If underweight and have a history of menstral irregularities or and eating disorder, the risk of stress fracture increases significantly
  • History of Stress Fractures – makes the athlete two times as likely to have another

Treatment & management

  • Alternate Training – cross train with non-weight bearing activities: bike, swim, elliptical
  • Gradually Build Up Fitness Level – wean into activity 1-2 miles, then add ½ mile at a time
  • Correct Biomechanics - Orthotics, Running shoes, see a Podiatrist
  • Gradual Change in Training Schedule
  • Gradual Change in Surfaces – ½ run on soft surface, ½ run on hard surface
  • Gradual Change in Footwear – walk in new shoes first, then run 1-2 miles
  • If Overweight – gradual exercise with diet, not too much too quickly. Mix run & walk every 10 minutes
  • If Underweight – improve diet maintain healthly body fat%
  • Consult Family Physician – early management often involves immobilization, rest, pain medicine 4-6 weeks for healing.

Visit your doctor regularly and listen to your body.