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Health & Exercise Forum

Watch Out for Stress Fractures When Training

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Sep 23, 2013

Dr. Mackarey's Health & Exercise Forum Steamtown Marathon is quickly approaching…

This is the time of year when local runners are ramping up their training for the marathon or gearing up for high school cross country. It is also the time of year when many runners come to our clinic with shin splints. Many of these athletes are female runners, however, to a lesser degree soccer and football players, cheerleaders and dancers can get them too. 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. Some of the questions they and other patients have had regarding this problem are:

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 for stress fractures?

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 of Stress Fractures

  •  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 healthy body fat percentage.
  • Consult Family Physician – early management often involves immobilization, rest, pain medicine 4-6 weeks for healing.
    • non weight bearing cross training such as the recumbent bike, swimming, elliptical
    • physical therapy modalities such as ultrasound, cold with electrical stimulation, biomechanical taping or orthotic supports, and exercises for foot, ankle muscles.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic


Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.