Stress fracture: This is one time when STOP RUNNING is imperative!

History:  Stress fractures of the lower leg are a serious injury which needs immediate attention.  This is another overuse injury all too common among runners.  This is never a traumatic injury.  It starts gradually.  The pain is worse when your heel strikes the ground and gets better almost immediately after you stop running.  In the beginning it only hurts when running.  As it gets worse the pain lasts longer and longer after you stop.

If you ignore a stress fracture and continue to run in can actually break while you are running!  Your leg will snap, and you will fall to the ground yelling for help!  Then you have a surgical emergency which may take several years to get back to running!!

Self-Exam:  Here are some things you can look for in yourself. 

1)      The two most telltale signs in an exam are a tib-tap and a heel strike.  Tib-tap:  VID   Whack yourself on your good leg with your middle knuckle.  Then do the same thing to your sore leg.  If it really hurts more, presume you have a stress fracture and seek medical help immediately.  Call me at home!

2)      The heel strike test:  VID   When you are sitting, have a buddy whack your heel pad with the edge of their hand.  If your bone hurts and your first reaction is to yell and whack them back, assume you have a stress fracture and get help.

3)      If there is any doubt, STOP RUNNING and see a qualified person.  The doc-in-the-box is mildly okay, but an orthopedic surgeon, athletic trainer, or physical therapist with experience treating stress fractures is best.

4)      The most definitive diagnosis for a stress fracture is a bone scan.  X-Rays may or may not show a stress fracture in the early stages.  Even if an x-Ray is negative in the early treatment, I recommend treating as a stress fracture as long as the clinical tests are positive.  An MRI also may or may not show a stress fracture in the early stages.

Treatment:   This is one time when STOP RUNNING is imperative!  This statement is so important I had to put it here again.

If we are wrong, then you may miss a few days or weeks of running.   That means you have a few days or week of rest and can get back to running.

1)      Manage the pain:

a.      IF THERE IS ANY DOUBT, STOP RUNNING NOW!

b.      NSAIDS will help. 

c.       Kinesiology taping for pain management will help.  Most runners have the pain in their anterior shin.  Tape for shin splints   LIN 

2)      Restore full motion:

a.      Keep up your stretching.

                                                              i.      Stretching does not have to be part of your warm-up or cool-down.  But it HAS to be part of your training program. LIN

3)      Begin non-weightbearing exercises to restore strength without any pain in your shin.

a.      You can begin swimming immediately.  This will maintain your cardiovascular conditioning while your stress reaction heals

b.      You MAY be able to start non-weightbearing exercises

                                                              i.      Cardiovascular exercises where your heel does not smack the ground.  The caveat here is that the exercise should not reproduce your pain.  If you get the same pain with these exercises, then stop them too.

                                                            ii.      Stationary bicycle/recumbent bicycle

                                                          iii.      Elliptical trainer

                                                           iv.      NOT a treadmill

c.       You will be at this level until you can run pain-free.

4)      Begin body weight exercises.

a.      Absolutely NOT body weight exercises until you are cleared by your doctor.

5)      Correct your running mechanics.

a.      No running until you have been cleared.

b.      Once you have been cleared, it may be best to start on a dreadmill for the first few runs.

                                                              i.      This way, if you begin to have pain the walk back to your car is pretty short.

6)      Return to running speed and hills.

a.      After you are able to run without pain you can gradually go back to your old routine.

b.      Please be sure to keep in contact with your physical therapist or athletic trainer as you return to running

c.       Most family practice doctors do not have any training on return to running after a stress fracture, so use an orthopedic surgeon.

7)      And the final step, which you should avoid.  Go back to abusing your body until you hurt something else.  😉

8)      If this exercise routine does not resolve your pain, then there may be something else going with your knees.  Please call us and schedule something Doctor Google cannot do; a personal hands-on examination.