Running Stress Fracture Types, Causes, and Treatments
Photo by Marques Jackson Photography.
By Marnie Kunz, CPT
If you have a running stress fracture, it can sideline you from running for quite a while. Rest and treatment are crucial for stress fractures to fully heal and prevent further bone damage. So what if you don’t know if you have a stress fracture? This guide will go over the common types of running stress fractures to help you prevent and identify stress fractures.
Note that I am a running coach and trainer, not a physical therapist, so this is not intended to replace medical attention but to help you seek care if you need it. We’ll also go over tips to help prevent running stress fractures so you can train smart and minimize your risk of injuries.
Related Post: 10 Common Running Injuries and How to Prevent Them
What Is a Running Stress Fracture?
A stress fracture is a small crack in your bone. Stress fractures can be painful, getting worse over time without treatment and rest. They can even lead to broken bones if left untreated. Stress fractures are a runner’s worst fear as they completely sideline you from running. Unlike soft tissue injuries, stress fractures have no gray area, and you cannot run at all with a stress fracture. If you have a running stress fracture, you must immobilize the injured part of your body and refrain from any activity that places weight on it.
I got a stress fracture while marathon training and was sidelined with a boot for a few months. If I had known the risk factors and signs of stress fractures, I could have prevented the fracture from getting to the point that it did. So, this article is to help you avoid my mistakes and get help if you have signs of a running stress fracture.
Causes of Stress Fractures
Stress fractures are caused by repetitive stress being placed on the bone. For runners, the pressure of pounding the pavement and overtraining are common causes of stress injuries. If you ramp up your mileage or training too quickly and don’t take enough rest days, this can put you at a higher risk of getting a running stress fracture.
Related Post: What Is Overtraining and How to Avoid It
Stress fractures are relatively common among runners since running is a repetitive activity that stresses bones, especially in the lower body. According to researchers, stress fractures affect about 20 percent of runners, and women are twice as likely as men to get stress fractures.
Some common risk factors for stress fractures in runners include:
Wearing a boot for my stress fracture was no fun but it was necessary to heal the bone.
Overtraining
Transitioning too quickly from different training surfaces (going from running on all trails to all concrete, for instance)
Vitamin D deficiency
Calcium deficiency
Women with low BMI
Osteoporosis
People with eating disorders or diets lacking in nutrients
Overstriding
People with flat feet or high arches
Running in worn or poorly fitted shoes
Related Post: Running Foot Strike Guide + Tips
Common Types of Stress Fractures for Runners
Running stress fractures are most common in the lower legs and feet. Some runners also get pelvis stress fractures, but not as often as leg and foot fractures. Here are the main types of stress fractures among runners:
Tibia Fracture
A tibial stress fracture is the most common stress fracture for runners. This fracture is characterized by a small crack in the tibia, the larger of the two bones in your lower leg. If you have a tibial stress fracture, you will feel pain in your lower leg, usually near your shin, and it will get worse with continued running.
Symptoms
Pain in your shin, especially during or after running or other high-impact activities.
Tenderness and swelling in the shin area.
Pain that worsens with running or other weight-bearing activities.
If you have a tibial stress fracture or pain in your shins that worsens as you place weight on your legs, see a doctor immediately. You’ll need an X-ray and treatment, which includes resting and immobilizing the area.
Metatarsals Stress Fracture
The metatarsals are small bones in your foot, which are common areas for stress fractures in runners. According to the American Academy of Orthopedic Surgeons, stress fractures are most common in the foot's second and third metatarsals, which absorb the most impact when you run.
Symptoms
Pain on the top of your foot that gets worse with running.
Pain progresses to hurt even when you are walking.
You may have swelling or bruising on your foot.
As with other stress fractures, you must stop running and seek medical help if you suspect you have a foot stress fracture. If you continue to put weight on your foot, it will deepen the fracture and increase pain.
Fibula Stress Fracture
A fibula stress fracture is a small crack in the fibula, the smaller of the two bones in the lower leg. Your fibula runs along the outer of your lower legs.
Symptoms
Shin pain increases with running and weight-bearing exercises.
Pain on the outer side of the lower leg.
Swelling and tenderness to the touch.
A fibula fracture will worsen if you continue to run on it, so it’s important to rest and seek medical care.
Femur Stress Fracture
A femur stress fracture is a small crack in the femur, the bone in your thigh that runs from your hip to your knee.
Symptoms
Pain in your thigh, especially during or after running.
Tenderness and swelling in the thigh area.
Pain that worsens with high-impact activities like running.
Treatment typically involves resting your leg, avoiding running, and not putting pressure on your thigh. You may have to wear a leg brace and go to PT as part of your recovery plan.
How to Prevent Stress Fractures in Runners
There are early signs of stress fractures you can watch out for and possibly prevent your injury from escalating to a bone fracture. In the first stages of injury, your bone may bruise or swell, which is called a bone stress reaction, according to the American Academy of Orthopedic Surgeons.
Stress Fracture Symptoms
Some of the most common early signs of stress reactions include:
Pain when running or doing high-impact activities.
Swelling or bruising in the injured area.
Pain often occurs three to four weeks after starting a new training program or rapidly increasing your mileage or intensity.
If you continue to run on your injury, it will progress to your bone, causing a crack or break in the bone. Then, you will have a stress fracture. Signs of stress fractures include:
Pain increases as you continue to train on your injury.
As the injury worsens, you will feel pain and discomfort even when walking and resting.
You may have swelling and bruising.
Preventing Running Stress Fractures
You can modify your training and lifestyle habits to decrease your risk of stress fractures. Here are ways to lessen your chances of getting a stress fracture:
Increase your training incrementally. Don’t jump into a new training program too fast or skip rest days. Build your endurance and speed gradually, and you’ll be less likely to get injured.
Eat a nutrient-rich diet with enough vitamin D. See your doctor about your vitamin levels if you aren’t sure you’re getting enough nutrients.
Change your running shoes every 300 to 500 miles. See our tips for When to Replace Running Shoes for more details on how often to change your shoes.
Take a break from running on concrete by training on a track, trail, or treadmill at least once a week. Running only on concrete increases your risk of stress fractures as the concrete does not help absorb impact when you run.
Take rest days. Most runners should take at least one rest day a week. This can include active recovery like walking or yoga, but it’s essential to have a break from running.
Strength train at least twice a week. Improving your strength will help improve your bone density and stabilize your muscles for better support when you run.
Follow a training plan. A training plan designed by a certified running coach will consider your fitness level and training goals and create a plan that helps you meet your goals without overtraining. Head to the Runstreet Training Center for a customized training program to help you become a better runner while minimizing your risk of injury.
FAQs
Can you still run with a stress fracture?
No, you should not run with a stress fracture. This will increase the bone injury and lead to more breaking and fracturing.
Will a stress fracture heal if I keep running?
No, if you have a stress fracture, you have to stop running. If you continue to run on a stress fracture, it will worsen.
What does a stress fracture feel like when running?
A stress fracture feels painful when running. Stress fractures usually occur gradually and start by feeling sore and uncomfortable. As the stress fracture worsens, the pain will continue even when you’re not running (such as walking or resting). You will feel pain in the fracture area and may also have swelling.
If you suspect you have a running stress fracture, stop running and seek medical help. You will need X-rays to determine if you have a fracture and how severe the crack is. The worst thing to do is to keep running with a stress fracture, increasing your injury and continuing to hurt your bone. See a doctor or physical therapist for a diagnosis and treatment.
When in doubt, it's better to rest and see a doctor than to keep running. I tried to run through my stress fracture (not knowing it was a bone injury), which led to a longer time wearing a leg cast. Swimming became my best friend. Thanks to wearing the cast and PT, I was able to recover well. Good luck to you, and take care!
Related Posts: Calf Pain When Running: Common Causes, When to Change Your Running Shoes, 10 Running Form Tips from a Run Coach
Marnie Kunz is a NASM-certified trainer and USATF- and RRCA-certified running coach, dog lover, Akita mom, and writer based in Brooklyn, NY.
