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Stress Fractures and Bone Health in Athletes

by Dr. Jason Barker September 16, 2016

Stress Fractures and Bone Health in Athletes

Stress fractures are a relatively common injury in even the fittest of athletes. Stress fractures are hairline fractures that occur most commonly in the foot and lower leg. Caused by overuse, runners and gymnasts are no strangers to them.

The connective tissues (ligaments, tendons, muscles) in the lower leg and foot normally absorb the impact from weight bearing activity like running and landing. The bones play a role in stress absorption as well, but when they become overstressed and inadequate time for recovery is allowed, a stress fracture will often result.

Symptoms of Stress Fractures

  • Pain with activity (running, jumping)
  • Pain resolves with some rest
  • Painful to touch
  • Worse at night
  • Slight swelling over the injured area

Causes of Stress Fractures

Put simply, repetitive pounding on the bones of the feet is the most common cause of stress fractures. You can get them in other areas of the body as well, but this is less common. We tend to see stress fractures in three types of people:

  • Causal runners who constantly run on concrete. It really doesn’t take much to get a stress fracture this way. Two problems – the person is a casual runner who runs under 25 miles a week, perhaps a bit inconsistently, coupled with running only on concrete sidewalks –which are much, much harder than asphalt in the street (and not to mention dirt trails!)
  • Women with thinning bones. Menopausal women with thinner bones because of hormonal status can fracture bones very easily. (Younger women can have low hormones as well, which can be a result of diet and excessive training. See our article on the Female Athletic Triad.)
  • High mileage runners. There is no single definition of ‘high mileage’ but as little as 30 or more miles a week could be enough to generate a stress fracture; runners who log more miles than this are at higher risk of developing stress fractures.

Diagnosis of Stress Fractures

Pain over the fracture site, whether it’s in the foot or lower leg is the first sign of a stress fracture. Aches and pains are common in runners, but they should go away in a few days, tops. If the pain doesn’t go away on its own, then it’s time to get a work up.

Here’s the tricky part. What typically happens is that your doctor will want to order an x-ray whenever you say you have pain in a bone. Stress fractures will not show on an x-ray for many weeks, if at all – they’re too small to be seen this way. If the x-ray doesn’t show anything, you need an MRI or bone scan to establish the diagnosis.

Regardless, if you have persistent bone pain in your foot or lower leg, you need to rest! Stress fractures take about 2 months to heal, with rest. Continuing to run will prolong and worsen the injury.

Prevention of Stress Fractures

  • If you have more than one stress fracture in a season, it’s important to have your hormonal and bone health evaluated. Imbalanced hormones can contribute to weakened bones.
  • Make sure you have a decent pair of running shoes, and replace them often! (Every 6 months of consistent running or 200 miles tops!)
  • The 10% Rule: Don’t increase your mileage by more than 10% each week.
  • Stay off pavement sidewalks. Run on asphalt or even better, trails.
  • Get adequate rest. Less is almost always more.
  • Keep your diet alkaline by eating plenty of fruits and veggies. Acidic diets must be buffered in the body – the bones will leach minerals to buffer the acid, weakening them over time.
  • Proper nutrients. There’s more to bone healing than just calcium. Other nutrients like Ipriflavone, boron, vitamin K2, vanadium and vitamin D are just as important. You can find all of these in our Osteo Formula, including a variety of well-absorbed types of calcium.

Not taking the proper steps to heal a stress fracture can lead to more time off, re-injury, chronic foot problems and constant pain. Take the time now to rest and heal your body so that you can get back to doing what you love as soon as you can!

Dr. Jason Barker
Dr. Jason Barker


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