Running injuries suck, but they’re usually manageable in the grand scheme of life. For all the love we show the sport, running gives us back achy tendons and sore muscles. These injuries can drive us crazy, but with the right prehab, we should confidently believe we can keep them under control. Stress fractures, on the other hand, are a bit more serious. They can take us away from the sport for weeks, months, or even a full season. A runner should do everything in their power to prevent them. Today we’ll summarize what the world knows about stress fractures and explain the best way for runners to prevent them.
Note: if you believe you have suffered a bone stress injury, please reach out to a sports medicine professional. The right diagnosis and treatment is key for a quick recovery, and this article is all about prevention.
What are stress fractures?
First let’s clarify what a stress fracture is. A stress fracture is a small crack in a bone cause by repeated stress (the tens of thousands of steps in a runner’s training) not trauma (like a fall). This kind of injury starts as a “stress reaction” (basically swelling around the bone). Then if it becomes more severe, a small crack might develop (more complete scientific explanation). If it makes it to this stage, a runner will likely have to rest fully for several weeks or months off to let the body heal.
What causes stress fractures in runners?
Runners usually develop stress fractures in these 3 areas: the bones of our shin, where our femur meets our hip, and in the bones of our feet (study).
To make it super simple, these bone stress injuries happen for two primary reasons.
- We load our bones too much. Stress fractures, like most running injuries, are typically caused by excess training load (relative to what the runner is accustomed to). The right amount of stress / load is good and drives improvement. But, we get injured when the stress becomes more than the bones can recover from. It’s hard to know exactly how much is too much, but going far beyond our bones’ training tolerance is what drives injury (study).
- We don’t take in enough calories / nutrients. The term RED-S (Relative Energy Deficiency in Sport) is the most up to date way researchers categorize the physical, mental, and social state athletes of both sexes get into when they’re not consuming enough calories relative to their burn. Not eating enough does not itself cause stress fractures, but athletes who under-fuel are at tremendously elevated risk of bone stress injury (consensus statement from The IOC). Not eating enough lowers training tolerance. All of the sudden the 35 miles per week (for example) that your body knows and loves becomes far beyond what it can take.
How every runner can prevent stress fractures
There is a lot of research on the subject, but the takeaways from all these papers are fairly simple
- Get strong. Muscle and bone are best friends for life. Strong muscles help bones handle force more evenly (study) and stronger muscles increase overall training tolerance which likely reduces injury risk. Strength is never a weakness when it comes to preventing injury.
- Jump occasionally. Hopping exercises, often called plyometrics, can tremendously increase bone strength (study). You can read more about the benefits of plyometrics in our article on the subject.
- Sleep. Especially in younger athletes, less sleep correlates with higher stress fracture risk (study) Sleeping is a good thing, especially when you’ve put in a bunch of miles on the day!
- Fuel fully. In order to be healthy athletes we have to be healthy humans. Questions of RED-S and disordered eating are beyond the scope of this one article, but if you think you may need help, you are not alone in the running community, and there are many resources available.
- When it comes to young runners, help them become athletes first: In 2005, researchers surveyed elite runners at the USA track and field championships. Those runners who played some form of ball sport outside running were much less likely to have suffered a stress fracture at any point in their career. Scientists suspect that the lateral movements in balls sports build a tougher skeleton. If we specialize too early, our risk of injury is far higher. Help young runners become an athlete who runs, not just a runner, and they’ll likely be a healthier runner over the long term. (study) (study).
To summarize, preventing stress fractures and lesser bone stress injuries comes down to avoiding unhealthy habits and building strength. Like all running injuries, stress fractures are non-fatal. If you or a training partner happens to develop a stress fracture, everything will be OK! Focus your recovery, then commit to making good training decisions going forward, and, of course, be sure to always include strength in your training program. The more we know, the healthier we can all run.
Recover Athletics cannot yet help athletes with fueling and sleeping, but we can help you build stronger muscles and bones through strength and plyometrics. Try our app. We have an unlimited free trial and a premium subscription costs less than one trip to a physical therapist.
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