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4 Tips to Reduce the Risk of Stress Fractures
What is a stress fracture?
When bone is exposed to load (weight bearing and especially impact, for example), it incurs microdamage. This microdamage is normal and desirable because the bone responds by remodeling to better withstand the loads placed on it. In less-than-ideal conditions, however, such as an energy/nutrient deficiency or insufficient recovery time, that microdamage accumulates faster than the bone can remodel. When this happens, a stress reaction develops, which is edema in the bone marrow or outer layer of bone. If unaddressed, a stress reaction may then develop into a small crack in the bone, i.e. a stress fracture. The term “bone stress injury” refers to both a stress reaction and a stress fracture.
What are signs of a progressing bone stress injury?
- Initial diffuse ache with activity (e.g. running) that resolves with rest, then:
- Pain earlier in the activity or with less impact;
- Pain with all weight bearing activities;
- Pain at rest, including at night.
What are risk factors for a runner developing a bone stress injury?
- Running more than 40 miles per week;
- Training errors, such as large jumps in volume or intensity (speed, hills), or sudden shoe changes;
- Being female;
- Inadequate nutrition.
It might be a bone stress injury. What next?
The treatment for a bone stress injury depends on its location and how severe it is. If you’re concerned you may have a bone stress injury, see a medical professional right away.
This doesn’t sound like something I want. How do I reduce my risk?
Obviously, it’s better to not get a bone stress injury at all. Here are four tips to decrease the risk of a stress fracture:
- More bone adaptation occurs with higher loads and higher rates of loading. That means you want to lift heavy weights, with speed. For example, do barbell back squats with a controlled descent and a fast, powerful ascent. Try 5 sets of 3-5 reps at a weight that is 8/10 difficult.
- For reduced bone stress injury risk, your bone has to be stronger than what you’re asking it to do in your activities. Do exercises that exceed the demand of your activities. For example, if you’re a runner, single leg hops that travel forward, sideways, diagonal, and change directions would be tougher than what the tibia has to withstand while jogging.
- Bone loading has diminishing returns for adaptation after about 40 repetitions. In the example above, you don’t need to do hundreds of hops–just 40. What’s more, 10 hops in the morning, 10 at lunch, 10 in the afternoon, and 10 in the evening works better than 4 sets of 10 reps all at once.
- Finally, make sure you’re eating enough food for your activity level. Calcium, vitamin D, and iron are especially important. Seek guidance from a nutritionist if you’re not sure.
Conclusion
- A bone stress injury occurs when microdamage to a bone caused by loading exceeds the rate of bone remodeling.
- Bone stress injuries can have serious ramifications, so a potential injury should be evaluated by a medical professional.
- Primary risk factors include training errors and insufficient nutrition.
- Reduce the risk of bone stress injuries by loading the bone: lift heavy, add speed, and do exercises that are harder than the activities you like to do.
Our Mission:
Here at Peak Endurance Performance & Physical Therapy we help active adults in the Madison Area get back to the activities they love without pain or limitations. We see people of all ages, ability levels, and individuals trying to get back to a multitude of movements including: getting back into running, women postpartum, CrossFit athletes, climbers, gymnasts, wrestlers, overhead athletes, and your recreational weekend warrior. If you’re looking to get back to the activities that give you meaning, relieve stress, and make you feel like you again, feel free to reach out below and we’ll see if we’re the right fit for you.
