Stress Fracture Prevention

A stress fracture is a small crack in any of your weight-bearing bones. Stress fractures are one of the most frustrating injuries a runner can experience, not just because of the pain, but due to the limitations in treatment. Runners with stress fractures are off the trails for four to six weeks. Therefore the emphasis should be on prevention rather than treatment.

Nelia Marsburg of Bloemfontein asks experienced physiotherapist, Garth Oliver, how to prevent and treat stress fractures.

Five Common Causes

1. Overtraining.

When bone is stressed, it actually gets weaker before it gets stronger. So increase your mileage carefully. While increasing your mileage by 10% every week is the norm, some research* suggests that decreasing mileage every three to four weeks will help give your bones the chance to remodel and get stronger.
A theoretical increase of 10% for three weeks and then a reduced week four would look like this:

Stress fracture prevention mileage

2. Continuous intensity.

The quality of your training can also cause a stress fracture. Running like a speed demon all the time can make you more vulnerable to injuring yourself because
speed increases impact forces. It’s important that you follow a structured training programme with easy days.

3. Hurried recovery.

Running too soon after an injury or illness.

4. Change of surfaces.

Running on tar has greater impact forces than running on grass or trail. If you have done most of your training on softer terrain and suddenly do the same mileage on tar it can overstress the bone.

5. Diet.

Insufficient calorie intake can affect bone density. This is more common in women but can affect men. Diet also plays an important part in preventing stress fractures. Some studies have proven that taking vitamin D and calcium supplements decreases the risk of a stress fracture.

Top Three Symptoms

  1. Swelling and tenderness emanating from the area.
  2. Pain when active but not at rest occurs in the early stages. Later, pain is constant and more intense at night.
  3. Tapping on the bone at a site other than the suspected fracture will produce pain at the fracture.


Nelia Marsburg in a moon boot recovering from stress fracture t14
Nelia Marsburg in a moon boot recovering from her stress fracture.

Treatment is limited. Runners diagnosed with stress fractures are prescribed strict rest. In severe cases, you will be in a moon boot and on crutches for four to six weeks.

During recovery you will be able to do non weight-bearing activities like aqua jogging, progressing to cycling. Always consult your physiotherapist, biokineticist or doctor if you suspect you have a stress fracture.

It’s much better to heal in the early stages than to run through the pain and end up with a severe stress fracture that will keep you off the trails for over a month.

*Beck, B. R., Tibial Stress Injuries – An Aetiological Review for the Purposes of Guiding Management. Sports Medicine 1998, 26 (4)

Article originally published in TRAIL 14.

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