Tibial Stress Fracture

Air CastThe secret to training is to train.  I can’t train right now.  Instead of making forward progress I’ll be lucky if I can even maintain my current level of fitness.   I’ve “earned” myself a tibial stress fracture or FSF as I like to call it.  I keep asking myself “how did this happen?” and “what do I do now?”  Read on for partial answers.

For those that do not know a stress fracture is an injury to the bone.  While it is called a fracture it is rarely a crack completely through the bone.  More often it is a small crack of other damage to the bone.  When you stress the bone, like when running, the bone temporarily is broken down.  The body then rebuilds the bone and makes it more dense – a positive adaptation.  If the breakdown exceeds the adaptation rate then you will eventually end up with a stress fracture.  That is why it is considered an overuse injury.

Runners dread stress fractures because they sideline you.  To heal properly you have to rest.  The healing process takes a long time.  Once you can start running again you have to be very conservative following a very slow build up.  Traditional recovery strategies are to refrain from running completely for 6-8 weeks followed by a 6-8 week build up to return to running.  Luckily there are ways to speed this up as I learned when I saw Dr. Swenson at University Sports.

Dr. Swenson was a a researcher in a study in 1997 that found some dramatic results.  The study consisted of 18 athletes suffering frmo tibial stress fractures.  The study group used a leg brace, and air cast (see the photo above), and the control group followed the traditional recovery techniques.  The control group took an average of 77 days to return to unrestricted activity.  The study group took, on average, only 21 days.  These results are so dramatic that I am skeptical.  I hope that I can fall into the 21 day recovery but the pain I’ve experienced has been very great and resting hasn’t seemed to help very much.  I’m cautiously optimistic.

“What do I do now?”  That’s surprisingly easy!  I focus on getting healed so I can train intensely again.  I also need to consider postponing my goals.  I was going to shoot to break 3 hours in a Fall marathon this year.  Now I’ll need to wait and see if that goal is feasible.  There’s a chance that I might not even run a Fall marathon.  It all depends on how training goes and what I feel like doing once I’m better.  I’m signed up for Goofy’s Challenge in early 2011 and I will be running Boston in April of 2011 so I need to watch the spacing of my races.  I don’t want to mess up either of those two events.  I’ve already completed a marathon this year, though it wasn’t a goal race.

“How did this happen?” That’s a more difficult beast that I’ll never really know the answer to.  I wish I knew with certainty so I could avoid this in the future but there are just too many variables to consider.  FSFs come on gradually.  It’s not like one day I was running and suddenly I experienced a crack in the bone.  I suppose that is possible but most likely, based on my symptoms, that is not what happened.  There was a span of about 7 days where the pain built up to the point that I couldn’t run on it anymore.  I’m sure the injury was brewing long before that.  Here’s how I suspect the FSF came to be:

  • Ran Miami shortly after running Vegas and didn’t really recover properly
  • Tried an experiment of running only in racing flats.  I had shin pain (shin splints) that I couldn’t run through.  When I switched back to trainers I was able to increase my mileage at a rate that I thought was reasonable.
  • I increased intensity.  I ran two half marathons 6 days apart.  I didn’t cut back on mileage and I added intensity in the form of intervals at the track.
  • I ran on aging shoes (though they likely have some life left in them still).
  • I used the aging shoes in Denver where I ran on cold hard concrete.  I did 12 miles the first day and then a bunch of shorter runs.  I think the 12 miler, which consisted of 6 miles downhill and 6 up, did me in.
  • I didn’t abort my interval workout in Denver (again, mostly on concrete in aging shoes) when my shin started to hurt pretty badly.
  • I ran on a painful shin the day after the interval workout figuring ignoring that the pain was on the top of my tibia and not along side it.
  • I tried to do a long run after limping through the airport.  I had a day or two of rest in between and the long run was going fine…initially.  The next day I was limping pretty badly.  The day after that I was still limping and quite worried.  Looking back I was right to be worried.

Dr. Swenson recommended I try running because I was able to hop on the affected leg.  That simple test is used as both a diagnostic and a prognostic.  Usually that hop causes significant pain by sending shock waves through the bone.  In my case it caused no pain.  That meant that either I was OK or that I had healed relatively sufficiently.  I ran that day.  I ran 1 mile before the pain was too great to bear.  I limped home.  The air cast went on after that run and since then I’ve been convinced that I truly have a FSF.  The pain was so severe that night that I couldn’t sleep without taking something to kill the pain.

I spent the next day walking for hours in downtown Boston with the aircast and dress shoes.  I know this wasn’t smart but this trip was not something that I was willing to avoid.  I know this set back my recovery by a few days (a week?) but it was worth it.

I’ve been biking a lot.  I’m trying to do at least 20 miles each day.  I figure that’s roughly equivalent to 30 miles per week of running.  Biking isn’t running but it’s better than nothing.

I am almost ready to start my “return to sport” training plan.  I have been able to hop pain free for about 2 days now.  After the third day I will start running.  The first workout will be walking 300 meters and jogging 100 for a total workout of 1 lap around the track.  It might only be 100 meters but it’s going to be incredible.

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