How to Prevent Stress Fractures
And why stress fractures become more likely as you get older
Mike Brosilow isn’t your typical everyday runner. He didn’t start running until turning 50, but quickly discovered he had a natural ability for it and fell in love with the sport.
Brosilow started training with a competitive group of runners and his weekly mileage climbed quickly. “I didn’t know any better,” says the Chicago-based photographer, who’s now 62. “I thought that’s what I had to do — I’d already had success and wanted to get better.”
In retrospect, Brosilow realizes that he pushed himself too fast, too soon. He started experiencing a pain in his shin and though he tried to run through it, the pain got worse. Finally, he saw a doctor, who diagnosed him with a stress fracture.
The doctor’s recommendation? A boot, to take the pressure off of the fracture and weeks of staying off his feet. Brosilow complied and fully recovered — only to suffer another stress fracture more recently, this time at the base of his ankle.
“I did it to myself,” he says a little ruefully today. “I broke my cardinal rule of running more than fifty miles a week because I wanted to qualify for the age-group championships.”
Brosilow did qualify, but says he’s learned his lesson. He’s now sticking to his self-imposed limit of 50 miles per week, with the goal of avoiding another fracture.
Stress fractures may be more common in active adults, but being sedentary doesn't protect you from getting one.
While Brosilow’s exercise regime is far more ambitious than most of ours, stress fractures are surprisingly common among serious athletes and everyday exercisers alike, comprising up to 20% of athletic injuries.
Complicating matters is that osteopenia, or thinning bones, makes you more susceptible to stress fractures (and other bone fractures) as you get older.
Here’s what you should know about these injuries, how to treat them and how to reduce your chance of having one (or more!) in the future:
What Is A Stress Fracture?
A stress fracture is a crack in a bone that doesn’t shift or displace the bone, says Dr. Kamran Hamid, an orthopedic foot and ankle surgeon in Chicago. It occurs when you place more demand on a bone that it can keep up with.
“That can happen for a couple of reasons, like when the load that has been placed on it is too much, such as training for a marathon or because the bone is weakening with osteoporosis or osteopenia,” Hamid says.
The classic case is when a casual runner starts training for a marathon or a former couch potato ramps up her exercise routine thanks to a New Year’s resolution or upcoming class reunion.
Stress fractures are most common in the bones of the lower leg, specifically the tibia, or shin bone, and the metatarsals, the long skinny bones in your foot. They typically produce pain, which can range from mild to severe, swelling and tenderness in the affected area.
You Can't See Them on an X-ray
Gwen Cornish is a regular exerciser who has had two stress fractures since her early 50s.
“The first one was in my shin — it started hurting like there was a needle there,” says the 65-year-old Traverse City, Mich., resident. “Then, years later, I got one in the ball of my foot and again, it felt like someone was putting a needle in the bottom of my foot.”
Physicians are more likely to diagnose a stress fracture based on your symptoms and exercise history than with an X-ray, which is commonly used to diagnose other broken bones.
“Oftentimes, you cannot see a stress fracture on an X-ray; it requires further imaging, like an MRI (magnetic resonance imaging) or CT (computerized tomography) scan to diagnose it,” Hamid says. “It depends on the bone. In some cases, you won’t see the fracture until later when you’ll see the bone callus, which looks like a cloud of bone … where the new bone is being formed around the crack. But there are some where you never see the fracture on an X-ray.”
Stress fractures may be more common in active adults, but being sedentary doesn’t protect you from getting one. Any uptick in activity (think walking more on vacation) or even switching shoes (which can change your walking/running movements) can be enough to trigger an injury.
Treating Stress Fractures
Treatment for stress fractures varies depending on their severity, Hamid says. Some people require immobilization in a boot or cast to take the weight off the affected bone. Others can simply avoid high-impact activity for six to eight weeks or so while the bone heals. (While six weeks is used as a general rule, a stress fracture can take three months or even longer to heal.)
Taking calcium and vitamin D3 can help improve healing as well, Hamid says. But consult your health care provider to determine how much of these supplements to take.
One of the newest treatments involves a bone stimulator, used to treat fractures that don’t heal well. One type employs sonic waves; another uses electrical impulses to stimulate the bone cells. Bone stimulators appear to help stress fractures, but can be cost-prohibitive because they’re usually not covered by insurance. In some cases, surgery may be required.
A gradual return to activity after a stress fracture is essential to avoid re-injury. “Start off with low-impact activities, like the elliptical (exercise machine) or bicycle," Hamid says. “You want to let your muscles and bones get stronger before you hit the road.”
The good news? With a little rest, and patience, you can look forward to getting back to your regular routine.
With both stress fractures, Cornish’s doctor had her take six weeks off from running, very gradually ramping up again. But she made a full recovery each time.
Perhaps the best approach is to avoid having a stress fracture in the first place. “An ounce of prevention is worth a pound of cure,” Hamid says.
You can’t help getting older, but you can help build stronger bones. So Hamid recommends patients of all ages lift weights several times a week. A routine that includes all the major muscle groups, done two to three times a week, will build and retain bone mass, making them more resistant to stress fractures.