Life After A Stress Fracture
I thought I would share my experience and rehab programme I followed, when in 2013, I suffered a stress fracture to the proximal end of my 2nd metatarsal of my right foot.
Training had been going really well and I was starting to feel fairly fit. My first mistake was to run a race that was totally different from my regular training and racing. This was the Castlewellan Christmas Cracker - A 10 mile race over road, fields, hills, and forest trail. My second mistake was to run in very flat trail shoes that I had never worn before. The length of the race, the terrain, and the footwear were not what my body was used to.
After the race, my calves and feet were "as tight as a tight thing". In the next few weeks, I got back in to hard training. Life and work were busy. My calves and feet felt tight and I didn't make time to stretch out properly or get a massage - I should have known better!
On the 26/02/2013, during a session of 20 x 1 minute efforts I felt an ache over the top of my right foot on the 19th rep and as a typical runner I completed the session thinking "awh, it's just a ligament strain". I remember once I finished the session, I chatted for a while (as you do) then when I went to do the cool down I couldn't run. The ache over the top of the foot was very severe.
With my physio head my gut feeling was "oh no, this could be a stress fracture" then I thought I was over reacting and decied to rest up a couple of days. I then attempted a run - not a hope. I didn't even get 100m's. The pain over the top of the foot was really severe and I couldn't get up on my toes.
My next port of call was to get an MRI scan to confirm the stress fracture. An ordinary x-ray will not see a stress fracture until it is a couple of weeks old. I had the scan on the 07/03/2013 and this confirmed a stress fracture to the 2nd metatarsal . Due to the anatomy of the foot the poor 2nd metatarsal is more at risk.
There are many risk factors associated with developing a stress fracture, the most common being - doing big miles and poor nutrition. However this was not the case for me. My risk factors were:
- 2nd toe longer than my big toe
- An over pronating foot with poor strength in tibialis posterior and calves and hip extensors
- Tight calves and tight plantar fascia
- Running more on my forefoot - as I was getting fitter I was doing more speed work
Once the dignosis was made, I then made every effort to make sure the fracture would heal well so that I could get back to running in the normal time frame ( 8-12 weeks ).
My rehab was as follows:
(You will notice I didn't go near a pool to swim or use a floatation jacket. I'm a terrible swimmer and don't like water, but swimming/running in the water is great rehab and can be a great way to maintain fitness.)
Fracture 26/02/2013, diagnosis made 07/03/2013, Rocker boot purchased next day and worn for 5 weeks.
For the first 5 weeks I made sure I did Pilates every day.
Out of boot, tibialis posterior strengthening, balance work on a balance board and squats. Continued with Pilates.
Added in walking. Started with 1 mile and then 2 miles etc. Continued with balance, Pilates and strength work for legs and feet.
Had soft tissue work to calves and feet. Started cycling. Continued with walking and strength work and Pilates.
By week 7 my balance was great on the right foot. I was walking up to 4 miles at a time and cycling 10 miles. I added more strength work with calf raising and lowering on a step and hopping. At times the top of the foot was a bit achy but this would clear by the next day.
Continued to cycle but in week 8 I fell off the bike! This made me realise that I should definately stick to running - it is a lot safer!
I continued with Pilates and strength work and I was now able to hop x 50 reps on the right foot. There was a very slight ache over the top of the foot but I thought it was time to try a very short run. Yippee!
I initally did a walk/run for 1 mile. Next day foot felt great. At the end of week 8 I did a very slow 2 mile run.
Slow running on a Monday, Wednesday and Saturday. 9 miles in total and no pain.
I continued to gradually increase my running. I continued with strength work, Pilates and balance work and I got orthotics made to help off load the 2nd metatarsal.
So overall, I was running again by May and still to this day continue with Pilates and strength work. I also try to do a lot of running on grass or trail and for me I feel I need to wear a good cushioned running shoe.
Should you need advice about this type of injury, please feel free to contact me - I've been there, seen it and bought the t-shirt! I will be happy to help. Having been through it I know how devastating it can be not to be able to run and meet up with your fellow runners, but there is life after the stress fracture. I think the main thing is to know how it has happened so that you can avoid it happening again.
- Don't over train. Increase mileage and intensity of training carefully and sensibly. Do a lot of your running on grass or trail.
- Stretch regularly, use a foam roller regularly.
- Strengthen hips, legs and feet muscles.
- Get regular massage.
- Look after your feet - a spikey ball is a great bit of kit to massage the feet.
- Comfortable training shoes.
- Nutrition - a good diet and plenty of protein with carbohydrates.
- Stay well hydrated.
- Listen to your body. Pain that doesn't go away or gets worse with running should be checked out.
- Work/life balance. Sometimes life gets bit hectic - sometimes better to just do an easy run than a hard session if your very tired.