I have had the book "Tim Noakes" "Lore of Running" for some time and recently read the chapter on stress fractures. A lot of good info there, but very much from the perspective of the doctor, not the patient. So here are some thoughts...
"the injury is usually a quite sudden onset, and there is no history of external trauma... runners get little notice of the tragedy that is about to befall them..."
Yep, that is really dead on and probably the most frustrating bit. I was fine one day, did a 12 mile run, then couldn't run. So what could I have done to avoid it? I'm not happy with this statement because it doesn't do much to help runners avoid the issue. In my case, I did feel a pain in the femur at the beginning of a 12 mile run, but did the run anyway. By about 8 miles, I was really hurting, but had to get back to the car. Had I known what a stress fracture felt like, I would have skipped running and taken a week off. That might have avoided my 8 week off period.
"hopping on the injured leg is painful"
I never really tried hopping on one leg. The thing that is frustrating about this statement is that now that I am 6 weeks into recovery, should I try hopping on 1 leg to see if it is painful or wait the 8 weeks? Will hopping on one leg make it worse? No idea.
'gentle pressure on the injured bone will illicit exquisite, nauseating pain"
Not so much. I had a deep tissue massage before getting the stress fracture diagnosis and while it was painful, I wouldn't classify it as exquisite, nauseating pain.
'the injury heals itself completely within 2-3 months'
This remains to be seen. The doctor told me to try running after 6 weeks. I am waiting for 8 weeks. Note that the 2-3 months is dependent on the location of the stress fracture. Noakes is a bit inconsistent because later he says 6-12 weeks, saying the smaller bones (ankle, fibula) take shorter than large bones like the femur, tibia and pelvis.
Hard to argue with that logic, but he then goes on to site some factors assocaited with stress fractures:
women are more prone, low calcium, menstrual abnormalities, shoes, training errors, genetic factors, low bone density, and race (african decent have fewer stress fractures).
There are only 3 things I can control on the list since I am not a woman nor of African decent (although one might say we are all of African decent, just some are more recent). The three things I can control are calcium levels, shoes and training errors....
'my clinical impression is that shoes play less of a role in this injury than do major errors in trainin methods... however, ...neoprene insoles reduce ....overuse injuries'
So, I'm not going to worry too much about my shoes.
'accumulated muscular fatigue ... may reduce the muscles ability to absorb shock... when the muscles are tired and unable to absorb shock that function is passed over to the bones, which must therefore become more likely to fracture'
Eureka! I think Noakes is onto something here. Having done an 80 mile bike ride the day before, not to mention all of the other training I had been doing, I believe the accumulated fatigue without enough time to rebuild is the main factor contributing to my stress fracture. Getting older and not building muscles as fast probably contributes. Not doing my weight training regularly probably contributes. In any case, this was my theory also and very much 'feels' right having lived through it. I can actually feel more strain on my bones when my mucles are fatigued.
"the injury is usually a quite sudden onset, and there is no history of external trauma... runners get little notice of the tragedy that is about to befall them..."
Yep, that is really dead on and probably the most frustrating bit. I was fine one day, did a 12 mile run, then couldn't run. So what could I have done to avoid it? I'm not happy with this statement because it doesn't do much to help runners avoid the issue. In my case, I did feel a pain in the femur at the beginning of a 12 mile run, but did the run anyway. By about 8 miles, I was really hurting, but had to get back to the car. Had I known what a stress fracture felt like, I would have skipped running and taken a week off. That might have avoided my 8 week off period.
"hopping on the injured leg is painful"
I never really tried hopping on one leg. The thing that is frustrating about this statement is that now that I am 6 weeks into recovery, should I try hopping on 1 leg to see if it is painful or wait the 8 weeks? Will hopping on one leg make it worse? No idea.
'gentle pressure on the injured bone will illicit exquisite, nauseating pain"
Not so much. I had a deep tissue massage before getting the stress fracture diagnosis and while it was painful, I wouldn't classify it as exquisite, nauseating pain.
'the injury heals itself completely within 2-3 months'
This remains to be seen. The doctor told me to try running after 6 weeks. I am waiting for 8 weeks. Note that the 2-3 months is dependent on the location of the stress fracture. Noakes is a bit inconsistent because later he says 6-12 weeks, saying the smaller bones (ankle, fibula) take shorter than large bones like the femur, tibia and pelvis.
Causes
'the exact reason why stress fractures occur is non known...(but) there must be abnormal concentration of stress... and the bone must be insufficiently strong to resist those forces'Hard to argue with that logic, but he then goes on to site some factors assocaited with stress fractures:
women are more prone, low calcium, menstrual abnormalities, shoes, training errors, genetic factors, low bone density, and race (african decent have fewer stress fractures).
There are only 3 things I can control on the list since I am not a woman nor of African decent (although one might say we are all of African decent, just some are more recent). The three things I can control are calcium levels, shoes and training errors....
'my clinical impression is that shoes play less of a role in this injury than do major errors in trainin methods... however, ...neoprene insoles reduce ....overuse injuries'
So, I'm not going to worry too much about my shoes.
'accumulated muscular fatigue ... may reduce the muscles ability to absorb shock... when the muscles are tired and unable to absorb shock that function is passed over to the bones, which must therefore become more likely to fracture'
Eureka! I think Noakes is onto something here. Having done an 80 mile bike ride the day before, not to mention all of the other training I had been doing, I believe the accumulated fatigue without enough time to rebuild is the main factor contributing to my stress fracture. Getting older and not building muscles as fast probably contributes. Not doing my weight training regularly probably contributes. In any case, this was my theory also and very much 'feels' right having lived through it. I can actually feel more strain on my bones when my mucles are fatigued.
Treatment
Noakes talks about water running, air casts, etc. I wasn't very impressed with this section of the book. I also haven't had good advice from my doctors on this either. Aside from taking calcium supplements and staying off the leg as much as possible, I'm confused about what I can do and what I absolutely should not be doing. For example, can I bike? How hard? Can I kick when I swim? I know it hurts to do the breast stroke with a frog kick, so I avoid that. What about pushing off the side of the pool? If I really did nothing, would it heal twice as fast or just a couple of days faster? Too many questions, not enough answers.
'few runners wil accept a two-month rest period without some visible evidence that the diagnosis is correct'
Moreover, during that 2 month rest period, runners want to know that some progress is being made. They want (need) some objective verifiable evidence that they are getting better... they want to know that they are 10, 20, 50% healed.
So what does it feel like?
When it first happened, I wasn't paying attention, so I just felt tired a lot from so much training and didn't hone into 'feeling' what was happening with my femur leading up to the injury.
So I started paying attention to it when I did a 12 mile run in early July. At first it was a dull ache above my knee on the outside of the leg. As I ran, if I had any sort of uneven stride due to the uneven road, it would hurt, so I tried to keep it very steady. I got through my 12 mile run at under a 7:30 pace average. I thought it was an IT band problem, so I took an ice bath and did not run the next day. I had a dull ache from halfway down the thigh to halfway down the calf and it was hard to pinpoint where the pain was coming from. It really didn't hurt to walk, so I tried running on the treadmill 2 days after the 12 mile run and the pain was 8.5 out of 10, but very consistent. Every step with my right foot sent a sharp, yet somehow dull and deep pain from my lower femur. I still thought it was an IT Band problem, so took a couple more days off and repeated. 2 weeks after the 12 mile run I did an Olympic distance triathlon race. It was sore from the start and got worse as I went.
Now that I have been off of it for 6 weeks, I can still feel a dull, deep ache sometimes when just sitting around. Occassionally when walking, if I take an uneven step or put excessive weight on the leg I can feel things are still not right.
I started riding my bike 2 days ago, doing a 40 mile bike ride. It mostly felt fine, but there was a moment when the pain kicked in for 10 seconds then went away.
Very strange indeed.
Now that I have been off of it for 6 weeks, I can still feel a dull, deep ache sometimes when just sitting around. Occassionally when walking, if I take an uneven step or put excessive weight on the leg I can feel things are still not right.
I started riding my bike 2 days ago, doing a 40 mile bike ride. It mostly felt fine, but there was a moment when the pain kicked in for 10 seconds then went away.
Very strange indeed.
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