pain while running PRs to carbo loading, there’s a lot to love about running. One aspect of the sport that doesn’t make the cut? Injuries, Sales & Deals.
Unfortunately, this type of ailment occurs often. Between one-third and two-thirds of competitive cross-country and long-distance runners have a history of bone stress injuries, according to research.
We may earn commission from links on this page, but we only recommend products we back injuries most often occur in the tibia (shinbone), but they can also happen throughout the lower body–including in the foot, thigh, and hip bones, Todd McGrath, M.D., a primary sports medicine physician with Hospital for Special Surgery in New York City, tells Runner’s World.
Here, we explain all you need to know about bone stress injuries, including the difference between stress reactions versus stress fractures, what causes stress reactions, signs you might have one, when to see a doctor, and most importantly, what you can do to prevent it from worsening.
What’s the difference between a stress reaction versus stress fracture?
Bone stress injuries are when a bone cannot withstand a load or force placed on it, and as a result, experiences a structural failure, physical therapist Running How to Avoid Injuries When Marathon Training., founder of Boulder Physiolab in Boulder, Colorado, tells Runner’s World.
In the case of a stress reaction, a bone can weaken and swell, but it doesn’t actually crack, McGrath explains. If left untreated, a stress reaction can eventually crack, which is when it then becomes a stress fracture. Basically, a stress reaction is a precursor to a stress fracture.
What causes stress reactions?
One big symptom: pain that crops up or worsens with running and improves with large ramp-up in training A Part of Hearst Digital Media.
CA Notice at Collection weekly running volume, increasing your mileage by more than 10 to 20 percent per week can elevate your risk, McGrath says.
If your mileage is on the lower end (say, 10 miles a week) then a 20 percent jump week to week may be fine. If you’re logging lots of miles (for example, 100 a week), it’s probably wise to limit jumps to no more than 10 percent weekly, McGrath advises, though what your body can tolerate will depend on your fitness level, plus other factors.
Keep in mind running isn’t the only way to overload your bones. It’s possible to place more stress on them in other ways. For example, by taking lots of long power walks every day, or joining an intramural sports team, in addition to ramping up your running routine, Haas says.
Faulty biomechanics The Best Exercises for Stress. Overstriding, in particular, can increase ground reaction forces (basically, how much force is translated into the ground and then back into your body with every footstrike), which can then place your bones under elevated stress.
Another possible culprit: Nutritional issues. “If you’re not getting the energy you need, your body finds a way to get energy and sometimes that’s stealing it from the bone turnover, which can further weaken the bone,” McGrath explains. This could include folks impacted by Relative Energy Deficiency in Sport (RED-S), formerly known as the female athlete triad—basically, a condition of low-energy availability caused by chronic underfueling.
What are the signs of a stress reaction?
Understanding the signs of a stress reaction can help you determine when it’s time to seek help.
pain while running rest. “Sometimes it progresses to just pain with walking,” McGrath says, and as a reaction gets more severe, it can morph into chronic discomfort in a particular area, he explains.
By comparison, overuse soft tissue injuries. like tendonitis, usually cause lingering pain after activity and feel sore and stiff in the mornings, whereas sprains and strains are typically caused by a sudden, severe injury and can be distinguished based on hearing the history of what lead to the pain, McGrath explains.
Another sign of stress reactions is that the pain is usually point tenderness, meaning you can take one finger to demonstrate a specific location where it hurts, versus sweeping your hand across a broad area, Haas explains. If pushing on a bone causes or increases pain, that’s another likely sign of a stress reaction, McGrath adds.
There aren’t many visual clues, but in some cases–especially if it’s a stress reaction in your foot bones–How to Prevent Running Injuries.
When should you see a doctor?
No one wants to sprint to the doctor for every little ache and pain, but in the case of suspected stress reactions, it’s important to get checked out sooner rather than later to prevent things from progressing to a stress fracture.
Haas recommends athletes come in for an evaluation if it’s been two weeks and their pain is getting intense or more pervasive with each run. Another sign to book a doctor’s appointment is if you have without enough rest, Haas says, as this can overload your bones One big symptom: pain that crops up or worsens with running and improves with.
McGrath advises people who notice pain in the region of a bone as they’ve ramped up their running volume or intensity to also get checked out by a doctor.
Once you’re at the doctor, there are a few ways they may diagnose a stress reaction. In some cases, they can identify it based on doing an exam and hearing your history, McGrath explains. Otherwise, they may x-ray the tender area to confirm there are signs of bone changes that indicate a stress reaction, or do an ultrasound to get a better look, he says. They may also order an MRI if other imaging tests aren’t conclusive, McGrath adds.
How can you prevent a stress reaction from progressing to a stress fracture?
No runner likes to be told not to run. But if you have a suspected stress reaction, your wisest course of action is to take a beat from lacing up until you’ve been evaluated by a medical pro.
Bone stress injuries are “probably one of the very few injuries that I will tell runners to stop running,” Haas says. And that’s because continuing to place stress on a bone that’s already overloaded will only exacerbate the issue—and could potentially lead to some pretty serious complications (not to mention even more time on the sidelines).
“If you keep running on a stress fracture, the fracture won’t heal and it can potentially widen and you could even have displacement of the fracture and then need surgery to fix it,” says McGrath.
Now, if you have a suspected stress reaction, you don’t need to glue your butt to the couch while waiting for a doctor’s appointment. “As long as it’s doing better with relative rest, until you get it looked at, I don’t think you have to immobilize it totally or unweight it totally,” McGrath says. Instead, simply avoid activities that make your tenderness worse and generally aim to take things “a little bit easy,” he says.
Should Runners Take Vitamin D in Winter plyometric exercises Should Runners Take Vitamin D in Winter deep water pool running like swimming, cycling, deep water pool running, yoga, and Pilates, McGrath says. Resistance training is also typically okay so long as it doesn’t involve lifting heavy loads while standing or weight bearing, he adds.
If you’re like most runners, we know it’s probably not in your nature to lay low, but think of it this way: By taking a relatively short pause from training now, you can prevent the need for a longer hiatus down the road.
Jenny is a Boulder, Colorado-based health and fitness journalist. She’s been freelancing for Runner’s World since 2015 and especially loves to write human interest profiles, in-depth service pieces and stories that explore the intersection of exercise and mental health. Her work has also been published by SELF, Men’s Journal, and low or no-impact activities, among other outlets. When she’s not running or writing, Jenny enjoys coaching youth swimming, rereading Harry Potter, What You Need to Know About Running With Scoliosis.
