The process of a stress fracture is a simple one. All of our bones are being constantly remodelled by cells that resorb the existing bone and cells that rebuild it. This rolls along throughout our lives, but is influenced greatly by mechanical stress – running being a big one.
If there is an increase or alteration of mechanical stress in one particular area, then the bone remodelling process speeds up. If there is repeated stress, the remodelling process can get out of sync. The cells resorbing the bone work quicker than those rebuilding it, leading to an area of bone weakness.
If the increased mechanical stress continues then the bone can crack or fracture microscopically. This is a bone stress injury or stress reaction and is when things become painful. If you ignore it then it can lead to a bigger crack and a full stress fracture.
Treatment begins unfortunately with a period of rest – just as you would for a broken bone. In fact the healing process is the same. if you load it then it simply will not heal or at least take a very long time.
During this time is when there is much work to be on the reasons behind that particular area of bone having been overloaded.
- Have you areas of weakness and tightness which have altered your gait pattern?
- Can these be worked on during the rest period?
- What cross training can you do?
- Are there any underlying metabolic reasons why the bone was vulnerable? Vitamin D or Calcium deficiency for example.
Once the 4-6 weeks has passed there is a graded return to loading. This is when we start the real work of changing gait pattern with lots more strength and drill type work whilst the bone continues to strengthen.
It is hugely important to make these changes because if you do not then a recurrence is highly likely.