It's the diagnosis every runner fears: a stress fracture. It's far from a nuisance injury, which requires a couple days of ice and rest. Rather, this type of issue generally demands months of time off and plenty of rehab.
Among the most reported serious injuries by runners, stress fractures are usually characterized by localized bone pain that hurts to push on. Runners commonly develop stress fractures in the lower legs and feet, but they can also occur everywhere from the femur to the pelvis to the spine.
While the word "fracture" may conjure up images of an acute injury, stress fractures happen over time. The result of micro trauma to the bones over weeks and months of running, stress fractures occur when tiny cracks in the bone aren't allowed to heal.
While some amount of microdamage is a normal result of a high-impact activity like running, the problem generally occurs via training errors or if the bone is already weak at the onset of training. Some common causes: increasing mileage too quickly, biomechanical issues, poor nutrition, and running in old footwear.
Research conducted in conjunction with U.S. military recruits suggests that women are particularly susceptible to this type of injury. Recruits with smaller tibias and femurs were also at greater risk, along with those who had done less physical activity prior to training. Other research found the compulsive exercise and eating disorders were significant independent predictors of stress fractures.
Is It Really a Stress Fracture?
Since runners experience all manner of pain in their legs and feet, it can be tricky to self-diagnose a stress fracture.
"It usually starts out as 'shin splints' or 'foot pain' that people think they can run through, but it continues to get worse," explains Ryan Smith, a Kentucky-based USA Track & Field certified coach who holds a master's in exercise physiology.