Stress fractures can be avoided - Time-to-Run Injuries and Treatment section - diagnosis and treatment of common running injuries

Do not be fooled into thinking that your injury is a stress fracture only if you are unable to run. Many runners could avoid stress fractures if they would only take notice of a pain in the legs after a run. At this point it’s possible to prevent a stress fracture by responding to the developing problem: Stop running and see a sports medicine specialist.

The words "stress fracture" strike fear into all runners. The diagnosis usually means no running for at least six to eight weeks. What exactly is a stress fracture and why should it scare you? More importantly, what can you do to avoid a stress fracture, and to deal with one if it does occur?

A stress fracture is a crack that does not go completely through the bone. Initially called march fractures, they were first noted in the 19th century in Prussian soldiers who marched too far or too often. The injury has two main causes: too much repetitive stress on a bone and/or weakness of the bone, which can result from a number of different factors. If the repeated strain is greater than the strength of the bone, then it will fracture.

The most common site of a stress fracture in the lower body is the tibia or shin bone, followed by the metatarsals, the bones in the foot behind the toes. Most stress fractures develop gradually. A typical tibial stress fracture will initially be felt as "shin splints," a catch-all term that refers to pain along the inside of the tibia. The pain usually starts out over a large area along the shin bone, and is mainly noticed after a hard training session or race, or the morning after a long or difficult workout.

Shin splints occur when the muscles pull away from their attachment site along the inside of the tibia. At this point it’s possible to prevent a stress fracture by responding to the developing problem: Stop running and see a sports medicine specialist. Left untreated, the muscles will continue to pull, and this may cause a crack to form in the bone. The pain will progress to the point where it is noticed more during the run, and become focused on a smaller area of the bone.

If the pain is very focused on one area and becomes constant or worse during a run, then you should see a sports medicine specialist immediately. Because the fracture is not completely through the bone, often it does not show up on traditional X-rays, and therefore a bone scan is a better way to detect the problem. The test usually involves an injection of dye into the arm, followed by a series of special X-rays taken at different time intervals. The cost, usually several thousand rand, is almost always covered by Medical Aid. The bone scan will show the approximate site of a stress fracture.

Some of the causes of a stress fracture include poor biomechanics, inflexible or weak muscles, overtraining, doing too much too soon, training on hard surfaces, wearing improper or worn-out training shoes and doing too many races in racing flats in a short period of time. In addition, some people are predisposed to stress fractures because of a calcium-poor diet or osteoporosis (a progressive loss of bone mineral), and if these problems persist, another fracture is likely to occur.