1) Recover from my tibial stress fracture
2) Do not contract a second stress fracture
3) Focus on strength and flexibility
4) SLOWLY rebuild my aerobic base from the dust
5) Set myself up for future success - follow the path of delayed satisfaction
I am literally fighting to keep my identity, sanity and sense of self here. Thank goodness I have an incredible job where I put others before myself. I can only imagine the pain and horror of being an injured professional athlete.
I have never twisted my ankle, but all in all I have broken four bones. Two tibias and two fibulas in three injuries to be exact. In fact, my left tibia is the only lower leg bone that I have not broken. However my two injuries preceding this one, a compound fracture of both my right tibula and fibula, and a 'hairline' fracture of my left fibula, were easy to understand. In both incidences someone kicked me. How do you prevent this injury in the future? Simply avoid having people kick you. Simple enough I think. At no point are you led to believe that you yourself defeated your own body.
I personally believe that my stress fracture occurred due to what I was not doing, and not so much by what I was doing...
My review of the literature has led me to believe that, for the most part, doctors and sports scientists cannot adequately explain why this injury happens to some and not to others. I found this study's abstract to be emblematic:
"This retrospective and comparative survey investigates an unusual number of stress fractures seen within a Division I college cross-country team. An anonymous questionnaire - designed to observe factors known to increase stress fracture incidence - was distributed to members of the current and previous seasons' teams. Running surface, sleep hours, intake of calcium, and shoe type were among the factors investigated. Eleven lower extremity stress fractures were found in nine athletes. Athletes with stress fractures reported significantly fewer workouts per week on the new track. All other study parameters had no statistically significant effect on stress fractures in these athletes."1
So, in short, there was a team of Division I runners. This team suffered a lot of stress fractures and a study was conducted which found virtually nothing useful for us to take away.
Great! So, where do I go from here?
Weightlifting and plyometrics will have a positive yet marginal effect on running performance. But will improving your overall athleticism ultimately reduce the risk of injury by building stronger bones? I think it will.
Mathew B from coachup.com offers the following:
• A moderate to heavy strength training program has been shown to increase antioxidant status and help reduce the long-term debilitating impact of physical stress.
• Lifting leads to the release of hormones like testosterone and growth hormone that counter the negative impact of cortisol for a better endocrine profile that may improve reproductive health.
• Heavy strength training that loads the spine (squats, deadlifts, overhead press) is by far the best exercise you can do to build bone strength. For instance, women who powerlift, doing near maximal squats and deadlifts have bone density that is comparable to that of a man, and far greater than that recorded for women in the past.2
Luckily, there is data to support strength training in runners, both for its impact on bone density, and to improve running economy. A study by Roelofs et al. observed a correlation between lean muscle mass and bone mass density leading them to suggest the following: "More muscle mass may associate with higher BMD [Bone Mass Density] and BMC [Bone Mineral Content] for stronger bone structure. Modifications in training strategies to include heavy resistance training and plyometrics may be advantageous for preventing risk factors associated with SFx [Stress Fractures] reoccurrence."3
There is a great deal of evidence that explosive plyometric strength training improves running economy and muscle power and that running training supplemented by strength training are better than running training alone. Spurrs, Murphy, and Watsford (2003) observed a 2.7% improvement in 3K running performance following six weeks of plyometric training in conjunction with participants normal running training, while no changes in maximal oxygen consumption (VO2 max) were recorded. Paavolainen, Hakkinen, Hamalainen, Nummela, & Rusko (1999) observed an average 3.1% improvement in 5K running time for well-trained athletes in a 9-week study. These improvements are thought to be the result of neural adaptations without observable muscle hypertrophy. Therefore, it appears strength training programs for distance runners must meet two requirements: (1) include full-range, running-specific movements for the prime movers and (2) emphasize training the stabilizers. - Mathew B 4
To be competitive as a runner in any aerobic reliant distance you need to have a significant base volume of running. As a general rule, the longer the race distance that you are focusing on, the higher the mileage that you will need to put in. In my particular case, which I don't believe to be unusual, my cardiovascular system will be able to put far more miles in than my skeletal system. Enter cross-training!
Cross Training can keep my cardivascular system strong, even as I build up the bone strength to be able to put the work in on my feet. Cross Training is less specific and, I believe, less beneficial. That said, not being able to run at all is certainty even less beneficial to running fast. Elite runners can use AltG Treadmills, for the rest of us, we have to cross train until Project Nike picks us up.
I hate to say it but, "Another small study found that treadmill runners may be at decreased risk for stress fracture compared with road runners because of less tibial strain seen with treadmill running. This finding indicates that training surface may have an influence on stress fracture risk."5
Although potentially useful to know for the rehabilitation period, treadmill running can and will not be a viable option for myself. Although we may run for hours outside only to return to where we first began, at least we don't run for hours in the very same two square feet area inside a concrete box.
Meb’s biggest bodily setback came at the 2008 Olympic Marathon Trials, held the day before the 2007 New York City Marathon. At the time the reigning Olympic silver medalist, Meb finished eighth, in severe pain. He later learned he had a pelvic stress fracture. Meb has said how even walking became so painful that he would crawl around his house. It would have been easy, even understandable, for Meb to have thought, “I’m 32 and an Olympic medalist. Time for something else.” Instead, in 2009 he became the first American winner of the New York City Marathon in 27 years. - Runner's World
Inconceivably, I can't seem to find a list of inspirational runners who have overcome the terrible stress fracture in order to continue to be the bad ax world beaters that they are….. Oh wait a list is below.
Great Runners who have suffered stress fractures:
*This is by no means a comprehensive list.
- Kenensia Bekele
- Meb Keflezighi
- Ryan Hall
- Mo Farah
- Dathan Ritzenhein
- Mike Wardian
- Paula Radcliffe
- Deena Kastor
That's right. Almost anyone you have ever heard of in distance running has endured at least one stress fracture, and some have endured numerous stress fractures! I guess everyone but us newbies in the running world know that everyone gets these things. Why would anyone waste their time compiling a list?