Stress Fractures: Avoiding them and starting to run again after they have healed

A Stress fracture is one of the most common running injuries.  If you “are a runner”, chances are you at least know someone who has had one, if in fact you haven’t had one yourself. This is when microscopic cracks in your bone start to become larger than microscopic. However, they are often unseen in X-rays images, and still sometimes difficult to be seen in MRI’s or bone scans. This is actually good news, this would mean you caught it early and can avoid a longer lay off.  Still, my advice, if it hurts enough that you’re thinking you need to go get imaging done, you should take two weeks off as a precaution. The larger risk is having this injury become a full fracture, which could lead to a severe break of that bone.

stress fracture tibia

Medial tibial Stress fracture…boo!


I’ve had a few over the years I’ve been running.  I typically feel the related pain along the medial side of my tibia, roughly just below the middle of my lower leg.  Thankfully, I have not dealt with this problem in about five years. That is to say, I got stronger, but more so, smarter and more cautious.

Preventing the injury:

I started rotating my shoes more frequently. Giving a running shoe at least 24hrs to rebound from the pounding you laid on it will give you a bit more mileage out of each shoe, and each time you run on it, it might be that much less beat up from the outset of your run.

Running on softer surfaces whenever possible.  This will lessen the impact your bones and joints experience on each run.

Improve your nurtritional intake-Calcium and vitamin D are important for healthy bones. The labels on the foods you eat might tell you that you need x amount of these.  Use some logic here, you beat up your bones, they probably need more than the “normal” amount. So just get more of it with foods and/or supplements.


Brocoli is truely a super food! It has so many nutrients in it, I don’t want to take the time to list them all. But most importantly, calcium, potassium and iron! Stuff runners need!



Chocolate Milk, tasty and loaded with calcium, vitamin D, Protein and potassium. Good for muscle recovery AND bone health!


Icing with “ice cups”-fill a waxed paper cup with water, stand it up in your freezer, use ice to massage the point of pain. As the ice melts, peel the paper away more. Massage until the ice has melted away. This is more effective than just strapping an ice pack onto your leg.

Listen to your body-If something hurts enough that the pain causes you to walk or run out of normal form, you probably need to cross train or rest entirely. The severity of the pain is subjective and thus the amount of time each individual needs to back off, may vary.

So, sometimes it seems you are doing “everything right”…and you get a stress fracture anyway.  You miss 6-10 weeks of running and you nearly loose your mind from missing your favorite thing (and the endorphins).  So when do you know to start again? How far or how long (in minutes) can you go on the first day and week back?
Again, these are subjective to each individual.  But let’s say, if you were a 20mile per week runner, and you did 4 days per week on average.  Well, I would say, try a single run of 1 mile (easy!), cross train every other day for a week. You can supplement the 1 mile run with non-impact bearing cross training. On the 2nd week, if no pain is present, increase each run by a small amount, maybe a 1/2mile.  As you feel comfortable, gradually work away from the cross training to the number of runs you want to be doing.  So, if week 1 is  3 miles, week 2 could be 5-8miles, week 3 might be 9-12miles, and so on.  Applying the “10% rule” here is wise (which states to not increase total mileage by more than 10% per week in training).

All along, you need to do a good job of preventing re-injury with preventative measures. And as always, have patience. Rome wasn’t built in a day, but it burned in just one.

Happy Running,
Mike A


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