One Easy Way to Prevent Bone Stress Injuries
Avoid pain with this simple change
“Well, it looks like you have a stress fracture in your tibia,” he said, somehow making this news sound matter-of-fact.
I stared at my doctor with a face of confusion and frustration reflecting on the race. Of course, there was pain, but I chalked that up to the fact I was running a marathon and pushed through. A stress fracture, really? I’m a seasoned runner. I thought only non-trained people got those.
He continued, “You’re going to have to take it easy. No running for six weeks.”
Somehow my restrictions sounded worse than the injury itself. How did I get here?
Between 33% to 66% of cross-country and long-distance runners have a history of bone stress injuries. Of them, 50% are at the tibia. Other common areas are in the femur, fibula, and foot. With this type of injury, prevention is the best treatment.
What is a bone stress injury?
A bone stress injury, or BSI, happens when a bone is under more stress than it can handle. Bones are used to taking a certain amount of your body weight during everyday activities like walking and standing, but things change when we add impact like jumping and running.
Think of your work situation. Humans can perform well and grow when under a certain amount of stress. But if the stress gets too high for too long, it can harm our performance and cause damage to our mental and physical well-being.
The same thing can happen to bones during high-impact activities. If the force repeatedly becomes more than it can tolerate, it may lead to bone breakdown and eventual pain. It progresses through phases.
Usually, it goes: Stress reaction → Stress fracture → Complete bone fracture
Signs and symptoms
Most people developing a BSI feel a gradual onset of pain. The other symptoms vary depending on how severe the injury is.
Early stages: You feel broad pain that happens at a certain amount and phase of running. The pain only goes away when you stop running, and it takes a little while to calm down. For example, you may feel discomfort in your shin after 10 minutes of running each time your foot lands. You stop running, and the pain eases up after 15 minutes of rest.
Later stages: The pain is more localized and severe. It comes on quicker into your run and lasts longer after you stop. Going back to our example, you can pinpoint exactly where on the shin it hurts. You feel high pain after only five minutes of running, but it takes 30 minutes to go away once you stop.
Advanced stages: You stop running entirely because the pain is immediate, high, and constant.
What causes bone stress injuries?
There are many things that can lead to a BSI. Some of the main ones are:
- Training load: Ramping up your training too quickly or not allowing enough rest days can place more strain on your bones.
- Diet: Lacking calcium, Vitamin D, or other nutrients can decrease your bone strength and overall health.
- History of BSI: Those who’ve had a BSI in the past are 2.2 times more likely to get another.
- BMI: Higher body weight places more stress through your bones, especially in the lower body.
- Stress: Cortisol, the stress hormone, blocks calcium absorption which decreases bone growth.
- Shoes: Like car tires, your shoes should only run a certain amount of miles before they get worn out and need to be replaced. Exact mileage varies.
- Step rate: Your cadence, or running pace, is a huge risk factor for BSI. Researchers associate taking fewer steps per minute with a higher risk of BSI.
How to determine your cadence
Cadence is how many steps you take in a minute while jogging or running. The easiest way to determine your cadence is to time yourself for 60 seconds and count how many steps you take while running.
Researchers say each one step per minute increase in cadence can lead to a 5% decreased risk of BSI.
That’s huge! The ideal tempo is running at 170–174 steps per minute with no additional benefit past 174 steps. That means if you increase your cadence from 165 to 170 steps/minute, you’re decreasing your risk of BSI by 25%.
How can stride length impact risk for BSI?
When you take fewer overall steps, your average stride length is longer. Longer strides mean more impact from the ground and stress through your foot and leg bones. Over time, that repetitive force can lead to a bone stress injury.
By taking shorter but more frequent steps, your feet cover less ground with each step. Think about eating an apple in five bites versus 10. You cover the same amount of surface with both, but you need to take much bigger bites if you only have five. This places more force through your jaw and teeth because you have to open wider to take a bigger bite. You also have more to chew.
But when taking 10 bites to complete the same surface area, you can take smaller and quicker bites with less stress through your joints.
The best way to improve cadence
If your cadence is less than 170 steps per minute, you could benefit from training. One way is by running with a metronome — there are many free metronome apps you can download and use while running. Aim to step with the beat.
Don’t increase your cadence too much too fast — aim for 5–10% each run.
Another cue you can focus on is to land quieter with each step. This will naturally decrease your stride length and help your body land softer.
Get those feet moving
With bone stress injuries, prevention may be the best treatment. One easy way to do so is by adjusting your cadence. Stay out of the 150s and 160s and try to aim for the low 170s of steps per minute.
It’s important to note this may vary for each individual. If you are a competitive athlete, work with your coach before adjusting cadence. Also, consider the other causes above to see if you can make any changes there. Happy running!
