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Things to Consider with a Stress Fracture or Stress Reaction

Updated: Apr 21, 2023

These are some questions to consider asking yourself when you've been diagnosed with a bone stress injury.

Question #1 - Where have you been?

With any injury we can use it as a learning opportunity. Bone stress injuries are typically due to multiple factors. It is a result of some form of training error. Ultimately, it is important to look back over the past few weeks, months, or perhaps even years and evaluate your training habits, nutrition, sleep, stress levels, strength, etc...Look at everything that plays into overall health - particularly bone health.

Use this time as a way to self evaluate and learn so that way you can come back as an even stronger athlete.

Question #2 - How is your sleep and nutrition?

Certainly two of the biggest recovery tools we have in life are sleep and nutrition. When evaluating patients we now call it "sleep hygiene" and along with nutrition are major factors in not recovering from a Bone Stress Injury. As a PT those are two areas that can play the difference in someones recovery. Are you getting 7+ hrs of sleep per night minimum? If not, something needs to change. Check out or consult a physician. Nutrition. Find a Dietitian and better yet someone who specializes working with athletes. Checkout for assistance.

Sleep is the most potent recovery tool known to science. Nothing else comes close."– Christie Aschwanden

Question #3 - Any other health signals?

Our bodies will often give us signals that our overall health may be suboptimal. When you develop a bone stress injury it can again be a learning opportunity and doing a self-evaluation for any other warning signs. We are concerned often for RED-S, or Relative Energy Deficiency in Sports (see below). The body requires a significant amount of fuel for basic functions alone and adding in endurance training increases the demand. Providing our body with enough fuel (calories) can help meet the demands. Our bodies will put off signals if we listen to them. RED-S is a serious issue in endurance sports. There are a number of symptoms as you can see below. Other things we will look at are in males sometimes erectile changes or significant weight changes can be an indicator. And for females menstrual cycle changes or losing your menstrual cycle is a significant concern. Learn to listen to your body and see if there is any other health signals present or that precipitated your bone stress injury.

Question #4 - Do you participate in strength training?

We know the health benefits strength and resistance training provides including for bone health. If you have been diagnosed with a Bone Stress Injury and do NOT engage in strength training certainly adding it in to your regimen 2-3x/week will be a protective mechanism against future BSI's.

Question #5 - Periodization?

Certainly going going going all the time with no chance to rest and recover is not appropriate for long term health. We all know the importance of taking down time and rest but how often do we truly take extended periods of rest/recovery? Unfortunately, many times it takes an injury to force people in to extended periods of rest. Periodization suggests breaking your training up in to periods often where you can have times of building and times of rest and recovery.

Final Suggestion:

Find a PT that can help manage your return to sport.

Elite Endurance Physio specializes at returning runners/athletes back from bone stress injuries.

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