Unfortunately, after years of training and racing in the mountains, some of us have had to battle bone injuries—more specifically: stress fractures. If you have ever had a stress fracture, you know that the recovery is long and tedious. Many months are spent without running, cross training and, in some instances, non-weight-bearing activity for what seems like forever. These injuries are tough, but here are some ways to help keep risk level low.
Lift Weights
Here is a theme that we seem to come back to again and again. A regular lifting program is essential for any athlete, but especially for runners. The strength needed to navigate ultra distances in the terrain that we tend to run on is so important. The litany of injuries that can be avoided and the speed over distance gains achieved are all well supported over years of studies. We can add stress fracture injuries to this list as well. Bone is built through something called Wolff’s Law. Simply put, when you stress a bone repeatedly, eventually, the body will change the structure and density of the bone to accommodate the stress. One way we can load bones to encourage Wolff’s Law to take hold is by lifting weights. Not only do our muscles and tendons get stronger, but our bones get denser, therefore decreasing the risk of stress fractures.
Eat Correctly
In many endurance sports, eating disorders are a thing that stem from a need to be as light as possible, a societal pressure to look a certain way, outdated coaching methods or personal trauma, and are all just the tip of the iceberg. The factors are extensive and I am not an expert, but there are many highly qualified and skilled people out there who help with eating disorders. I strongly suggest that if you or someone you care for may have disordered eating, please try to get them the help that they need. I have struggled with anorexia myself in the past (which is underdiagnosed in male athletes), and I am very thankful for those who were there for me.
The combination of high mileage and disordered eating in the ultra community is a recipe for disaster. There are many adverse health effects from this combination including, but not limited to stress fractures. As mentioned above, when a bone is stressed, the body will attempt to change its bone structure and density to handle the stress. If we are limiting the nutrients that the body needs to reinforce itself, then, eventually, those structures succumb to the stress and falter. Clinically, I have seen many times how disordered eating and stress fractures go hand-in-hand. We must fuel our bodies appropriately for the challenges of the sport of ultrarunning. Adequate caloric intake and appropriate amounts of bone-building nutrients such as calcium are just a few of the ways we can avoid stress fractures. Eating properly also allows us to run farther and faster. Sounds like a good plan to me.
Vary Your Training Terrain
This one is pretty straightforward. Constantly pounding the same surfaces day after day (asphalt, cement, dirt) can have a cumulative effect on your bones, contributing to a stress fracture. The same can be said about terrain. Day in and day out, hitting the downhills hard is also stressful. Try and vary your surfaces and terrain from one training session to another. If you did a fast and hard run on the road one day, opt for easy hiking or a bike ride on the next. Got a big vert day with a lot of downhill smashing on tap? Go for a swim the next. All of your body structures will thank you and, hopefully, decrease your stress fracture risk.
Retire Those Old Shoes
Who doesn’t need an excuse for new shoes? Kidding aside, all shoes have a life span. Running in worn out shoes doesn’t feel great for a reason. There is a lot of information out there on the effectiveness (or not) of different shoe cushion types, but whatever camp you fall into I think we can all agree that, at least subjectively, we feel less stress when our feet hit the ground in a new pair of kicks. Make sure to keep track of the milage in your shoes so that when the time comes, you can slip on a new pair. Your bones, and everything else in your body for that matter, will thank you.
By following the above guidelines to help mitigate stress fractures, you’ll be more likely to stay injury-free. As one final note, if you do happen to get a stress fracture, please be patient. If you push too hard, too soon, the pain and suffering will only persist, leading to more time off the trails. Listen to your providers and you should be back at it as soon as possible.