Stress Fractures: 7 Common Risk Factors AND…The Breakthrough Training Tool Proven To Help You Return To Running Safely!

“I have a pain in my shin every time I run and it really hurts!”

If this is something you or your child has said recently it is worth paying attention to because it may be more than just the classic shin splints.

Shin splints are one of the most common sports and running injuries and present as localized pain in the front of the lower leg bone.  Shin splints happen due to overuse causing muscle tightness, tendon changes, and stress to the bone itself.

The pain is worse with activity and better with rest.  Although these are the classic signs of shin splints they are also the initial warning signs of an impending or present stress fracture.

Shin Splints → Stress Reaction → Stress Fracture

This is the common progression of untreated anterior shin pain or any other common site of stress fractures including:

Once the muscle has been strained due to running too much too fast (shin splints), or with poor mechanics, it starts to affect the bone itself.  Basically, the muscles stop absorbing the shock impact of running resulting in the bone trying to absorb shock (not its original goal).  The impacts of running frequently occur at such a fast rate that the bone itself can’t rebuild in time before the next run.  This creates bone changes called a “stress reaction” that can be picked up by imaging by your doctor.

Again, if you were to continue to run without resting the bone the stresses on the bone itself will create a small break in the bone called a “stress fracture”.  These are scary words for any youth athlete, runner, or even adult runner since it means…

…no running for 4-6+ weeks and the usage of a walking boot or cast. 

It is important to recognize the risk factors for stress fractures to stop an injury before it gets severe. 

It is also VITAL to learn proper running technique to avoid re-injury.  Before I tell you about the breakthrough treatment helping runners return to running confidently and safely after a stress fracture…

7 Common Risk Factors Associated with Stress Fractures

#1. Too Much, Too Soon

A sharp increase in volume, during, or intensity of running has been linked to a higher risk of stress fractures.  Especially vulnerable are 12-14 year old cross country or track and field athletes at the start of the running season.  Most youth athletes fail to perform the slow increase in running progression over the summer or off season to tolerate the high training loads at the start of the season.

#2. Female Athletic Triad

Females are more likely to sustain a stress fracture than males.  Some female athletes have what is known as “female athletic triad.”  These young athletes present with:

  1. Disordered eating—such as anorexia or bulimia
  2. Amenorrhea—Loss of menstruation secondary to poor diet and excessive exercise without enough body fat
  3. Osteoporosis—Decreased estrogen resulting in decreased bone mineral density and “weak bones”

#3. Vertical Posture During Running

Running with your back up straight increased impact loads during running.  Landing upright leaves little room for shock absorption when initially landing the from the “float” phase of running.

#4. Increased Ankle Angle

Higher ankle dorsiflexion (lifting the front of the foot off the ground) increases impacts during running.  This is most true for calcaneal and tibial stress fractures.

#5. Increased Up and Down Movement

Running with high vertical displacement, or up and down motion, also increases impacts during running placing greater strain on the bony anatomy.  The idea is to put more effort into running forward versus running vertically.

#6. Lower Step Cadence

The slower your step cadence the higher the ground reaction forces and stress.  Running cadences below 170 steps per minute are associated with higher rates of impacts and stress fractures.  It has been suggested that the ideal step rate is 171-180 steps per minute although this largely depends on running speed.

#7. High Ground Reaction Forces

The resulting effect of the previous risk factors is higher impact forces when hitting the ground.  Higher impact forces result in more bone stress, which over time and with poor diet and increased training, results in stress reactions and stress fractures.
As you can see most of the risk factors involve the running form itself. 

The question is what is the BEST way to return to running SAFELY so that the stress fracture does not happen AGAIN?

The Breakthrough Treatment

Controlling impact loading during running is the number one way to prevent and recover from stress fractures.  Most treatments advice on a walking to running program, some strength training, and stretching.  The typical rehab program is focused on easing back into running but rarely does it actually address the running for errors themselves.

In order to return to running safely and avoid future stress fractures you have to improve your running form since that is the reason the fracture happened in the first place.

Now, with state-of-the-art running biofeedback, you can practice running in real-time!

At Competitive EDGE Physical Therapy in San Jose, and other specialized running centers around the country, you have access to running biofeedback equipment that is helping runners recover from stress fractures for good.

With the usage of 3D motion sensors and high speed video you can have direct biofeedback on your running form as you run allowing you to make faster and more lasting changes to your form. 

The Breakthrough treatment for stress fracture management is the usage of real-time impact force feedback.   

With a specialized treadmill that is equipped with over 5,000 pressure sensors, you can actually see when you hit the ground too hard and make immediate changes.  

Real-Time Education and Pressure Feedback

Here is a video of how we train runners at Competitive EDGE Physical Therapy using real-time pressure feedback.

If you are recovering from a stress fracture or have current pain with running that you would like relief from please contact us at Competitive EDGE.

with this number 408-784-7167 for additional information about our Breakthrough running treatment program.

By Dr. Kevin Vandi DPT OCS CSCS

Dr. Vandi is the founder of Competitive EDGE Physical Therapy — with his background in physical therapy, orthopedics, and biomechanics, he is a highly educated, compassionate specialist. Using state-of-the-art motion analysis technology and data-driven methodologies, Kevin has assisted a wide range of clients, from post-surgery patients to youth and professional athletes. When he isn’t busy working or reading research, he spends his time with his wife Chrissy and their five wonderful children, often enjoying the outdoors and staying committed to an active lifestyle.

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