Everything was going your way. It had been three weeks or so since you began a schedule of brisk walking after a long break. The body was responding well. You just started your transformation from walking to slow jogging. And then it hit: a slight pain or tenderness along with swelling on the shin bone. You wonder if it is stress fracture, but brush it aside as soreness.
Two or three days on, the pain was making it difficult to even walk. Hoping the ache would subside after a couple of days’ rest, you took a break. However, the moment you got back to walking, it resurfaced.
This type of pain, or the way it progresses and lingers on, happens to be a classic symptom of stress fracture. Leaving it unattended could lead to severe pain, damage to the bone and joints, and other health complications.
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Stress fractures follow a similar script, hitting runners or brisk walkers who change their pattern abruptly. Three in every 1,000 active walkers or runners suffer stress fracture, says Dimple Chand, senior sports physio at Aspire Physiotherapy, Gurugram, Haryana.
“Along with its health benefits, brisk walking or jogging also gives constant stress on multiple joints in the form of small jerks with varying speed,” says Chand. “Our body is designed mechanically to withstand these repetitive jerks or stress which can be termed stress shock.”
Stress shock is normal during physical activity. However, over time and with repeated shocks, this may lead to stress fractures or hairline fractures in the load-bearing bones.
Causes of stress fracture
The most common reason for stress fracture is muscle imbalance due to inflexibility and poor muscle training or conditioning. This coupled with sudden changes in walking or running speed could produce instability, making the person vulnerable.
Apart from this, deficiency of vitamin D or calcium, wearing shoes that are too worn out, flimsy or too stiff, low fitness level, sudden increase in volume of physical activity, running on irregular and hard surface, overexercise and weak bones also lead to stress fractures.
People in their old age are susceptible to it because of low bone density. Women with lower body mass index and irregular menstrual cycles are also prone to it. Another major risk group are those suffering from osteoporosis.
Where does stress fracture hit?
Weight-bearing bones such as pelvis, femur, tibia, fibula and metatarsals are commonly affected by stress fractures. If ignored, the spine could also be damaged.
“The most common complication is severe muscular imbalance that may put stress on other important joints such as knee and spine, which may also get affected by fracture,” says Chand.
Spinal stress fracture may cause paresis (severe weakness and malfunctioning of the lower limb) while the knee joint may become unstable, leading to ligament or meniscal tears.
Running technique matters
Marathoner Anupam Gupta, who has had his fair share of stress injuries, emphasises the need to take time while graduating from brisk walking to running, or when changing intensity.
“If someone is starting initially or after a break, it must be kept in mind that the individual should not do too much too soon,” says Gupta, who is based in Greater Noida, Uttar Pradesh. “So, an individual should start with brisk walking which elevates the heart rate to a little extent more than normal walking and which should be continued for three to four weeks. Following this, a mixture of brisk walking and light jogging can be included where initially the ratio should be 80 per cent brisk walking and 20 per cent running, which can be further changed as one progress.”
Technique matters too, with the gait and strides having a major say in how the body handles the stress of running.
“For walking, everyone follows the ‘heel to toe’ format where an individual lands first on his heel and then goes towards toe,” says Gupta. “But for running, care must be taken that you land first on the midfoot. And along with this the stride length is also important; so take small strides where the feet should not cross the chest line. By doing this less pressure will be exerted on the shin bones and the knees, thus helping in avoiding injuries.”
There are many specialised shoes in the market with ‘shock absorbers’ that are advertised to be helpful in preventing stress injuries. While such costly shoes may work for some, refining the running technique will work for everyone.
“Such shoes have heavy cushioning due to which the feet do not get proper feedback from the ground and thus it doesn’t help in learning the proper form,” says Gupta. “An individual should know how their feet are landing on the ground during running and walking so that the form can be corrected. A newbie should go with proper comfortable running shoes and should constantly watch the form. And rest is essential in every form as the muscles which break during walking or running need recovery time as well.”
Prevention of stress fracture
- It can be avoided with training that includes exercises to increase flexibility, strength, coordination and balance. Having a proper warmup and cooldown routine will help as well.
- Ensure intake of food rich in vitamin D, vitamin B12, calcium and iron.
- Walk or run on a flat surface.
- Take adequate rest and stay consistent with the schedule.
Treatment of stress fracture
- Rest the affected area.
- Apply ice for seven to ten minutes for at least four times a day for 48 hours to relieve pain.
- Compress the area with bandage to immobilise it.
- Elevate the affected region to reduce the swelling.
- Consult a doctor if the symptoms persist.
- A sudden change in routine or intensity could lead to stress fractures among runners and brisk walkers. It usually affects weight-bearing bones such as pelvis, femur, tibia, fibula and metatarsals.
- Sticking to a training schedule that incorporates exercises to increase flexibility, strength and coordination, warmup and cooldown routines will help prevent stress fractures.
- Incorporating food rich in vitamin D, vitamin B12, calcium and iron in the diet will help improve bone health and thereby reduce chances of stress fractures.
- Proper technique with emphasis on how one lands the foot, along with taking shorter strides can minimise the risk of stress fractures.