Life Stresses & Stress Fractures: My Most Impactful Running Injury as a Running PT
Fourteen years ago I was just starting college, and in the best running shape of my life, running 60+ miles/week at sub-7 minute pace - but I had a big issue that soon stopped all running dead in its tracks. It started with shin pain, familiar to me through my experiences with shin splints in the past - but this time felt different. My left shin felt significantly worse than the right, and it was a sharper, more pinpoint pain than I’d felt in the past. That sharp pain ended up taking me out of running for the entirety of my freshman year of college; and wasn’t formally diagnosed with a tibial stress fracture until the following summer when I went home for break. Why do I say all this? My experience with this injury felt like it changed the course of my life at the time - from a potentially successful college runner (D3, sure - but a huge deal to me) with an exciting college experience ahead to a young man who didn’t feel like part of his team and suddenly didn’t know what to do with himself. Today, I wouldn’t change these experiences - they’ve shaped who I am now. However, some better education, running-specific physical therapy, and lifestyle habit change would have saved me a lot of suffering.
My injury experience (and the causative factors I’ll discuss) are all too common in young runners. Bone stress injuries (BSIs), often better known as stress fractures, may be the most serious injury you can get as a runner. That’s not to say that any other running injury can’t affect someone’s life just as much - but with a BSI, you often NEED to take some time off of running lest the problem become much worse and progress to a fractured bone.
Stress fractures are NOT this large - but as anyone who’s had one can attest, they can feel this dramatic.
Why BSIs Happen: External vs. Internal Drivers
So what IS a BSI, and how does it happen? The simple answer is that it’s a reaction of the bone to stresses that are more than it can tolerate - and can progress to an actual fracture if left untreated. External and internal factors both contribute heavily to their development, and both were active in my own experience.
External factors include things like rapid increases in volume and intensity of running, stressful environments, and cultural pressures to push hard at all costs (like in an unhealthy team environment). Looking back, I had both of those in spades. The increase in my running volume was not graduated enough for my body to handle, and our team environment was less like a team than a collection of competitors.
Internal factors involve your body’s innate ability to fuel itself and recover. Bone health is heavily dependent on your body’s energy input - and my dorm room outside the frequently noisy common room (along with unfortunately chosen 7am classes) made for woefully inadequate sleep quality. Nutrition is another huge factor - and as a college freshman, I hadn’t quite figured out how to adequately fuel for the huge volume we were doing.
At the end of the day, all of that suffering could have been prevented by addressing internal and external factors- but even barring that, the barest minimum of medical screening by a physical therapist who treats runners would have caught the issue early on. Instead, I got an overworked Athletic Trainer who told me my “hamstrings sucked” and sent me to sit with my legs in an ice bucket for 20 minutes after each workout.
Why Early, One-on-One, Runner-Specific Physical Therapy Can Help
Good running physical therapy is about understanding all the factors going into an injury- and that requires listening to a patient’s full story. Oftentimes, the full picture doesn’t emerge until a couple of visits in- we’re all that complicated, and we all deserve the type of one-on-one care that allows us to get to the bottom of our issue. If you’re struggling with unexplained or persistent pain that hasn’t responded to treatment, and you don’t know what to do next - and don’t want surgery - I would love to talk and see what I can do to help.
