Happy New Year!
I have NEEDED to run so many times this year – to escape life stress and to think. Even though my runs are infrequent, short and slow, I am running. And for that, I am thankful.
So how does one return to running after a tibial stress fracture?* Very gradually.
Most of the return to running after stress fracture programs that I’ve seen – and the one that my doctor has me following – incorporate the following principles:
- Start off VERY gradually with a period of alternating walking/running intervals.
- Running only every other day (or every third day). Why? The rationale here is that when you are returning to running you do want to put some stress on the bone because that allows remodeling and calcification to occur. Putting stress on the bone allows collagen fibers to organize, which strengthens the bone. But you want to rest it, so that you are not applying too much stress, which may cause another stress fracture or complete break. You want rest to allow the bone to adapt to the stress you are now putting on it.
- Active rest on your non-running days. Active rest includes non-weight bearing activities such as swimming, water running and cycling, that will keep up your cardio fitness.
- A total rest day each week initially. Many runners are overachievers (which likely led to the stress fracture in the first place) so this total rest day is hard to do. But it’s important! I have found that I am able to do it by reminding myself that one total rest day a week isn’t a big deal if it will prevent me from having to take 168 days off from running if I get another stress fracture!
- Very gradually increase duration (mileage or time), frequency (number of times a week you run) and intensity (speed) and don’t increase duration, frequency and intensity all at the same time. In fact, most of what I’ve read says not to even worry about intensity at all as you are returning to running. This has been easy for me to do – because in my beginning weeks of returning to running my duration has been so low that I want to savor the time on my feet, so I don’t even want to run fast! Plus, it’s been so long since I’ve run fast that I don’t even think I could right now!
- Return to running after stress fracture programs last from 6 weeks to 4 months.
Is soreness at the stress fracture site (or around it) normal? Yes – discomfort and soreness is normal. PAIN is not. Some discomfort and soreness around the stress fracture is normal when returning to weight bearing activity after an extended rest period. Pain should not be constant, sharp (like how your stress fracture originally felt) and it should not continue after exercise stops. You shouldn’t feel pain walking around or at rest. I have not felt PAIN at all – but when I add mileage each week I feel sore (in that good way – you know the next day soreness after a tough run? That! Which is funny that it happens after 1.75 miles of running in a day!). I would also say that two times I have felt AWARE of my stress fracture area. Not pain. Not even really discomfort. Just awareness. I see the doctor again in a few weeks, so I’ll talk to her about it but I think it is normal, from what I read.
My return to running program is a 14 week program. It was given to me by a doctor at TRIA. With the mileage in week one being 1.5 miles TOTAL and in week 14 being 25 miles total. For the curious – and because I actually use this blog to look back on and remind myself what I did and when – my return to running program by weeks in general is:
- Total miles: 1.5; 3 days of running, 1/2 mile
- Total miles: 3.75; 3 days of running 1.25 mile
- Total miles: 4.5; 3 days of running 1.50 mile
- Total miles: 5.25; 3 days of running 1.75 miles
- Total miles: 6; 3 days of running 2 miles
- Total miles: 8; 4 days of running 2 miles
- Total miles: 9.5; 2 days of 2.5 miles, 2 days of 2.25 miles
- Total miles: 11; 4 days of running 2.75 miles
- Total miles: 12; 4 days of running 3 miles
- Total miles: 14; 4 days of running 3.5 miles
- Total miles: 17.5; 5 days of running 3.5 miles
- Total miles: 19; 2 days of 3.5 miles, 3 days of 4 miles
- Total miles: 21.5; 3 days of 4.5 miles, 2 days of 4 miles
- Total miles: 25; 5 days of running 5 miles.
All runs are preceded and followed by 1/4 mile walking warm up and 1/4 mile cool down. In addition, my physical therapist has me doing a “dynamic warm up” before my walking warm up – it takes about 8 – 10 minutes and includes light jogging, high knees, butt kicks, some active hamstring and quad stretches, some squats and a couple other things I don’t know the name of! PLUS – I’m doing about 15 – 20 minutes of PT stuff each day that strengthens the areas that were weak (hips, glutes and core) and likely contributed to biomechanical deficiencies that led to my stress fracture. I have to say that I FEEL a lot stronger in my glutes now and feel like I can balance better (my core feels stronger).
So there you have it. My return to running program in a nutshell. And I have to say that the best part about it is the mental boost that returning to running has given me. I have my “me time” back. And that has been the best part of my 2014.
*Disclaimer: I am not a doctor. Everyone’s body is different. Therefore, what works for me might not work for you. So consult with your doctor and follow his/her advice!