The Baltimore 10k we ran was almost a month ago now! And what a great time we had. Peter and I both beat our expected time by 5 minutes, which is pretty huge in the running world. It pays to be newbies.

When I crossed the finish, Peter asked me – hey are you ok? You came in a little funky on your left ankle (read PROBLEM ankle – the one I’ve sprained twice in the last 6 months). I told him I was fine and thought nothing of it for the rest of the day. Enjoyed a reuben at our local diner and took a nice nap.

Sunday morning I woke up with point tenderness along the distal portion of my lateral malleolus – anatomy jargon for the bottom of my outside ankle bone. In school we learn that you should get an x-ray any time you have point tenderness along that portion of the bone.

Full of annoyance and dread (I’m a runner now! I can’t stop!) I reached out to my favorite sports med doc, Jasmine Toor, and confirmed that I did need to get imagining.

Long story short – I do in fact have a fibular stress fracture. I have just now finished my time in a boot and now I get to start slowly rebuilding my strength before I rebuild my tolerance for impact.

Most runners are just worried about running. They don’t often concern themselves with the nutritional, sleep, load, and biomechanical factors that can cause your bone density to decrease enough for you to end up where I currently am. So what should we be aiming for?

Nutrition – more often than not, running ends up being a weight loss plan. What does that mean? Running while you’re under-fueled. Avoiding carbs because according to diet culture they are “of the devil”. Here’s the thing though, your body needs those carbs to help create energy to keep you fueled for your run AND your day. Nutrition is something I screen for, but I don’t treat. Why? That’s not my specialty and it’s out of my scope. Check out great, evidence based, resources like Grace Kelley for how to fuel yourself better for your runs.

Sleep – per this paper, as well as some research coming out of the military, getting less than 7 hrs of sleep per night while training puts you at a higher risk of stress fracture, especially the higher risk ones (sacrum, pelvis, femur). Your body needs this time to recover and heal itself! This is especially critical for my new moms. Keep your training load low while your babies aren’t sleeping.

Load – Training too much too fast can create a problem as well. The typical recommendation is to slowly increase your milage, no more than 10% per week. Rest should also be incorporated, especially after a race. Find a really good running coach to guide you through this process.

Biomechanics – per this paper, people who end up with high risk stress fractures (again pelvis, femur, sacrum) are more likely to be more bouncy while running (or increased Center Of Mass vertical excursion) and run at a lower cadence. Both of these elements put a higher demand on your musculature.

Now these are just a few elements that we look out for. There is a whole collection of symptoms that diagnose someone with Relative Energy Deficiency in Sport (RED-S), but that’s another topic for another day.

Are you a runner who is struggling with chronic injuries? Reach out today to get an assessment from a holistic PT!

-Naomi