Over the years I have met a ton of endurance athletes, and one thing that they all have in common is their own personal list of annoying injuries. Many people have a war story to go with each injury on that list.
All you have to do is say to an endurance athlete “pulled hammie” and you will watch their whole body scrunch in reaction to how painful that is in real life and how annoying it is to manage the recovery.
Stress fractures not only hurt, but they are traditionally really annoying because it takes so long to heal bones. Hobbling around on crutches, keeping legs elevated, or having an inability to put weight on that region for any athlete is super-duper, big sigh, frustrated kind of annoying.
Taking steps in advance of an endurance event to avoid stress fractures is the “pay attention” advice for the athletes reading this article. This blog series is really focused on the things that happen on the trail and how a support team is going to react to those events, so I will focus on what to do after the injury has occurred.
The chances of a stress fracture for endurance athletes is high, especially for athletes that are pushing their muscles to the very limit. A normal athlete has between a two and 20% chance of having a stress fracture. An endurance athlete will most likely have one at least one in their personal list.
The reason a stress fracture happens is the muscles themselves become too tired to do the work. In order to pick up the impact of the work being performed that the muscles can’t manage, it directs that stress to the bones.
The majority of stress fractures that I have seen on the road really happen in the areas of the feet and the legs.
The athlete will know that they have a fracture because they have a pain that is traditionally getting worse, it will have a lot of swelling, and it may end up with a slight bit of bruising, but it will be first noticeable by pain. You’ll also know it’s a fracture when the pain is reduced as soon as any weight is lifted from the area or it will immediately start to feel better from rest, and then spurs back as soon as motion or weight is applied to that area.
The hop test- have the athlete hop on the one side where the pain is. A stress fracture will deliver a pinpoint sharp pain.
Your best option is always to STOP-REST-ICE. If you are a trail driver, 100% of the time my advice is to have the athlete pulled off the course, and I will tell you very few athletes want to be pulled from the course. They will endure huge amounts of pain to not leave the course.
My advice to the athlete in a situation like this is to give them as much information as you can about where you think their injury is or where it is heading. Invite them to discontinue what they’re doing if it is causing them pain. In this case if it is a fracture they could actually double the amount of time that they will be unable to perform and be recovering.
Because this type of pain can often look like many other things that are not as critical, like shin splints, you really need to pay attention to the swelling, and how the pain changes when the area has weight taken off of it. When you have pain that is in the muscle tissues, it will start off REALLY screaming. If it is a bone pain, it will get progressively more painful as they move.
There are many athletes that will choose to continue on and bull their way through a stress fracture just to meet those goals. For those crazies, try to wrap the area tightly, give ibuprofen and a sturdy warning. That is all I can offer that will be accepted.
I will leave you with an odd fact, and that is if your athlete was also an athlete as a child, orthopedically they are less likely to get a stress fracture as an adult. And that has to do with the placement of the hip being different in athletic development of children.