You've been training diligently for your first marathon. The usual muscle soreness after a long run improves with ice and ibuprofen, but your right shin still hurts.
"It's just shin splints," you tell yourself. But you start to wonder as it gets more and more painful when you run. Now, it's starting to hurt when you're simply walking during your daily activities and even during the night. Should you be worried about a stress fracture?
"Stress fractures, which are tiny cracks in bones, can occur when there is a repetitive load-bearing activity that leads to more bone breakdown than bone repair," says
Dr. Benjamin Saben, a Sharp Rees-Stealy family and sports medicine doctor.
"In runners, this most frequently happens to bones in the foot, lower leg or hip. However, for women participating in certain sports like gymnastics or tennis, it can also occur in the bones of the wrist or ribs," says Dr. Saben.
The female athlete triad
Stress fractures can be a sign of a more serious medical condition called the "female athlete triad," which consists of the following circumstances:
- Low energy availability — an imbalance between the amount of energy or nutrition consumed and the amount of energy expended during exercise
- Irregular (or lack of a normal) menstrual cycle — intense exercise paired with deficient caloric intake can lead to decreases in estrogen, which helps to regulate the menstrual cycle, resulting in irregular or missed periods
- Low bone mineral density — decreased estrogen levels coupled with insufficient nutrition can lead to osteoporosis, a condition in which bones become weak or brittle and prone to breaks
Diagnosis and treatment of stress fractures
Diagnosing a stress fracture can be tricky. There may only be tenderness or a bump felt over the painful area. The initial imaging tests are X-rays, although they do not often show stress fractures for the first few weeks. Your doctor may order an MRI or a bone scan that can be more definitive for detecting these injuries.
"Stress fractures can be very frustrating because the treatment mainly consists of rest from the painful activity — a very tough thing to ask an athlete to do," says Dr. Saben.
"Sometimes a brace or cast to immobilize the injured area is recommended, but there is not much else that can be done and surgery is very rarely needed to fix the fracture," he continues. "A patient must simply practice self-care, especially as it relates to proper nutrition, ensuring the return of menses and allowing the body to heal over time."
It may take 8 to 12-plus weeks for a stress fracture to heal, and if proper medical advice is not followed, a stress fracture can recur. However, once you've dealt with the components of the female athlete triad, you can cross-train by doing non-painful exercises, like swimming, to stay in shape as your body heals.