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Stress Fractures: Treatment for this Common Runner Injury

by Nora Gilman, MS, LAT, ATC

Stress fractures in runners occur the most in the lower leg, such as the shin bone and the foot. When runners overtrain without proper training and recovery, the mechanisms that break down bone out-do the mechanisms that rebuild the bone. This results in a stress fracture. Break down of the bone cannot be avoided. This is a crucial aspect of training to make bones stronger to endure the loads. The best thing runner’s can do to avoid stress fractures is to allow for appropriate recovery. If you suspect you might have a stress fracture, here are some treatment options to resolve this injury quicker or prevent it from getting worse.

Vitamin D supplement:

Vitamin D aides in bone development. Vitamin D is found in dairy products and sunlight. Taking a Vitamin D supplement can support bone growth at this time.

Period of Offloading

Constant impact, like running, causes the bone to break down. Therefore, choosing activities that are non weight bearing can help keep your aerobic fitness while allowing appropriate recovery. Water jogging with the water at the hips or chest or cycling are two good options. If these two activities cause further discomfort, discontinue these activities as well.

Open-Chain Strengthening

In addition to improper training and appropriate recovery as common mechanisms, weak muscles can also cause stress fractures. Muscles are the first tissue to take on loads, if there’s not enough muscles, the loads stress the bones more. Open-chain strengthening means strength training where your feet are not in contact with the ground such as single leg raises and clam shells. Examples of closed-chain strengthening are squats and glute bridges. Strengthening larger muscles with the foot not in contact with the ground can ensure the training is not causing more harm to the stress fracture.

When, or Won’t, Dry Needling help Runner Injuries

When: Acute injuries

Injuries such as calf and hamstring strains are considered acute injuries. “Acute” means there was an identifiable instance that the injury occurred. A muscle strains when force exceeds load capability of the muscle and the muscle stretches and in some instances, partially or fully tears. This damage of the muscle is tight, painful, and inflamed. Dry needling is very effective in this instance because the injury primarily needs to repair and recover, as opposed to chronic injuries. Dry needling muscle strains in conjunction with rest and proper rehabilitation of the muscle can expedite the recovery time and remedy pain. A study examined a hamstring strain in a pole-vaulter and concluded a combination of dry needling and eccentric hamstring strengthening expedited recovery and restored function in the injured hamstring.

Won’t: Stand alone treatment

Countless research studies conclude that dry needling is best used in conjunction with other rehabilitation approaches such as strengthening. Dry needling is a tool in the tool box and not an absolute fix. Dry needling is a treatment option that makes other approaches work better, such as mobility, recovery, strength training, and injury prevention.

When: Areas that receive little blood flow for healing

In addition to releasing trigger points in the muscle, dry needling ‘damages’ the tissue. This damage can be beneficial because your body will again respond to the original injury, sending inflammatory markers to the area. Inflammatory markers bring healing mechanisms. Areas that receive little blood flow but can occasionally endure an injury are areas like the plantar fascia, tendon attachment sites, or joint spaces. Dry needling these areas is like telling your body to ‘notice’ the injury again and use your own body’s healing mechanisms to expedite recovery.

Won’t: High volume running

Dry needling can be compared to a reset button on your computer. When you reset your computer, it erases all the tabs and files that were open and gives you a blank desktop to start over. Dry needling releases trigger points in the muscle which is causing pain and injury. By locating and releasing these trigger points, it allows the athlete to start over with their recovery plan. Therefore, dry needling will not provide much help if the athlete treats dry needling as a reset to go back to training. It’s likely the issue will come back. Most practitioners recommend modifying your activity in addition to dry needling to benefit from the treatment the most.

Source: Dembowski SC, Westrick RB, Zylstra E, Johnson MR. Treatment of hamstring strain in a collegiate pole-vaulter integrating dry needling with an eccentric training program: a resident's case report. Int J Sports Phys Ther. 2013;8(3):328‐339.

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