Stress fracture. These 2 words can cause a runner’s spine to tingle. Most of us have either had a stress fracture or know someone who has had a stress fracture. The most common place for stress fractures are the foot. The most common site is the second and third metatarsal bones. Other sites include the heel, the navicular bone (top of the midfoot), and the fibula (outer bone of lower leg). The most common cause of stress fractures are overuse, weakening of the bones also known as osteoporosis, poor foot wear, and the female athletic triad to name a few. There are other causes but these are common risks for women.
This is my third stress fracture in the past year. Each fracture has been in a different place. Both of my feet have been injured. I have thought about my recent stress fractures at length. I know the pain started at mile 25 of the marathon. I have reviewed that final mile over and over in my head. Did I step wrong? Did something happen earlier in the race. Was my foot already broken and I made it worse? I keep a running journal and I don’t make any reference to the site where my fracture has occurred. I talk about my toe hurting and the plantar fasciitis at length. A common cause of a stress fracture other than overuse is change of gait. Did I change my gait without realizing it? I don’t think so. I believe the cause of my recurrent stress fracture is bone loss. I asked a fellow colleague who is an orthopedic surgeon to review my x-ray. He told me matter of factly that I have bone loss. We discussed my mileage and activity and he did not feel it was excessive. We discussed the recommendation for running.
So what is the female athletic triad? The female athletic triad is a combination of energy deficiency with or without eating disorder (poor nutrition), infrequent or absent menstrual cycle, and bone loss. When I think about this model, I always think of the high school distance runner. She is young, thin, and active. What I failed to think about was, how do I fit this model. I fit all three of these categories.
1. I am an older runner who fertility days are far behind me and therefore have absent menstrual cycles. Ok let me just say it. I am in Menopause. It is so hard to say that one word. It makes me feel old. I therefore have estrogen deficiency due to this. Decreased estrogen can lead to bone loss.
2. I don’t have an eating disorder but I am always on a diet. I am always trying to lose that last 10 pounds. My diet is quite poor and that’s why I’m always on a diet. My favorite meal is hamburger and french fries. Calcium is not in my diet. Maybe once a week if I treat myself to ice cream. Hence poor nutrition.
3. Osteoporosis or thinning of the bones is a risk for stress fractures. Risk factors include age, menopause, female, low body weight, and smoking. Bones need both calcium and Vitamin D to help prevent osteoporosis. I slather sunblock on my body when I run. Bones need both calcium and vitamin D. Vitamin D is produced by the body in response to the skin’s exposure to sunlight. It helps the body use calcium. Sunblock limits the absorption necessary.
So now every morning I take my calcium supplement. I am scheduled for a bone density test. I know I am not 21 and my training has to change. I know I have to incorporate cross training. I have always known this but have not been compliant. I love to run it’s what I do. The bike to me is tedious. I often tell people I would rather run 20 miles on the treadmill than bike for 1 min. Swimming doesn’t let me listen to my music. I really enjoy listening music. Every song on the radio has the potential to make it to my running playlist. Weights are just a punishment. They say old dogs can’t learn new tricks. Well I am going to attempt to change. This year I will share my journey of this change. I may not like it but if I want to continue to run then it’s what I will do.