What I learned from my stress fracture: Five Lessons
I've had a hard time with my recovery from my Fibular stress fracture
& I feel I've learned some lessons the hard way. I am finally back running again approximately 7 months after my injury. For the possible benefit of
others, here is a distillation of what I have taken away from the
experience:
- Take it seriously. The same day I got my hairline crack in my bone
that didn't even shoe up on an x-ray, a friend had a bike accident and
had to undergo surgery for a broken hip that included implantation of a
steel bar in his leg. He was back on the bike before I was -- largely
because neither I nor my stupid doctor took the injury seriously enough and I
reinjured it, probably a number of times. Ironically, if I had had a
catastrophic fracture and been put in a cast I'd have almost certainly healed much
faster. If you get a fracture, do yourself a favor and push for a cast or a boot.
- Pain is a poor guide. Some activities feel fine while you're doing
them but nevertheless prolong healing. For me, those included cycling
and swimming. A good guide: if you can't do it without pain the day
you're injured, don't do it until you're healed.
- An injury can be a blessing. You might be cursing your sore knee for sidelining you, but it could be saving you from a far worse injury (see below for fuller explanation).
- Increase your running VERY gradually. As I've written before, the 10% rule is too fast, especially once you get beyond a few miles. Think in terms of several years to build up to marathon distance. That's because while the muscle soreness you feel goes away in 3 days, tendons and ligaments and bones are on a minimum 6-8 week healing cycle.
- Building endurance requires walking a fine line. If you want to increase your ability to do long runs or other activities, you must of necessity strike a delicate balance between stressing your tissues enough so that they get stronger, and stressing them so much that they get injured. I wrote about this before, but I have since refined my mental picture of how this works. Here is a graphic showing how I think about it (click for full-resolution).
Here's my explanation of what this means: When you do a run (any workout but let's use running since it's the most stressful on bones & tendons) of a distance that is the green zone, a particular tissue -- your patellar tendon, let's say -- can withstand it without injury; it is adapted to that distance. But if you don't do any longer runs, it will never get stronger. When you do a longer run that stresses it (distances in the blue zone), you damage that tissue slightly, though not enough to disable you or even to notice. If given the chance, the tendon will heal, toughening in the process, and it and all the other tissues you stress will then be stronger (your green zone will grow).
But, if you keep doing long runs before your green zone has time to expand and/or without enough healing rest time and/or without increasing your distances gradually enough, the condition of your patellar tendon (represented by the black line) will continue to get more ragged until one day boom! you've got an injury. You're in the red zone.
The above chart just shows one tissue. Really of course there are hundreds of tissues stressed when you run (or maybe thousands -- check with your favorite anatomist). Let us imagine that we were able to chart the condition of a bunch of them; you'd get a mess that might look something like this:
What this tries to convey is, if you've been running a lot, you're likely stressing a whole bunch of tissues beyond their capacity. However, it only takes one to break through into the red zone to put you on the couch. The result is that all those other tissues (which you are probably not aware are nearing injury) then have time to heal. That is what I mean when I say an injury can be a blessing -- a bout of tendonosis may seem like a curse but by taking you off your feet it may be giving your bones and other tendons a chance to heal, and possibly saving you from a far more serious red zone incident. If you're lucky, that tissue that first registers its complaint -- the canary in the coal mine -- will be
something that heals relatively quickly and easily rather than, just to pick a random example, something like a fibular bone fracture that will sideline you for 7 months!
Maybe some doctor would like to take issue with minor or major details of this view, and I'm all ears, but until I'm persuaded otherwise this is my own working theory for How Things Work that will guide my future training.