When you’re dealing with a broken bone, there’s no one-size-fits-all strategy because the type of fracture matters significantly for your treatment plan.

While activity and rest are always recommended to some degree, how much of both will depend on what cracked the bone in the first place—and part of your healing will be to think about what you can do to prevent another fracture.

Stress Fractures vs. Acute Fractures

The first step to recovering from a fracture is understanding how an injury-related break is very different from a stress fracture. While both affect bones, they’re distinct when it comes to treatment plans.

One of the most common injuries in runners, stress fractures are very different than an acute fracture like breaking your arm or leg in an accident, said Clint Soppe, M.D., orthopedic surgeon and sports medicine specialist, and orthopaedic consultant for the LA Galaxy team.

“While strategically putting weight on an acute fracture over time will be helpful, stress fractures are the complete opposite,” he tells Runner’s World. “If you continue to over-stress that bone, it will get worse rather than better.”

That’s because an acute fracture is often a cleaner, more prominent break, he says. In comparison, a stress fracture represents microtrauma to the bone that is done over time, rather than in a single event. Continued and direct force, even to a minor degree, can weaken the bone, and even increase risk of stress fractures somewhere else in the body, Soppe said.

The other difficulty is that you might be a runner for 20 years, doing the same mileage at the same speed, religiously changing out your shoes every six months, and then find yourself with a stress fracture.

“We don’t necessarily know why this happens, it may be related to hormonal changes or other biochemical shifts that come with ageing, such as lower bone density overall,” Soppe says. “What we do know is that you need to stop running on it, so the bone can heal.”

Continuing to do activities that allow you to maintain cardiovascular health is important, he adds, as long as that exercise is low-impact—think: swimming, cycling, gentle yoga, or rowing.

“The key takeaway is that if you have an acute fracture, you should allow that bone to be stressed once it’s considered stable, because that stimulates increased healing,” says Soppe. “With stress fractures, the focus should be on maintaining your endurance through exercise that doesn’t put any load on that affected bone.”

The Role Strength Plays in Healing

In addition to low-impact endurance exercise, strength training is crucial, according to Carol Mack, D.P.T., C.S.C.S. She tells Runner’s World that boosting your resistance workouts can preserve as much muscle strength around the fracture as possible while it heals.

“The muscles surrounding the fracture are very important for healing, and also for preventing the injury from happening again,” she says. “Some weight-bearing exercises are okay with low-risk fractures that heal well without surgery, such as the shin and top of the foot, but that’s only if it’s not painful to walk.”

How to Return to Running After a Fracture

As you gradually increase the amount of weight-bearing forces or load on the bone, coming back to running should be slow—probably much slower than you’d like, Mack says. Many of her clients coming back from a stress fracture start with a run-walk interval program once they’re pain-free for at least five days in a row. And running only increases if you continue to run without pain.

“The key through all of this is for the runner to pay close attention to how they feel during and after runs,” Mack says. “Any pain with activity or at rest is telling us the injured structure has been irritated in some way. As a result, the activity needs to be temporarily modified so re-injury doesn’t occur.”

Look to Fracture Cause for Prevention

Although Soppe notes that some stress fractures seem to come out of nowhere, that’s not usually the case. Part of recovery should be cultivating a deeper understanding of how the stress fracture began, according to physical therapist Jason Kart, D.P.T., who tells Runner’s World that returning to running without sorting out the details of what caused an injury will only lead to problems again down the road.

“Stress reactions in bone are an overloading issue and excessive forces are breaking bone down faster than the subject can rebuild it,” he says. “There are some simple explanations, as well as more complex ones for this type of injury.”

The simple ones are often behavioural or environmental: Were there any major changes to training in the months leading up to the injury? This could be changes in frequency of running, big uptick in miles, even dietary changes. Environmental factors include use of old or poor footwear or changes in training surface.

“If so, you’re probably progressing or changing your training too fast for healing to keep up,” he says. “Evaluate if any of these types of things occurred and ask a professional how to best remedy them to strike a better balance.”

In terms of complex causes, Kart suggests having your running mechanics assessed since improper form and the repetitive nature of running will boost risk of stress fractures. For example, Kart says overpronation at the feet will cause you to lose recoil, and that means more force is entering the body—and jarring your bones—similar to a car bottoming out over a series of bumps.

Leg length inequality of even half an inch could be another disruptor, he says, since the shorter leg “falls” further and absorbs more impact. Finally, there could be something medical at play, such as a bone density issue.

“Remember, body tissues don’t just start malfunctioning and breaking, especially bones,” Kart says. “All injuries have a reason, whether they’re traumatic, micro-repetitive, or medical. Knowing why this happened is a big part of preventing more fractures in the future.”

How Long Fractures Take to Heal

No matter what kind of fracture you have, or how you got it, it’s crucial to work with your doctor to figure out the best treatment plan. In general, while healing time is very individual (it depends on things like your body, the type, the severity, and the placement), both stress fractures and acute fractures can take anywhere from six to eight weeks to fully heal, Soppe says.

The bottom line: Don’t rush getting back out on the road to run after a fracture—let your body recover to the fullest before you clock miles, so you can stay in the game longer without re-injury. Also, when you are ready to make a comeback, make sure you ease into a regular run routine.

 

 

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