Well just when I did not think things could get much worse… my bone scan was positive for a stress fracture of my sacrum (bottom of my spine). I had kind of figured it was a stress fracture all along but this solidifies it. But on the bright side of things I have already been off running for 5 weeks now. So it should only be a couple more weeks of cross training before I can start to ease back to running.
But I wanted to talk about this a bit as stress fractures in general are a common injury in the running world. Often with some negative connotation. When we learned about stress fractures in school it seemed like you would have to be an idiot to get a stress fracture. But this is not the case. Now this is an injury that is happening over time. But you may not actually feel it until it is too late. It is something that is on a continuum it starts as a stress reaction to the bone and if you continue to train on it, it can become a stress fracture. The trouble is that you often do not feel it and once the pain comes on it typically forces you to cease running.
I am not the first to get a stress fracture and I certainly will not be the last. Shalane Flanagan had a iliac crest stress fracture which forced her to pull out of Boston in 2017… but she came back to win the NYC marathon that same year the first time in 40yrs an American woman had won. There is also a handful of runners that inspire me that have had sacral stress fractures and gone on to be incredibly successful the likes of Emily Infeld, Emma Coburn and Kara Goucher. So I am in good company. Emily Infeld won a bronze medal in the 10,000m World Championships the year after her second sacral stress fracture. https://www.runnersworld.com/news/a20803232/are-sacral-stress-fractures-on-the-rise/ The frustrating thing is that walking, sitting, biking all contribute to compression forces to the sacrum as well so I am stuck in the pool for the time being. So naturally I am trying to become the best swimmer I can be.
My initial reaction to getting injured is always to be embarrassed as I am a coach and manual therapist… I should not get injured. But I am also a human who really likes to push my limits. So I am not invincible. As my husband said when trying to reach your potential you push the edge of your limits and sometimes you may tip over in to injury especially when other stressors are involved, like they were in my case (https://torunningchiro.com/2018/09/25/stress-is-stress-is-stress/). So I am at peace with getting hurt and doing what I can to make the most of the time and allow my body to heal. If there is anything I have gained over the last couple months it is perspective and I know I will run again in time. There are after all far worse things in the world.
Now I do want to talk a bit about the specific injury. It is relatively rare to get a stress fracture in the sacrum, but does seem to be much more common among elite runners. But in regards to stress fractures generally they happen because our bones are always undergoing a cycle of breakdown and repair like our muscles. If they get overwhelmed with stress and are not able to repair due to lack of recovery or nutrients tiny cracks can form ultimately leading to a stress fracture. How you move and strength can contribute to the bone taking on more stress as well.
I did have some red flags and I think these are things that do not get talked about often enough but are indications of being at risk of a stress fracture. I had lost more weight than I typically do while training (*not on purpose) and nothing crazy but a difference from previous seasons. I also had not had my period for 2 months. Both indicators that I was likely somewhere in the RED-S continuum as well.
Typically with a stress fracture people are experiencing RED-S (Relative energy deficiency in sport) formerly known as the female athlete triad. “The syndrome of RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency.” -IOC consensus statement 2014. Here is a link to the article if you are interested: https://bjsm.bmj.com/content/48/7/491 This basically means an athlete is not taking in enough fuel to support normal body function + training. So the brain will start to shut things down in order to conserve energy. Injuries or burn out often happen in order to force the athlete to stop the pattern and heal.
Inputs—so how do we get to this point? Remember as I discussed in my previous blog that stress is stress is stress so that means that it is not just training stress that contributes to risk of getting a stress fracture. But also emotional and mental stress as well. The brain does not differentiate between the types of stresses. In the graph below we often just think of the physical stress that pushed it up toward the red line but other forms of stress can also contribute. And it is important to keep in mind when experiencing high stress and high training load.
So all in all I think this is a topic that should be discussed and runners should be aware of it. The more we talk about it the more awareness will be brought to it.
As for my recovery I have to use pain as my guide and try my best to avoid anything causing pain and compression to the sacrum. So for now it is pool running/swimming plus strength training. I will come back and I will be stronger and better for it. And I will keep chasing my crazy dreams!!
Stay tuned for more blogs about cross training etc. I am trying to make good use of my none running time! 😉 In hopes that others can learn from my mistakes and experiences.