Frustrated by 2nd stress fracture in foot

Discussion in 'Chapters' started by pjballard, May 11, 2011.

  1. pjballard Barefooters

    Member Since:
    Apr 18, 2011
    Message Count:
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    Started running in VFFs in Feb 2010, right after the Mercedes Marathon. Loved them, because they felt good and because they totally solved severe iliotibial band pain I was getting in right leg after about mile 4 or 5.

    However, last year during the Statue to Statue run, I suffered a stress fracture to my right calcaneus. I let it heal for 4 months, then began slowly getting back into it. I figured it was just due to poor form on downhill, causing me to slam my heels into the ground when running downhill.

    When I resumed running, I was careful to work on my form to figure out how to run downhill and still forefoot strike. Made good progress and, this year, was able to do the Red Nose 10-mile, the Mercedes 1/2 marathon and the Statue to Statue 15k in my VFFs completely w/o injury.

    Then, last weekend, was on a planned 8-mile run w/ my usual running group and at about mile 5 or 6 I suffered a stress fracture to the 3rd metatarsal on my left foot.

    Went to Dr Garth Monday, and he confirmed it was a stress fracture. Because of the 2x in one year, he sent me for a bone density scan, but, based on my x-rays, expects the scan to be normal.



    Any thoughts?



    Fx occurred while running on essentially flat sidewalk. Did not hit anything on my foot, land funny, or anything obvious I can point to. Had felt absolutely great right up until that point.

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  2. Matt Smith MD Chapter Presidents

    Member Since:
    Nov 4, 2010
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    I'd have to agree with Dr. Garth on that point. Make sure that you're not osteoporot/paenic, that you're 25 OH vitamin D3 level is 30 ng/ml or more, that you're getting enough dietary magnesium. That said, you're going to have to stay off of your foot with any running for a while, shod or not shod.



    How much are you running and at what distance? As awesome as barefoot running is, any long duration repetitive activity, no matter how close to perfect form and no matter how in line with natural human physiology, is apt to cause stress injury. This is as much from chronic cortisol elevation as from repetitive injury without adequate healing time.



    I personally am of the bent that long distance running for training can be detrimental. I think once you're all healed, you should try to ease into more of a sprint training with only occasional long distance covered. 8 miles should only be for recreation and/or competition and only rarely for training. The reasons for the degeneration are multifactorial and often have little to do with form, good or bad, though bad for is of course worse than good form.



    This also goes for cardiac health as for bone. Though chronic long distance running is actually associated with poorer bone health, not better, as well as increased incidence of atherosclerosis and cardiac events.



    Hope this helps.



    Matt

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  3. pjballard Barefooters

    Member Since:
    Apr 18, 2011
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    Did Dexa scan for that very reason, just today.

    Dr. Garth said no running for 2 months -- which I will, of course, comply with.

    Last week, ran 4 miles per day M-Th. was off Friday -- was doing planned 8-10 on Saturday when injury occurred. I enjoy running and usually run with my wife, who is also an avid runner -- but not a barefooter

    Garth suggested running every other day at most. I agree.

    My personal goal is to be able to run between 1 to 3 marathons per year and do a 5 - 10 mile run on weekends and 2 or 3 shorter runs during the week just b/c I enjoy running. I am particularly interested in getting into trail running, which I used to do as a teenager. (I'm 56 YO now).

    What's a good source of dietary magnesium?

    Thanks for the thoughts

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  4. Matt Smith MD Chapter Presidents

    Member Since:
    Nov 4, 2010
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    Regarding magnesium, magnesium citrate 100mg by mouth nightly should be sufficient.



    Get your vit D (25 OH vit D3 level) checked by your primary.



    Regarding lots of running and heart disease:http://www.ncbi.nlm.nih.gov/pubmed/19332846



    In short, I would be even more conservative than Dr. Garth. I think you should lay off all running for at least two months. Following that, I would do virtually no running past two miles at a go for a long time and only after your are completely pain free and remain pain free after your runs. I would limit your greater than two mile runs to no more than weekly. I would then train by doing sprints, squats, jumprope, lunges, one-legged squats, overhead squats, etc. Limit all of this with the caveat that you must both be able to start and finish without any bony pain. This is basically Lee Saxby's method in his "Proprioception: Making Sense of Barefoot Running" book and it does make a lot of sense. This is essentially what I do too. In fact I do all of my working out completely barefoot (I have a home gym).



    Physiologically, prolonged moderate intesity exercise, such as jogging, causes chronically elevated cortisol that is essentially no different than that produced by chronic psychological stress and/or taking prednisone. One of the effects is a deterioration of collagen, which makes up your bones, thus predisposing you to injury. This, combined with a chronic repetitive force (even with excellent form), predisposes you to musculoskeletal stress injury. The chronically elevated cortisol is also the hypothetical mechanism by which your chances of getting coronary artery disease also go up, though I recently read a study that also implicates a depletion of b-vitamins by way of chronic exercise, thus leading to an exercise-induced vitamin deficiency, which leads to a buildup of something called homocysteine, which is also correlated with coronary artery disease. As to the exact relationship between too much cardio and heart disease, it is likely multifactorial.



    It's all complicated, but the moral of the story is: take it very easy. Take easy walks and train for endurance primarily with sprints once you're up to it. There is very excellent scientific evidence on this as well. Numerous marathoners and even ultra-marathoners have switched more toward speed work as it makes them both faster and has just as good of endurance effect as endurance work.



    Plus, it also makes you more insulin sensitive and it increases your resting metabolism (because your muscle mass is greater doing sprint work rather than endurance), so you also get leaner and stronger.



    Just a few thoughts.



    Good luck.



    Matt

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  5. pjballard Barefooters

    Member Since:
    Apr 18, 2011
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    Thanks for the thoughts. Having studied phyisiology in one of my past lives (B.S. in Animal Science from Texas A&M), your comments make a lot of sense. The abstract of the NIH article was also very interesting. Could not read the full article b/c not a subscriber to pubmed but the abstract sure made sense. Wow!

    Does that mean that the training mantra of "no more than 10% mileage increase per week" is a myth or am I misunderstanding the training regimen concept?

    How do you go from series of short runs + cross training to a marathon w/o hurting yourself?

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  6. Matt Smith MD Chapter Presidents

    Member Since:
    Nov 4, 2010
    Message Count:
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    Well, from what I understand, if you're going to do a marathon, you do need to incorporate *some* long runs into your routine but not much. These runs are primarily for psychological reasons--to get your body used to the idea of a prolonged run, as you're primarily training for speed and intensity--and for technical aspects, like pacing.



    Regarding not hurting yourself, the lack of chronic stress from avoiding too much endurance should, in and of itself, lessen your chances of that happening. You are already at high risk, no matter what you do, given your history, so it's better to be more, rather than less, conservative.



    If you want to send me your email I can send you a PDF of that whole article.



    Cheers,



    Matt

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  7. pjballard Barefooters

    Member Since:
    Apr 18, 2011
    Message Count:
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    6 month post-script from Pat Ballard



    Turns out I WAS osteopenic due to vitamin D deficiency. Got that fixed now through 1000 IU dose/day via Citrical.



    Back to running. 1 short and 1 long run per week -- ran the Ruben Studdard 1/2 marathon successfully and working towards the Mercedes -- would like to do 1 full marathon -- just to "conqueor the mountain" so to speak.

    To placate my wife, I switched to New Balance Minimus shoes from the VFFs I was running in. I like them and, so far, so good, though I would really prefer to run completely barefooted, but I like peace in the house more than running bf.



    Thanks for your advice.



    Hope to see you at a run, soon



    Pat

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