PDA

View Full Version : Stress Fracture/REaction prevention



Cedar1974
06-25-2015, 11:20
https://youtu.be/VljVTSQCmvg?list=PL4p96ziEpQP2eG1Y3FWvc5qaguL020_N L

I was watching this CDT video list, and I was wondering if anyone had suggestions on how to prevent Stress Reactions/fractures on the trail. I have high arches, and have suffered stress fractures in both shins in the past, so it is a concern for me. I have a set of custom orthoic insoles, but for a long hike, I want to be double sure with the proper shoes, and I will be starting to use poles as well.

burger
06-25-2015, 11:33
I've had a stress fracture in my foot (from running) and a stress reaction, too, plus shin splints several times. Here's why my doctor told me/what I've learned on the trail/what I've read in the scientific literature.

1) Make sure you get enough calcium. But if you do get enough, don't bother taking supplements--excess calcium seems to be bad for your heart.

2) Strengthen and stretch your calf muscles. I had a lot of shin splints when I first started running, and they didn't go away until I did a lot of strengthening of my calf muscles. Along with that, keep your calf muscles well stretched. On the trail, you can do this by finding a small rock or root and stepping on it with your toes while your heel is on the ground. I try to stretch every couple of hours on the trail, especially right before a break. I've found that if I'm starting to have some shin pain, simply stopping and stretching my calf for a few minutes will often make it go away.

3) Keep your gear as light as you can. More weight = more stress on your bones and muscles/tendons.

4) I have custom orthotics that I use for hiking, too, and they seem to help the shin issues. YMMV.

Spirit Walker
06-25-2015, 12:54
Shoes with more support and/or padding may help. I know when people first began wearing trail runners there was an increase in foot injuries, in part because their packs weren't light but their shoes were. Also try to avoid jumping/leaping. I knew a hiker who had constant foot fractures. I watched him hike once and saw him leap from rock to rock, jump creeks, jump down from rocky overlooks, etc.

Big thing is to not ramp up your activity too suddenly. Training hikes before you go will strengthen your bones and muscles and tendons. Increase you distance gradually. I had a pelvic sfx when I started running, partly because of a lack of calcium but mostly because I went from couch to half marathon in just a few months and my bones couldn't handle the drastic increase in impact activity. A lot of shin splints on the trail in the early weeks are because hikers go from couch to thruhike without building their fitness first.

rocketsocks
06-25-2015, 14:34
Most of those issues are from over use, in addition to the already mentioned ideas, reduce the work load...the effects are cumulative. you could also try a shoe that has a rock plate in the fore foot, like the Brooks Cascadias.

http://www.brooksrunning.com/en_us/mens-cascadia-10-trail-running-shoes/110187.html?dwvar_110187_width=D&dwvar_110187_color=094#q=trail+runners&start=1

Ladyofthewoods
06-25-2015, 15:18
Came home a week ago from my FlipFlop Thru Hike attempt after 450 miles because of stress factures. Cannot adequately express my frustrations. I'm an experienced backpacker/hiker, but failed to recognize the signs. I put it down to normal foot fatigue. The danger of a lot of hikers is we expect some discomfort so we suck it up and keep going. Big mistake. My pack weight was under 30lbs, but I still should have stayed with a heavier trail boot. I switched to a Merrill Moab Ventilator, but they just don't hold up on the trail. I was a couple days away from switching out in Kent, CT, to a new boot when I felt a 'pop' in my foot. That was it for my hike. A hard lesson to learn. Another friend I was on the trail with is also home recuperating with a stress fracture.

Cedar1974
06-25-2015, 15:42
Came home a week ago from my FlipFlop Thru Hike attempt after 450 miles because of stress factures. Cannot adequately express my frustrations. I'm an experienced backpacker/hiker, but failed to recognize the signs. I put it down to normal foot fatigue. The danger of a lot of hikers is we expect some discomfort so we suck it up and keep going. Big mistake. My pack weight was under 30lbs, but I still should have stayed with a heavier trail boot. I switched to a Merrill Moab Ventilator, but they just don't hold up on the trail. I was a couple days away from switching out in Kent, CT, to a new boot when I felt a 'pop' in my foot. That was it for my hike. A hard lesson to learn. Another friend I was on the trail with is also home recuperating with a stress fracture.

See, this is exactly why O bring these kind of things up. so we can all learn from the mistakes of others. I got my Stress Fractures when I was in the Army from being made to run in combat boots, and over gravel. Yeah Uncle Sam broke both my legs in boot camp. Doc kept telling me it was shin splints, until I bet him a month's pay it was a stress fracture. And I was right. I was discharged and told not to do more than walk in soft shoes for 2 years.

burger
06-25-2015, 15:55
I was discharged and told not to do more than walk in soft shoes for 2 years.

That is the worst advice I have ever heard. Typical stress fractures heal in 6 weeks.

MuddyWaters
06-26-2015, 04:26
https://youtu.be/VljVTSQCmvg?list=PL4p96ziEpQP2eG1Y3FWvc5qaguL020_N L

I was watching this CDT video list, and I was wondering if anyone had suggestions on how to prevent Stress Reactions/fractures on the trail. I have high arches, and have suffered stress fractures in both shins in the past, so it is a concern for me. I have a set of custom orthoic insoles, but for a long hike, I want to be double sure with the proper shoes, and I will be starting to use poles as well.

Slow down
Take care to never land on your downhill leg with jarring impact
This us hard to do going downhill. Focus
Use your poles to do this.
See SLOW DOWN again, espevially for downhill.

These are repetitive motion injuries.
Every jarring landing hammers your leg bones
Till they break

1000 times per mile
2,000,000 times in 2000 miles

Cedar1974
06-26-2015, 17:04
That is the worst advice I have ever heard. Typical stress fractures heal in 6 weeks.

Well, this was more than just a single stress fracture, both my legs from my knees to my ankles had stress fractures, multiple stress fractures.

Wyoming
06-26-2015, 17:20
Lots of good thoughts above. One other thing to consider and it may apply to you or it may not. The biomechanics of how a person walks has a huge amount to do with injuries like stress fractures, plantar fasciatis, and shin splints. As was mentioned above impacts are one of the key factors in getting these injuries.

Many people when they walk pretty much slam their heels on the ground. Studies have shown that folks walking this way actually generate more shock into their feet and lower legs than someone running does. This mistake in walking technique is learned because we spend our lives in shoes which allow us to (mostly) get away with using the wrong mechanics. If you have even been somewhere where large numbers of people still walk without shoes and you pay attention you will notice that their stride is very different from what is the typical city persons stride. A person who walks barefoot has a stride that more resembles that of a runner in that they do not hit hard on their heels. If you slam your bare heel on the ground very often it is going to hurt! They put their foot down much more softly and land with a light amount of pressure on the heel and most of the force of landing is dissipated by the mid-foot which is designed to flatten, spread out and sort of slingshot you into the next step by rolling over the big tow. The knee also gives substantially and dissipates an additional significant amount of the impact. Very similar to a running stride.

So if you are one of those folks who have a long stride and your heel hits hard and puts your knee in a position where it cannot flex properly to absorb the impact this might just be a factor in your problems.

It is not that hard to learn how to walk this way. For instance walk around in your bare feet as much as possible and emphasize the shorter stride and putting your foot down with a very soft heel strike and giving cushion with your knees. Imagine you are running really slowly. It is a sort of gliding action. No bouncing up and down. Soft footfalls. Then try and do the same thing when hiking. It just takes some concentration on the technique and practice and can be learned in very little time. If you really have it down you will make almost no sound when walking. It will not impact your walking speed at all once you learn how to do it. Soft short(er) quick steps.

I am sure you have noticed how much noise some people make when they walk. Boom, boom, boom. You don't even need to look to know they are wasting a lot of energy trying to beat that ground into submission.

A side benefit of walking this way is that there is much less severe forward motion of the foot in the shoe for the lacing to hold in place. Thus less blisters. It is also very efficient as there is a lot less of the momentum killing long stride hard heel strike and you will expend less energy per step.

burger
06-26-2015, 17:46
I think that Wyoming's advice is very bad. One thing I've noticed is that people get stress fractures when they change things: new shoes, big increase in mileage, etc. When I got my stress fracture, the first thing the doctor asked me was "What did you change recently?" It was my shoes--just a couple of days before the break.

So, drastically changing your walking style, when you may have been walking the same way for decades, is asking for trouble. Much better to try the other things mentioned above before you go about reconfiguring how you walk.

Walkintom
06-26-2015, 18:59
I think that Wyoming's advice is very bad. One thing I've noticed is that people get stress fractures when they change things: new shoes, big increase in mileage, etc. When I got my stress fracture, the first thing the doctor asked me was "What did you change recently?" It was my shoes--just a couple of days before the break.

So, drastically changing your walking style, when you may have been walking the same way for decades, is asking for trouble. Much better to try the other things mentioned above before you go about reconfiguring how you walk.

Gawds no. Don't treat the root of the problem. Use lots of bandaids instead.

I tend to agree with Wyoming. Decrease the stress you're putting on your feet by using a stride that doesn't cause jarring impacts.

Wyoming
06-26-2015, 20:12
I think that Wyoming's advice is very bad. One thing I've noticed is that people get stress fractures when they change things: new shoes, big increase in mileage, etc. When I got my stress fracture, the first thing the doctor asked me was "What did you change recently?" It was my shoes--just a couple of days before the break.

So, drastically changing your walking style, when you may have been walking the same way for decades, is asking for trouble. Much better to try the other things mentioned above before you go about reconfiguring how you walk.

Hmm...well if you read the OP's first post you will find that it is already too late for your idea. He is already getting hurt and some remedies are being used. The issue for him is to try and figure out 'why' the injuries are occurring and if it is possible for him to do anything about it. There may well be nothing he can do about it - but maybe there is.

And you might notice that I did not suggest he 'do' anything or tell him to do anything and I acknowledged that the advice/information above mine was valuable.

I provided information which 'might' help him figure out if there is anything he can do about his issue. That is what we are here for. The more knowledge he has at his disposal the better off he will be.

As to retraining the mechanics of how we do things to be better at them I would suggest to you that that is exactly what all good coaches in all the sports us humans play at do. Most of us who have led athletic lives can attest to the positive effect of someone training us to do something in a more efficient fashion and to lesson the chances of injury. There is nothing special about doing this (nor is it inherently risky - especially if we are talking about walking) and one can easily use G**gle to find information about what I was talking about.

And you might keep in mind that in your case that the doctor is just repeating his most common result. Remember that correlation does not equal causation. Your new shoes may have or may not have been a contributor to your stress fracture. There are a number of other possible causes as well. Unless you felt it go on some kind of impact you will never know for sure what caused it.

As an example of this: a few years ago I was in a horrible accident (4 broken vertebrae, broken ribs, bruised heart, etc.). I am all rods, screws and bone grafts now. After a couple of years of therapy I worked up to about 5 miles of swimming a week and about 35 miles of walking a week. That was the most I cold do because every time I worked out I would eventually start experiencing severe pain and then severe cramping in my calf's, feet and then legs which forced me to stop. I tried everything that the docs and I could think of to get past this point of failure and nothing worked. I have had so many MRI's, nerve test, blood tests to check for vitamin deficiencies and what not you can't imagine. No solution and no apparent cause of this pain and cramping could be found. But it must be the back right? One day I asked the doctor if it was possible that what the problem was was not my destroyed spine but circulation problems. He said 'No way. It is not possible for someone in as good of shape as you to have circulation problems." Well about a month later I went down to REI and bought a pair of compression sleeves for my calves after one of the guys I swim with said his brother was the strength and conditioning coach as Texas A&M and that he insisted that all of his athletes wear them. I have never had cramps again and 90% of the pain I had is gone. Go figure! When they say that doctors are "practicing" medicine they mean it. No one has all the right answers. I can swim for miles at once now and am taking off on the AZT this fall and heading for the PCT or CDT in the spring.

burger
06-26-2015, 22:55
Gawds no. Don't treat the root of the problem. Use lots of bandaids instead.

I tend to agree with Wyoming. Decrease the stress you're putting on your feet by using a stride that doesn't cause jarring impacts.

How do you know what the root of the problem is? If you go to a PT with shin splints, they'll have you working on your strength and flexibility, not telling you to learn to walk all over again.

Traveler
06-27-2015, 04:59
How do you know what the root of the problem is? If you go to a PT with shin splints, they'll have you working on your strength and flexibility, not telling you to learn to walk all over again.

This lines up with my experience dealing with stress fractures. With the addition of seeing a sports medicine MD to diagnose the problem to be sure thats what is happening. They will be a good resource for what the treatment should be.

Cedar1974
06-27-2015, 05:11
This lines up with my experience dealing with stress fractures. With the addition of seeing a sports medicine MD to diagnose the problem to be sure thats what is happening. They will be a good resource for what the treatment should be.

I just applied for school here, so I may take advantage of this and ask the SPorts Medicine people at the school to see if they can help me get in proper shape for a long thru hike.

Wyoming
06-27-2015, 11:09
How do you know what the root of the problem is? If you go to a PT with shin splints, they'll have you working on your strength and flexibility, not telling you to learn to walk all over again.

Well you hike your own hike.

But you don't know anymore about what the right answer is than anyone else and you do a disservice to folks when you try and reject info which may be useful to them out of hand for some unexplained reason.

Ignoring a whole large part of the spectrum of ways to address the OP's issues makes no sense. Chronic injuries are, a great percentage of the time, cause by bad mechanics so 'considering' that aspect makes a lot of sense. People are not born with a built in knowledge of exactly the right way to do physical things so we very often hurt ourselves. Even the greatest Olympic athletes spend extensive time constantly perfecting their mechanics. There is a wealth of knowledge out there on a multitude of activities about better ways to performing every kind of sporting activity. Walking is not an exception. I fail to see how this can be a mystery to you or why you want to reject its value.

Providing information so that the OP or anyone else with similar issues can explore their options is just the right and smart thing to do. But YMMV as they say.

Walkintom
06-27-2015, 12:03
How do you know what the root of the problem is? If you go to a PT with shin splints, they'll have you working on your strength and flexibility, not telling you to learn to walk all over again.


I actually have a good idea that the root of the problem is overstressing of the body parts and I have that idea because the OP asked about how to prevent stress reactions and stress fractures.

Wyoming's advice addressed specifically that. Reducing stress on your body parts by changing how they impact against hard objects; the ground. I stand by my opinion that he offered sound advice.

Cedar1974
06-27-2015, 12:10
I actually have a good idea that the root of the problem is overstressing of the body parts and I have that idea because the OP asked about how to prevent stress reactions and stress fractures.

Wyoming's advice addressed specifically that. Reducing stress on your body parts by changing how they impact against hard objects; the ground. I stand by my opinion that he offered sound advice.

As the OP, I can honestly say that my problem is both overstress on the parts, and the fact I have higher arches than a McDonald's, so all this advice really applies to me. I'm just glad I haven't fractured my feet yet, just both shins from running wrong in the Military.

Wyoming
06-27-2015, 16:52
As the OP, I can honestly say that my problem is both overstress on the parts, and the fact I have higher arches than a McDonald's, so all this advice really applies to me. I'm just glad I haven't fractured my feet yet, just both shins from running wrong in the Military.

A couple more things to think about.

Have you talked to the doctor who made your custom orthotics about what you want to do. Some folks have big blister problems from them and it could be that your doc would want to have you use one more designed for what you are planning on doing than the ones you have.

If you are still in the process of figuring out what kind of shoes you need make sure that when you are trying shoes on that you remove the inserts that they come with and put your custom ones in the shoe. Some folks mistakenly think you put the custom inserts on top of the ones the shoes come with and you do not want to do that.

I have no idea which brands of shoes are used by folks with high arches so if you need help on that you might start a thread just to ask that question. Various manufacturers seem to specialize in basic setups. Some do not make wide shoes, some have narrow heels, others wide heels, big toe boxes, etc. I imagine there are a couple who can handle folks with high arches - hopefully.

Walkintom
06-27-2015, 17:20
I have high arches. I get good performance from Salewa Wildfires in many areas, though in rockier uneven terrain I switch over to wearing Lowa Renegades because they seem to have a stiffer tougher last in them. Because of my arches I tend to get foot bruising easier than I think I should so the Lowa really help with that issue when it