Learning About Returning to Running After a Bone Stress Injury

A bone stress injury happens when a bone gets more stress than it can handle. Over time, small areas of damage build up. A stress fracture is one type of bone stress injury.

Returning to running after a bone stress injury involves slowly building your bone back up so it can handle the pounding of running again. Bone needs time to get stronger. Adding too much too soon can injure it again.

Your doctor, physical therapist (a specialist who helps you move better and get stronger), or athletic trainer will guide you through each step. The goal is to protect your healing bone while you get your fitness back.

Before you start running, you need the okay from your doctor or rehab team.

You may be ready when the area over your injury is no longer tender to the touch and you can walk and do daily tasks without pain. For some injuries, your doctor may order imaging, such as an X-ray or an MRI, to make sure the bone has healed. An MRI is a scan that uses magnets to take pictures inside your body.

Your doctor or rehab team may check your leg strength and watch you do moves like hopping and jumping. They may also look at other things that affect healing. These include your diet (nutrition), your shoes, and your running form.

Once you are cleared to run, you will need to start on a flat, even surface, such as a track or treadmill. Run at a pace where you can still hold a conversation. If you can't talk, you are pushing too hard.

With bone stress injuries, no pain is allowed. If you feel any pain, stop until it goes away completely. Then restart at a lower level.

Your program is made just for you. You and your rehab team decide the plan together. Before you start, your team sets your warm-up, your mix of running and walking, your rest days, and ways to check your pain.

Bone stress injuries are grouped as low-risk or high-risk. This is based on where the bone is and how well it heals. A low-risk injury may move through the program faster. A high-risk injury may need more rest days between runs.

To keep up your strength while you recover, your rehab team will give you strength-training exercises to do. Cross-training—such as biking, swimming, or running in a pool—can help you stay fit.

Here is one example of a daily walk-run plan. Your plan depends on whether your injury is low-risk or high-risk. If your rehab team gives you a different plan from this one, follow theirs. Each session starts with a warm-up and stretches. You do a level once a day and repeat the level for a few days, or until it feels comfortable, before moving to the next. Rest at least 1 one day between runs.

• Level 1: Walk 9 minutes, then run 1 minute. Repeat 3 times.
• Level 2: Walk 8 minutes, then run 2 minutes. Repeat 3 times.
• Level 3: Walk 7 minutes, then run 3 minutes. Repeat 3 times.
• Level 4: Walk 6 minutes, then run 4 minutes. Repeat 3 times.
• Level 5: Walk 4 minutes, then run 6 minutes. Repeat 3 times.
• Level 6: Walk 2 minutes, then run 8 minutes. Repeat 3 times.

If you feel pain at any point, even after you have finished exercising, go back to the level before.

Bone pain is a warning sign. Unlike sore muscles, bone pain is not something to push through. If you feel any pain at the injury site, stop running until the pain is gone. Then restart at a lower level of the plan.

Contact your doctor if the pain comes back when you walk, if you notice swelling, or if the area becomes tender again.