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What Would Another Mother Runner Do: Stress Fracture, or Not?

Susan and son Seth at an event that looks, to us, like it involved a race, but no fireworks.
Susan and her son, Seth, at an event that looks, to us, like it involved a race, but no fireworks.

This installation of our on-going series of mother runner dilemmas came to us from a longtime member of the tribe, Susan DiLeo. If you've been on our Facebook page or Strava discussion boards, you probably feel you know this compassionate, dedicated runner who lives in New Jersey. We have been all sorts of excited to hang with Susan at November's Philadelphia Marathon (which is shaping up to be the marathon/half-marathon for mother runners to convene at this fall!) This edition of WWAMRD is about, alas, an injury--and whether or not to ramp up training for a race, or not. Read on! 

Susan has spent most of this year ignoring shin splints, employing the logic that as long as running felt better than the splints felt painful, she’s keep hoofing it. A few weeks ago, she took her younger son, Seth, to see fireworks in her town. Rushing across the street, Susan landed on her left foot and felt a new and intense shooting pain--"the kind where you immediately and instinctively realize it’s not right," Susan told us. What began as a lovely evening devolved quickly as she nervously and obsessively contemplated the discomfort she felt with every step. Susan could not even acknowledge the feeling as pain, she tells us, because she was set to begin Philadelphia Marathon training in a mere two days!

As any slightly obsessed runner would do, the next day Susan ran around the indoor track for three miles. She says, “I managed it as long as I thought about nothing but maintaining form and cadence. My shin barked the entire time. But I could run! That’s still a 4 on the pain scale, right? Riiiight.”

By the next morning, she could press on a spot and find pain and tenderness. Since she had never failed the hop test during her bout with mild shin splints, she hopped. She failed. Miserably. She could no longer rationalize the pain away. Susan called her physical therapist, who suggested an X-ray.

She stopped running. Without even realizing it, Susan admits she followed the grieving steps in Train Like a Mother: “I wept and binge-watched, ‘Orange Is The New Black.’ As soon as my husband uttered a phrase I could interpret as less-than-supportive, I stopped speaking to him. I watched my friends post excitedly on Facebook about beginning training. I ate French fries.”

The X-ray showed no evidence of a new or healing stress fracture. As her running friends gently pointed out, though, this is cold comfort: just because there’s no evidence of a stress fracture doesn’t mean there isn’t one. Susan thought about having an MRI done, but being a typical mother runner, she decided the money would best be spent helping her son buy his textbooks for the fall semester. Her PT suspects tendonitis.

Susan racing a strong (and buff!) half-marathon last year.
Susan racing a strong (and buff!) half-marathon last year.

To maintain a schedule, fitness, and sanity, Susan is replacing runs with pool running or Spin class, and adding some extra strength training along with a little bit of walking. Yoga, “lots of stretching,” and self-myofascial release. “I had no idea how many ways there are to use a foam roller!" The tender, inflamed spot on her shin is no longer tender or inflamed. The shooting pain in her shin has diminished noticeably.

Susan's quandary is whether or not to rehab the injury as if it is a stress fracture--which means six to eight weeks of no running, and writing off doing even the half-marathon in Philly. Alternately, she could give herself until the end of August or maybe even early September to see if training for the half is an option--even on a run-walk interval plan.

What would you do?

Sarah answers: My mind would be spinning, whirring, and grasping for an immediate answer, just like Susan's is. But I'd talk myself down from the ledge and take the wait-and-see approach. If I had money left over after getting textbooks, I'd buy an entry to the half-marathon--hey, I'm an optimist!--but wait until early fall to make my final decision.

Dimity answers: I always say: You've got one body, and there are always more races. As much as it probably pains Susan to read this, I'd table a fall race and concentrate on getting better in the worst case scenario: 6-8 weeks of no running. I played wishy-washy with a stress fracture in my foot for a few months before deciding to finally give into the boot and heal the thing once and for all. I'm not saying Susan needs to do that, but the collective us are not getting any younger—and neither are our bodies. Her body has been repeatedly sending her signs that it's time to chill out for a spell. She's an experienced runner who has many more fast, strong races ahead of her, if she can just give this one speedbump the attention and respect it deserves.

What Susan is doing: She is honestly going to wait to make her decision until she's read through all the comments from you mother runners!  Susan is hoping other gals, "have had similar experiences with a positive outcome."

What would you, another mother runner, do? 

Susan giving a royal wave in a 2012 half.
Susan giving a royal wave in a 2012 half.

And if you’ve got a running-related moment you’d like some clarity on, via WWAMRD, feel free to email us at runmother [at] gmail [dot] com. Thanks! 

36 responses to “What Would Another Mother Runner Do: Stress Fracture, or Not?

  1. I can totally relate to Susan’s quandary. I developed some nagging hip pain about 4 weeks ago that radiated into my pelvic floor with every foot strike. I waited and rested and foam rolled and finally broke down and went to an orthopedist. My X-Ray was normal too but an MRI showed a stress fracture in my pelvis. Needless to say, the Portland Marathon (my first) is out for me, and I’ve already blown through seasons 1 and 2 of Orange is the new Black on Netflix. I say get the MRI and I hope she has a speedy recovery!

  2. I had a stress fracture in my 5th metatarsal last fall. Notoriously the worst one to heal! I’m still dealing. Was out from September until January and had to take it very slow. I had no idea that the peroneal tendonitis I was ignoring would lead to that.

    I say let yourself heal. You don’t want to end up with a stress fracture if you are close! Listen to your physio therapist. Don’t push it. I wouldn’t count on the run in Philly. I ran the Calgary half June 1st and even then it was only a half run/half walk. I was okay with that, because I just wanted to get out. That was after 5.5 months of incredibly slowly getting back to running.

    I am however running the full in Vegas this November! So all is not lost. I’ve taken the time to heal. Make sure I wear my KT-tape when needed and found shoes that work better for my current needs. Take care of your body. It’s the only one you have. If you take care of it, it will take care of you.

    Good luck and take care!

  3. I have struggled with this exact same thing for 3 years! I treated it like a stress fracture 3 times and ended up doing lots of HIIT training but missing my running. I finally got serious with running working up slowly AGAIN and sure enough, the same exact pain this summer. So, I pulled out a foam roller and watched videos about trigger point massage. Holy hurt! I cried, I screamed and it hurt so bad for 3 days really working it, I learned mine was a knot or scar tissue that I had to work out. I am so mad it took me so long to figure out, but now, I am faithful to massaging and rolling my calves after every run. Good luck!

  4. I would treat as a stress fracture and be very faithful to the treatment and physical therapy. This is an injury that will come back and make your life miserable and possibly prevent you from running at all if you don’t take it seriously. Also, be grateful (if that is possible) that this happened before you started training for the next big event. I am currently just getting back to running after getting a stress fracture 4 weeks before a marathon that I had trained very hard for and hoped would finally be my BQ event. The other thing you should do is find out why it happened. A good PT should be able to take a good history, and do a gait analysis. Based on the information in your story, I wonder if the shin splints was messing up your gait resulting in increased forces on your foot. So very important to address any existing injury and muscle imbalances that you at have while you rehab. When you come back, you will be stronger than ever. All though I am in the beginning of my back to running program (currently running 4 min then walking 1 repeating that 6 times) my running pace seems to be better than pre-injury. =)
    Good luck and get well soon! Take care of yourself!

  5. I was 9 weeks into an 18 week training plan for my FIRST full marathon – when I felt that sharp pain. I went to my physica therapist and they sugested an x-ray – it showed nothing. A week later I was still in pain and limping while walking – she suggested an MRI – sure enough, my 5th metatarsal was fractured. 6 weeks in a boot, just got out of it a week ago today. So disappointed I had to withdraw from my marathon plans (it was on my sons birthday). Don’t trust x-rays!

  6. It sounds to me like a stress fracture. Last year, I was training for my first marathon and got myself one. Similar to what’s happening to you, before my MRI, I had professionals telling me it was okay to keep running. I knew it wasn’t, but listened to them instead of myself and ended up missing the marathon. I will say, it was this same time of year, and my race was the beginning of Nov. I also was terrible about keeping up my fitness, I basically just alternated between sitting on the couch eating chips and chasing my toddler. What I mean is, you could still be fine if you take all these weeks off of running altogether, but keep up your cardio and eat even half the amount of chips that I did. The lessons I learned were that I was the very best person I knew to diagnose and treat my injury, and that I was not very confident in myself. I wrote many more details on my blog last year, if you’re interested. Good luck! I really hope you make it to your race, whatever race it happens to be!

  7. Even if you are able to nurse your leg along enough to run either the half or the full marathon, neither will be the race that you would have had without this incident. Is that what you want: just to participate and finish? Or will not being at your best make you feel worse afterward? Not to mention the risk of having a serious injury during the race and a DNF. I would recommend waiting until your leg is healed to a stronger level.

  8. I would get the MRI. I’ve had insurance issues with these before – last time I called and asked for a cash pay discount and got it done for a fraction of the price. I had a tibia stress fracture a few years back and tried to keep running through it and just made the recovery that much longer – 5 months instead of 8 weeks. I know it sucks so bad to not be able to run and do the race that you want – but the healing time for a stress fracture is much less than a complete fracture, or surgery with rods, bone grafts, etc. (And at the time of my stress fracture, I was also seeing a sports chiropractor and a physical therapist who were certain it wasn’t a stress fracture and thought it was okay for me to keep running as long as I kept lying to myself and them about how bad the pain really was.) There’s always another race.

  9. I just want to chime in and say I really, really appreciate the wisdom of this tribe and the stories you’re sharing. So many of your experiences sound like mine! I have professionals saying don’t worry, it’s tendonitis — but there’s that doubtful voice in the back of my mind. At the very least I plan to pay VERY close attention to how my body behaves after a few more weeks of no running. I’m closing in on three weeks of no running, and I haven’t (completely) lost my mind. I’d hate for all that time to go to waste, so I’m not going to rationalize any twinges I may feel after that time. Unfortunately, an MRI is really not financially feasible (even if my insurance company approves it, which it likely would not).

  10. I went through something similar and found that massaging the sore spot (self-massage, sometimes with ice, sometimes not), stretching my calves, and wearing KT Tape Pro all helped me keep running through it. I didn’t regret it (no problems on or after race day), but after reading the other comments it sounds like I was one of the lucky ones.

  11. I just did my first walk-run today after 9 weeks off with a metatarsal stress fracture. Do not push it. You are actually really lucky that you can walk and cross-train right now. Think about what a bummer it would be if you couldn’t do anything except swim, which was me for the first 6 weeks of the injury. Plus wearing a boot is very hot in the summer!! It will probably be only a month or two more of cross training, and then you can see how it feels to walk/run! You could also go to the pt a few times a week and do a lot if pool running and strength training so you are really strong in October. If I has just taken it easier when I felt slight pain in my foot, I would not have had to go through this! Don’t be dumb like me.

  12. I would either get an MRI and know and treat it appropriately or treat it as a stress fracture. This happened to me last year on my birthday, none the less. I too was told by physicians and therapists that was tendonitis as the xray was negative. I strongly suspected it was a fracture and am a nurse practitioner myself. I waited for 2 months to get an MRI and in the mean time after 2 weeks of pain, placed myself in a boot that was my daughters at one time. Since I didn’t have a specific test that told me what is was, everyone had so much advice for me and meant well but I started to feel “weak” on top of my self doubt so took myself back out of the boot and cross trained. I told myself it was for my own sanity. The MRI showed a stress fracture but at the point I had progressed my cross training back to run walking and was convinced I would do my half marathon, which I did. 25 min slower than usual. Hey, it was still a run with fellow friends. Then I went in a boot again for 8 weeks and slowly worked back into running 2 weeks after that. So far, no problems this year with continued cross training. But had I just treated it right last summer I would have had the fall to do more outside activities including some running and a lot less weeks of the self doubt, pity, irritability, etc. that comes with it. NOt to mention the risk of a malunion to a fracture that requires surgery and may or may not heal after that and you can imagine the down time there. Anyway, that is my story and why I would suggest the correct treatment the first time!

  13. Good luck with your decision. I don’t know what I would do because I mostly run out of gratitude. 37 years of running, rarely injured and for the past 2 months, I have been sidelined due to back pain. I agree that 4 -6 weeks off is much better than 4-6 months. I have already told my daughter that I will not be running the half in November that’s been a favorite. I’m relieved that it’s out there now and I can focus on getting stronger. Gotta love the foam roller. By far, my favorite purchase of the year.

  14. Oh, the dreaded “hop test”. I have suffered from tibial stress fractures in the past, and they are no joke.
    Having said that, I feel like since you have had a few weeks already of resting from running, and are keeping up your cardio fitness, a half marathon is a possibility Nov.23. I wouldn’t set any crazy goals, finishing feeling good and without pain should be the goal. Once you are without pain while hopping, start up your runs very carefully, with a walk/run program to start. Don’t jump right back into your normal training plan. I wish you the best, I know exactly how you feel. I will be at that race, I’m registered for the marathon. I hope to see you there.

  15. Your story sounds very similar to mine. I had the same shin splints and kept running bc I had a half marathon to do. I did end up finishing the race with a stress fracture. They do not show up in an x ray. If you have any question get an MRI. Catching it early is the key. Yeah it really sucks but better to be out for 6 weeks than 6 months with a more severe one. That’s my 2 cents! Wishing you a speedy recovery

  16. I hate to say, but backing off completely would be what I would do.
    Biking, swimming are good.

    I had a tibial stress fracture a few years ago, did not show up on an xray but did on an MRI.I had started training for a full, went into rehab mode and did the half. It was upsetting, but we do only have one body. There will be other races (not to sound too pat.)

    My dr. recommended an air cast, which did seem to help move things along a bit quicker. When I started back I did so super conservatively (run 30″, walk 30″.)

    Hope you get some good ideas here!

  17. I just went through this! The week of a big 1/2, too. I took it REALLY easy on taper week, ran the half as hard as I could (a 5 minute PR!), and took 10 days off completely before seeing the doc. No evidence of a stress fracture, but we decided to be conservative and treat it as such; I had a half in 6 weeks, 14 weeks, and a full in 4 months all paid for so I wanted to run as much as possible. I did pool running and boing when it didn’t hurt, but after a month, I still wasn’t feeling better so I got the MRI (I have an HSA that paid for it so it wasn’t out-of- pocket money). Turns out it was a cyst! I could still run! And it started feeling better that week, I was able to run the half (about 10 minutes slower than PR to be conservative), and am now training for the other half and full.

    I say get the MRI—so worth knowing if you can run through the pain! Pool running and biking still had me lose fitness—a month of no running and I’m sore for days at runs shorter and slower than before (though 3 weeks back in and I’m almost back to normal, I hope). Good luck! Not running is awful, pool running and biking are not the same.

  18. I had a probable stress fracture (like you I didn’t want to spend the $$ on an MRI) in my foot whilst training for a full marathon in March 2013. I went 6 weeks in a boot cast (not by authority of a doctor but myself) and cut back almost all exercise (I did weight lift). I attempted to try to run a half marathon a year later (May 2014) and made it through all of the long runs only to have my foot cramp/get the same feeling it had at the beginning almost at the start of the race. I dropped out at mile 4 and stopped running for a month. I’ve gotten back up to 3 miles distance at a slower pace 3x a week and sometimes at the end of a run, my foot will still bother me. I wish I would have rehabbed and rested immediately when I got hurt in 2013.

  19. I suffered a tibia stress fracture that could barely be made out on an xray, last summer (June 6th). It was an unmistakeable pain, that “I shouldn’t be running on this” type of pain. (though I did have warning aches that I should have paid more attention to). I halted running. Then after 4 weeks when I thought it was better, I would take test runs and learn it wasn’t ready. I kept doing that over and over. Finally I just had to completely shut it down. New Year’s Day I was able to start coming back. I agree with Dimity, shut it down now and you’ll come back much quicker. Stay off it for at least 6 weeks (and believe me I know the agony of that long of time!!!). Good Luck.

  20. Oh, I’m sorry to hear of your injury! But — either get the MRI and confirm the diagnosis, or don’t get the MRI, and treat it as a stress fracture. My thinking is that you only get one body, and while running is a source of enjoyment and challenge, it is just dumb to risk serious injury and infirmity for a hobby.

    Can you defer your entry till next year?

  21. I guess the question is, do you want short-term success, or long-term? I would recommend getting the MRI. If it is a stress fracture (the fact that the pain started acutely in the middle of the run is a strong sign), get it addressed now and bail on the race if you have to, rather than make it worse. Better to have to take 6-8 weeks off rather than 6-8 months.

    I know that’s a hard thing to hear. I had to take 5 months off completely for a torn ligament in my toe. I ended up swimming and strength training (CrossFit – modified) during that time. I am now seeing faster times and better results in my running, so it turns out that taking that time off from running was actually good in the long-term. Good luck to you.

  22. Oh man. It’s like reading my own story – had the EXACT same thing happen to me about this time last year and I had the Another Mother Runner Ragnar Relay to attend in DC in October. The pain you describe sounds exactly the same and my X-rays showed nothing. I was not willing to give up on running Ragnar, so the doctor prescribed me a boot that I wore all day, and I used the spinning bike and pool ran to keep up my fitness, then wrapped by leg in an ace bandage and compression socks for the race and was able to complete Ragnar … albeit very, very slow. After Ragnar I took four weeks completely off from running and it finally healed completely. I guess you need to decide if you are happy just completing the half marathon or will you be disappointed in a slower time? If you are happy just completing the half, continue to cross train for a few weeks, then add back a few short runs on very flat terrain with no speed, then build from there. Really focus on form and strengthening the muscles in the shin and hips. I also found that the elliptical did not bother my shin, so was able to get in some good work outs that way. Good luck to you!

  23. Hi Susan! Get the MRI…stress fractures do not show on xrays. I had a stress fracture 2 years ago…it was heartbreaking to not run for so long, especially when I needed it the my Ortho told me, “Keep running and your are going to break your leg!!!”
    Rest, heal and look forward to running with a healthy body in the near future. Keep up with the pool running..I found that was the best exercise for me too!

  24. I would get the MRI. It’s the best test to see exactly what you’re dealing with, and if its a money issue, most places will set up a payment plan. Otherwise, you’re trying to make a decision without all of the information. Get the facts, not guesses, and then decide what to do.

  25. First of all, as a Canadian runner I had a hard time wrapping my brain around that “buy textbooks or pay for MRI to rule out stress fracture” decision — poor you! Our system has flaws but I can’t even fathom having to think like that.

    Anyway I’m a family doctor and I definitely agree with Mel the orthopaedic surgeon, get it diagnosed properly or you could really mess yourself up. Stress fractures definitely get trickier the longer they are ignored. Even when the diagnosis and treatment are free, I see plenty of athletes who try and ignore it and end up with much worse situations than if they had dealt with it properly in the first place. I don’t mess around if I suspect one in the office.

    Would a bone scan be cheaper? We use those a lot for diagnosis as well (not bone density, but bone scan).

  26. Been there done both. Diagnosed with possible stress fracture via X-ray, had MRI 10 days later which confirmed stress fx. Took prescribed 6 weeks off – literally no exercising of any kind- then ran/walked/ran a half marathon 2 weeks after 6 week recovery- 2:45 time. A year later I still ended up in a cast- not a boot – due to my run thru pain mentality. Only a cast would keep me from running! I strongly suggest the MRI and then follow doctor’s orders. Even 2 years later I have runs that still hurt – feels similar in pain to shin splint but in exact location of my fx.
    Best of luck!

  27. I’d pay for the MRI. I was diagnosed with a metatarsal stress fracture last summer and against medical advice I did a splash and dash and a triathlon after the diagnosis. Instead of 6 weeks in a hard shoe I ended up with 10 weeks in a boot and months before I felt back to normal. Plus my messed up gait exacerbated arthritis in the opposite knee. It’s important to have as much information as possible – you do not want to have to have surgery.

  28. As an orthopaedic surgeon (and Type A personality who HATES taking time off), I STRONGLY advise for the MRI (or bone scan) and if it is a stress fracture, take the time off. If you run on it and it doesn’t heal, you are looking at surgery- a metal rod placed down your tibia.

  29. Oh, and by “hurt”, I don’t mean a “can I run through this pain”, I mean “does this feel off?”
    I’m pretty good about being honest about this sort of stuff and listening to my body. If you tend to silence your pain, this may not work!

  30. So as of right now, Susan doesn’t have any definitive evidence that it IS a stress fracture and her PT suspects tendinitis. So I would hold on to some hope that it isn’t a stress fracture. That said, it does seem that SOMETHING is wrong and that the rest is healing it up. So I’d stay this course for another week or so, then try a very short (like a mile or even half a mile), no expectations run, then ask myself after and the day after whether it hurt. If the answer is no, I’d try a 2 mile run, skipping the day in between. If that honestly doesn’t hurt, I’d do another 2 mile run with a day in between… keep repeating. If it does hurt, I’d rest it another two weeks before trying it again.
    I wouldn’t sign up for any races right now. I think that the external pressure of having an upcoming race would make me less honest with my pain level and leave me jumping in too soon. There are always less popular races that can be signed up for without much notice that she can register for when she’s certain she’s healed.

  31. I have to say I let a full go in the fall of 2012 after a three month healing process from a bad case of Plantar Fasciitis. If the race is already paid for, I would wait until the absolute last minute to bail. See how the leg feels. Defer if you must.

  32. Like Sarah, I’m an optimist, so would take the wait and see approach. Because she’s such an experienced runner with a solid running base, I think I might still hold out hope for doing the full marathon, even though the start of training is a bit delayed.

  33. Ooh Ooh, pick me, pick me! LOL
    Ok, Here’s my story. On January 23rd I ran my last comfortable 5 of 6 miles and mile 6 I knew something was going wrong. What had been some shin discomfort for the last few runs became much more. The next morning walking was difficult and painful. I stopped running for a few days and saw no real improvement. My running coach suggested I see our “team” chiropractor who specialized in sports medicine. He didn’t feel as if the pain was a stress fracture and I did a few sessions with him but the pain only increased. I couldn’t run without pain, but worse, I had point tenderness and I too failed the jumping test. I knew it was a stress fracture and I was determined to rule it out. 3 weeks later after several clear xrays my MRI was positive. For 10 weeks I conceded to cycling and swimming and was finally released to begin running as the point tenderness had resolved and I was pain free. I maintained 2-3 days of running a week for about 6 weeks but had twinges of pain every run. On Memorial Day I raced my first 5K after the injury and did fine – until the next morning. Severe point tenderness, walking was painful and I was sick about it. MRI #2 revealed an even worse stress fracture (I suspect it never healed completely) and I was put on non-weight bearing mode for 6 weeks. At that point I began walking and on my 4th walk, all of my symptoms had returned. I am schedule for surgery on the 26th to put a rod through the tibia. At least I know after 6 weeks in a boot I can begin running again and should never have this issue again.
    NOTE: I began a regimen of Calcium/Mag/Vit D, and have had bloodwork and bone density scans. What I can take from this is I ran through a lot of pain in early spring and I will always wonder if I had been more aggressive in my treatment (stay off 100%) would I be better or not?

    1. I must add I was never the best listener to practitioners or my body. I ran through a lot of pain and denial. Watching my friends race and be supportive of them was the hardest thing I learned to do but I know I will be a better runner because of it.

  34. Not the answer you want to hear, but I recommend you take the time to heal well. Use the running downtime to explore other fitness options and learn another level of mental toughness. I’d seriously consider adding yoga to the mix. The running hiatus might also help any other body imbalances that contributed to the initial
    problem. Good luck!

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