A stress fracture occurs when there is an overload of stress in a bone because of poor biomechanics and sometimes accompanying nutritional imbalances. Poor biomechanics occur due to muscle imbalances, which are a result of mechanical and nutritional problems. Improper footwear is a very common mechanical factor that results in muscle imbalances and, subsequently, a stress fracture. Those wearing footwear designed to absorb shock and control motion can be setting themselves up for a stress fracture because the major muscles that help disperse and absorb shock naturally will no longer work correctly.
Orthotics and Footwear
Orthotics typically cause similar problems, as do arch supports and shoes that lift the heel too far off the ground and put excess stress on the mid- and forefoot. This type of footwear disrupts normal gait, causing muscle imbalances and dispersing stress to isolated areas that are not meant to handle such a load. Eventually the areas break down—literally. For most, wearing minimalist shoes is very important when you walk and run so your gait is not altered, and even going barefoot at times can be very beneficial. When you’re walking around the house and office, going barefoot is preferable to strengthen all the muscles, tendons, and ligaments in your foot that affect your gait and entire body. Remember to gradually work your way into minimalist shoes and going barefoot if you’ve been wearing supportive shoes and/or orthotics for some time.
Another mechanical factor that can contribute to or directly cause a stress fracture is poor gait mechanics, but not due to improper footwear. Your gait is a reflection of muscles and joints working in harmony, and when this is disrupted, an injury often results. If the injury is impacting a bone, an athlete can all of a sudden develop a stress fracture, although it has often been weeks or months in the making, as an improper gait has slowly been isolating stress to a specific area that is meant to handle only so much stress.
A lot can affect your gait other than just what is on your feet. Past injuries, dietary and nutritional considerations, and hormonal imbalances all will affect how you move. More on gait here.
Speaking of nutrition and its effect on muscle balance and gait, nutrition also plays an important role in the health of your bones and joints. Therefore, poor nutrition can result in a stress fracture. This is especially true when a stress fracture develops in a major bone such as the femur, which unfortunately is all too common in female distance runners, who often don’t eat well or suffer from anorexia or bulimia. Many think a bone density scan that showed a good result means they have healthy bones. But that test measures only the quantity of bone in certain areas tested, not the quality of bone or the quality of health.
How About Specific Nutrients to Heal?
There’s a lot more to bone than just calcium and vitamin D, though both are definitely important here and for overall health. Probably the most important nutrient that is overlooked for bone health is the mineral manganese (Mn). Your body needs a lot of Mn when bone is injured; I sometimes give a patient 50–100mg of Mn a day for a couple of weeks if they have a bone injury. Other nutrients like magnesium, copper, zinc, and silicon are also important for bone health. Most people don’t need more calcium, but rather they need to stop stealing it from their bones. Many think their calcium level is good because they take a supplement or the level is normal in their blood, but they could be robbing the mineral from their bones. The body pulls calcium from bones when the blood and tissues are too acidic, which happens when a diet is high in caffeine and/or refined carbohydrates, as well as when there is too much of the stress hormone cortisol. Elevated cortisol is a result of training too hard (anaerobically), not resting enough, or too many other high stressors in life that you’re unable to deal with. So rarely do I see a need to give a calcium supplement to a patient with a stress fracture, but I often see a need to address diet and lifestyle.
GAGs synthesis is all about how we all keep our joints and connective tissue strong and healthy. Read more about that joint and tissue repair—it’s an important consideration when it comes to preventing or healing stress fractures (fast!).
How About That “Stress Reaction” Diagnosis?
Basically, I think “stress reaction” is a pathetic diagnosis given by physicians who don’t know why the patient has the problem they’re presented with. All it means is that you’ve suffered some trauma/injury in an area because your body was unable to handle the amount of stress to that area. Stress reactions mean nothing: They don’t tell you what exactly is wrong, how you got injured, and they sure don’t give any insight into how to correct it. A brace (tape or orthotic) might be prescribed, as well as anti-inflammatory or pain meds, but they’re not going to address the source of the problem.
In a stress reaction, much like when there is a stress fracture, you’re not dispersing impact correctly throughout the proper areas of the body (typically the foot), so you’re isolating the impact when you walk/run to a specific area or areas, causing trauma. So a stress reaction occurs for the same reasons that many other injuries occur, including stress fractures. Gait imbalances, improper footwear, and dietary and lifestyle considerations top the list when dealing with a “stress reaction.” We all react to stress—it’s the type and amount of stress and how we react to and recover from that stress that is going to determine whether we remain unaffected, become more fit, or break down with an injury.
