Injury Update: Stress Fracture or Bone Bruise?

A Stress Fracture or a Bone Bruise?

I miss running Central Park. (Photo: Phil Hospod)

I saw my doctor on Monday after taking two full weeks off from running and all weight bearing exercise, wearing a foot pad and wrap, and avoiding heels like I avoid broccoli.

Last I saw the doc, he had my MRI results in hand. “Findings suggestive of a stress fracture of the tibial sesamoid,” read the radiology report. When doc pressed on the area—one of the two tiny bones in the ball of the foot—it was pretty painful.

Now? No pain whatsoever, not even when he really dug in there. Based on that, he thinks I may not have had a crack in the bone, but a bruise.

Bone Crack Or Bone Bruise?

A Stress Fracture or a Bone Bruise?

My MRI results

The American Academy of Orthopaedic Surgeons describes it this way: “A stress fracture is a small crack in a bone, or severe bruising within a bone.” They’re both stress fractures, but two different types.

A crack and a bruise can appear the same on an MRI, which doesn’t necessarily show the fracture. MRIs might show swelling, or edema, which is indicative of a stress fracture. But I’d have the same swelling whether it was a crack or a bruise, my doc said.

He thinks I caught the bone bruise right away and nipped it in the bud before it had the chance to become a crack. That’s the theory anyway.

So what next? He told me to try a short run on the treadmill, 20 minutes or so nice and easy. If I had any pain, he wanted me to march right back into his office, at which point he’d slap me with a full stress fracture diagnosis, put me in a cast, and pass down a sentence of four more weeks without running.

If I had no pain, he said I could ease back into running every other day, with short, easy jogs. He wants me to keep wearing the foot pad and wrap for the time being. If the pain creeps back in at any point, I march right back into his office. If I’m still pain free, I see him for a follow-up in three weeks.

Test Run

Soooooooo? I hopped on the treadmill Monday night for that test drive. Talk about knots in my stomach! I don’t think I’ve ever been as conscious of one teeny, tiny bone as I was for that 20 minutes, constantly assessing for the slightest hint of discomfort. The good news? It never crept in. Those 20 minutes—building slowly up to a conservative for me 11:30 min/mile pace—felt great. Yee-haw!

Don’t worry. I’m not plowing ahead into training or making any plans to run the Suja Rock ‘n’ Roll San Diego Half Marathon just yet. I really am a follow-doctor’s-orders kind of person. It’s why I went to a doctor right away in the first place. It’s why I’m running after just two weeks: he told me to. I want to be smart about this, heal right the first time, and try to make sure it doesn’t happen again. So I’ll do another easy, 20-minute treadmill run Wednesday. If that goes well, I’ll run again on Friday. I’m taking this one short, easy run at a time.

Yes, my doctor said that if all goes well, he doesn’t see any reason why I couldn’t run an easy half-marathon in four weeks, working back up to my regular weekly mileage by then. But that’s if. I really want to listen to my body and see how I feel. For all I know my next run could hurt and I’ll be back at square one. Or maybe I am totally healed and can proceed. Whatever the case, I really want my body, not my brain, to make that decision.

Vitamin D Deficiency

A Stress Fracture or a Bone Bruise?

That’s me and my purple shoe at 6 o’clock in Runner’s World!

During those two weeks off from running, I made an appointment with my primary care doc to talk about bone health, since I found myself in this position. She suggested testing my thyroid function and Vitamin D levels. My thyroid was normal. My Vitamin D levels? Not so much. Apparently, a score of 50 nanomoles or more per liter of blood is considered “adequate,” 30-50 is considered inadequate, and below 30 is deficient. I scored 25. Yikes.

Am I surprised? No.

Yes, I drink milk every single day. But people get 80 to 90 percent of their Vitamin D from sun exposure, according to the National Institutes of Health. Yes, I run outside, but I also wear sunscreen like I’m a vampire. Our bodies produce Vitamin D when bare, non-sunblocked skin is exposed to the sun. Sunblock means no Vitamin D.

With two pre-cancerous moles (one whose removal knocked me out of marathon training for three weeks), a family history of skin cancer, skin that burns easily, and membership in the highest risk group (pale skin, light eyes, blonde or red hair), it’s the smart thing to do. I’m also coming off of the longest, coldest, dreariest winter in New York history. But even then, I still wore sunscreen every day (UV rays will get you in winter too!).

But all this means I need to make sure I’m getting my Vitamin D from somewhere else. My doc prescribed daily supplements. She wants to test me again in 3 months to see if we need to adjust the amount.

Will a Vitamin D deficiency itself cause a stress fracture? No. But the Mayo Clinic says Vitamin D improves bone health and decreases the chance of fractures. The hormone plays a major role in bone health, helping your body absorb calcium. You can eat and drink all the calcium you want. It does a body good. But without Vitamin D to help you absorb it, it won’t do your bones any good.

I used to take Vitamin D supplements. But I ran out and didn’t buy more. I won’t do that again.

How To Avoid Foot Fractures For Runners

I wrote this story back in 2010, but it bears re-sharing because it really lays out all the basics, with links to the science that backs the data. It’s just a shame that I ignored my own advice and didn’t buy more Vitamin D supplements when I ran out.

Water & Weight Training

A Stress Fracture or a Bone Bruise?

My Aquajogger belt

During my two weeks off from running, I kept busy by water running, swimming, and non-weight bearing strength training. I was pleasantly surprised by how much fun I found water running. I had company with me both times I did it and really enjoyed the workout. It takes a little bit to get the hang of the form, but once I did it felt great.

I’ve also started swimming laps again, starting with 30 minute sessions. Now that summer, and potentially triathlon season, is coming it’s a great time to get back in the pool. Every year I’m reminded during my first few swims that it’s a challenging and hearty workout. I’m always ravenously hungry afterward! During these next few weeks, if all keeps going well, I’m going to alternate my running and swimming days.

Strength training is going well too. I’ve been able to modify my workouts to skip leg presses, squats and the like in favor of seated leg extensions, leg curls, and a wide array of upper body and ab work. In the last four weeks I’ve managed at least two and sometimes three strength sessions a week. I hope it holds me in good stead when I return to regular running. Like the running, I’ll slowly reintroduce weight-bearing strength exercises into my routine.

So that’s it. There’s light at the end of the tunnel. I’m not in the clearing just yet, but I’m hopeful that I’ll get there soon.

Karla Bruning

About 

Karla Bruning is a race announcer at the TCS New York City Marathon + other major events, TV host for the Panasonic New York City Triathlon + regular contributor to Shape + Redbook online. She used to report for Newsweek but spent her free time squeezing in workouts. Now it's her job. She's run 8 marathons, 30 halves, 10 triathlons + open water swims, spoils her dog + travels compulsively.

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05 2015

16 Comments Add Yours ↓

The upper is the most recent comment

  1. 1

    Oh I’m so glad to hear that your “test run” went well! Such great information about the vitamin D tooI would be willing to bet I would be low too, I really should look into getting it tested!
    Danielle recently posted..A Quick School & Life Update!My Profile

  2. 3

    Wow, so sorry you’re dealing with this! But I’m so glad you caught it quickly and were sensible and didn’t push through like many do. (Been there, learned lesson!) Good luck with training and healing!

    Also, thanks for this reminder. As fair-skinned girls wearing lots of sunscreen, we need to be extra careful. But when I tested low on D, I did a lot of research too, and apparently it’s a widespread issue: Essentially if you live in areas like we do, it’s virtually impossible to get it during much of the year. Plus, a few years ago the recommended doses were raised (http://www.nlm.nih.gov/medlineplus/magazine/issues/winter11/articles/winter11pg12.html). But again, thank you for this reminder, I went right to the kitchen and took my D! : )

    • Karla Bruning
      4

      Thank you! The Vitamin D thing is something I knew, I just got lax about it. It was a great reminder to me that I always have to be vigilant.

  3. 5

    Let’s hope it is a bone bruise and you caught it early. That way you can get back out there.
    Lesley recently posted..What I’m NOT LovingMy Profile

    • Karla Bruning
      6

      Thanks Lesley! I’m back to running and feeling good. So far so good!

  4. 7

    Boo to injuries. Glad to hear the test run went well and hopefully you’ll be out there running soon enough.
    Elle recently posted..Old friends at Newport 10KMy Profile

    • Karla Bruning
      8

      Thanks! I’m back to running. Finally got my blog tech problems fixed so I can comment and post again. Yay!

  5. 9

    Woohoo for successful runs! I’ll keep my fingers crossed for you that they continue to go well! And good for you for following doctors orders! I’m kinda the exact opposite…or rather I will take as long as possible to go see the doctor period. This is why you will be back to tip top running game before you know it and I’ll be “running” Brooklyn with a wrapped ankle lol
    Kellie recently posted..United Airlines NYC Half Marathon 2015 RecapMy Profile

  6. 11

    Great news re the bone bruise, Karla. Hope you’re feeling 100% soon. In the meantime, good job on the swimming and weight training. Keep us posted, okay?
    Janice Brown recently posted..Running lessons: April showers bring May flowers (I hope)My Profile

    • Karla Bruning
      12

      Thank you! I’m back to running and slowly building my mileage.

  7. 13

    Glad to hear you’re doing better, Karla. You did the right thing when went straight to your doctor. I didn’t do that and can’t run since January. Two months in a cast, two months recovery… still painful to walk. But getting there…
    Get well! Happy running!

    • Karla Bruning
      14

      So sorry to hear that. How incredibly frustrating. I’m glad to hear you’re getting there. Hope your recovery continues well and speeds along!

  8. 15

    YAY!!!!! So happy to hear/read this! Keeping my fingers and toes crossed for you that all of your test runs are pain-free! You’ve definitely taught us ALL a lesson about the importance of following “doctor’s orders” and listening to your body.

    Also, I’m EXACTLY like you when it comes to the sun…my skin burns almost immediately, and I practically bathe myself in sunscreen every time I leave the house. Thanks for the info — this is definitely something I’ll be looking into!
    Jennifer @ The Final Forty recently posted..Race Recap: New Jersey MarathonMy Profile

    • Karla Bruning
      16

      Thanks! Here’s a to a sun safe and vitamin D full summer for all of us!



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