When Should I Run Again After A Fracture?

As a runner with a 5th metatarsal fracture, I understand the desire to return to running.  This type of fracture doesn't just hurt physically, but interferes mentally because you may need to cancel your race and can't get the runner's "high" that comes with a nice run.  In fact, runners often get in a hurry to get back and can cause additional injury from not waiting until the appropriate time to return to running. 

With this thought in mind, and while currently only 2 weeks into the healing process, I thought it would be useful to discuss how I will be transitioning back to running.

- Pain is improved can I run?  Depending on the extent of the fracture, pain can significantly improve and sometimes resolve at 2-3 weeks, with most fractures being painfree at 4 week.  Although painfree is a good sign it is not a guarantee that healing is complete and running can be initiated.  I am 2 weeks into a fracture and have a painfree foot (finally).  My x-rays, however, show a fracture that is still healing.  If I were to run too quickly, I could create a situation requiring a return to cast or boot and possibly even surgery.

- What is the most accurate indication of healing?  Bone healing, as with fractures, is usually confirmed on x-ray.  If the x-ray shows sufficient callus formation across a fracture, the area is healed.  This means the bone is stable and reinjury risks are decreased.  I wll therefore be confirming healing on x-ray and only start running after the bone is visibly healed on x-ray.  I want to get back to running painfree, and will not rush it for that reason.  I plan for years of running, not just one more race, etc.

- How do I get back to running?  The best way to get back to running is to do it slowly.  You have been limited activity for 6-8 weeks and should take twice to 3 times that (at least) to get back to where you were.  Start slow, preferrably on a surface that will protect you from reinjury.  As I transition back (hopefully in 4 weeks), I will be running upto 1 mile only for the first 3-5 days, and then start progressing slowly back to my normal running routine.  Again, I will take close to 12 weeks to get back to the point where I am ready to train for a marathon.  This will preclude me from running my marathons this year, but will allow me to run many marathons to come.

Just like you use care in training to not under or over train for any particular event or race, you should use care to not progress to soon or too quickly back to running after a fracture.  Your body will thank you!

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Proper Running Technique For Hills

I was talking on Sunday with a runner who is training for the Wasatch Back Relay and has been running without difficulty for months. Recently she has been runnning hills and is trying a new hill running technique taught at the local Rec Center and has started having leg pain (shin splints). The cause of this new pain is improper running of hills, as this instructor told the runner to turn their upper body sideways and push up the hill (after they start getting tired) with almost a side step running technique. Whether you lead with your right shoulder or left shoulder, the technique is biomechanically unsound and caused her current overuse injury. I will therefore give my recommendations for hill running:

1. Hill running should always be a part of training, as the running of hills improves your mental attitude (you believe you can) and increases conditioning. Many studies have shown improved performance in races from running hills as part of your training.

2. Run up hills utilizing the same energy as on flat ground. Instead of "attacking" hills, I recommend running at the same energy expenditure, meaning slightly slower with shorter steps. This will allow you to reach the top of a hill without being short of breath and permit you to return to your pre-hill speed (often passing many runners that overexerted on the hill).

3. Use proper running technique. As you run, arms should swing at your side toward the front and back. Never allow arms to swing across the body as this reduces efficiency of running and interferes with proper swing of the legs. Legs should move straight forward (not to the side, not crossing).

4. Arm swing should be shorter and lower. By less aggressive arm swing, you are keeping the legs closer to the ground allowing better propulsion up the hill.

5. Set mental goals as you move up the hill. A majority of hill running is mental (as is most running) and setting short goals helps keep you moving up the hill. Don't allow the hill height to win by thinking your not moving very fast. I don't like to stop and walk when running, therefore I break hills into little sections and countdown the sections as I complete a long or difficult hill.

Uphill running can be a great addition to any running, and can provide you with an edge when racing. Run smart and keep running...

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com