Posted on

How to Stop Stress Fractures With Good Weight Gain

How to Stop Stress Fractures With Good Weight Gain

How to stop stress fractures with good weight gain is a topic that most people don’t discuss. After all, a lot of people run to lose weight. That said, here is an importune question. Are you a female runner? How many times have you suffered a stress fracture  over the past decade of competitive  running?

It’s pretty frightening to think about, isn’t it? And if you’re like most people, you have no idea about the answer – and you’d rather not know. Because most people don’t want to know the factors that put female runners at an increased risk of developing a stress fracture. It’s not a fun topic to talk about.

However, starting to achieve overall fitness as a runner means facing things we’d rather not face. And that includes how low body mass Index [BMI] can lengthen healing time for athletes suffering  from stress fractures.  It may be painful. It may be difficult. But once you really examine the role of low BMI, you’ll be glad you did. And that’s because you’ll learn how to become a healthier runner and continue on the mission of overall fitness without risking injury.

Let’s have a look at this topic of running while under weight  in more detail, and then you’ll learn how to strengthen  your heart without breaking your bones.

So, without further introduction, let’s review what happens to your body when you run.

Endurance Running  and Repetitive Stress

If you recall my past post about the stress that is imposed  on your body when you run, you will recall that  running  is   sometimes described as a series of crashes.

What that refers to, as I pointed out, is that when you run your body is under constant pressure. Endurance running places repetitive stress on the lower limbs and lower back.

This is How it Works. This is What We Mean by Crashes

When you are running, your feet strikes the ground. With each foot strike inducing ground reaction forces equivalent to 2–4 times the body weight. [1] This means that if you weigh 100 pounds you are slammed with 200 to 400 pounds of pressure that is like a shock wave to your body.

As one of my readers, and a fellow runner, notes:

“ I will pay for it for days if I put too much strain or pressure on my joints so I definitely  understand it being compared to a crash.”

Let’s now consider what role body mass has on an athlete’s ability to withstand pressure.

Underweight Female Athletes at More Risk of Injuries

    

A  new study reported by the Indo Asian News Service (IANS)  found that  female runners who have a body mass index (BMI) of less than 19 “are at a higher risk of developing stress fractures– a tiny crack in a bone caused by repetitive stress or force, often from overuse — than women with a BMI of 19 or higher. “ [2]

 

Lt. Col. Mark Cucuzzella, a professor at West Virginia University School of Medicine, says female runners with low BMIs should be aiming to add fat to their bodies. “In this age group, body fat should be in the range of 20 percent to 22 percent for hormonal health,” he says. “If it’s not there, all the calcium and vitamin D in the world won’t heal a  stress fracture .” [3]

Fat Intake and Injury in Female Runners

We are now ready to fully consider the subject at hand. According to a  report by The Journal of the International Society of Sports Nutrition, a lower daily fat intake and lower percentage of total energy from fat is associated with increased injury risk among competitive female runners [4]

Another study found an association between increased levels of cognitive dietary restraint and stress fractures [5].

Finally, there’s  study that  was part of a larger multi-factorial analysis of risk factors for lower extremity injury in female runners [6]. Runners were recruited through flyers at local races, college campuses, and health clubs; advertisements in local running newsletters and web sites; and by e-mail to area running clubs. Ninety healthy adult female runners, aged 18 – 53 and running a minimum of 20 miles/week, participated.

Subjects were contacted every three months for one year and asked about the frequency, intensity, and duration of their running; about any changes in their health or menstrual status; and to describe the occurrence of any running-related injuries.

Over half the runners in this study sustained a running-related injury in the year following their initial assessment. These injured runners consumed a diet significantly lower in total fat and lower in percentage of total energy from fat.

This finding agrees with two studies which both reported correlations between low fat diets and incidence of stress fracture risk in female runners.[7, 8].

All these studies are confirmed by the experiences of, Samantha Strong, a former collegiate triathlete and high school runner. The 22-year old graduate student estimates she had eight or nine  stress fractures over her high school and college careers. Each one, she says, took longer than the last to heal.

“Although Strong admits she is never far from the urges to control her eating and stay at a low weight, she is in a much better place than just a few years ago. “Since getting it out in the open and working with a nutritionist, I’ve had a growth spurt,” she says. “I put on about 15 pounds and grew two inches once I started eating.”

Even better: She now finds joy in running and is able to maintain about 50 miles per week without injury. “I haven’t had a stress fracture in a full year,” she says. “It’s exciting to be here.” [9]

Conclusion

In previous posts I covered how overtraining can lead to injury. When not consider overtraining, studies have found that fat intake was the most useful dietary factor in predicting future injury. Runners consuming less than the commonly recommended 30% of total calories from fat were 2.5 times as likely to sustain an injury compared with runners consuming 30% or more.[10]

As Dr. Timothy Miller, assistant professor of clinical orthopaedic surgery and sports medicine, points out: “When body mass index is very low and muscle mass is depleted, there is nowhere for the shock of running to be absorbed other than directly into the bones. Until some muscle mass is developed and BMI is optimized, runners remain at increased risk of developing a  stress fracture “. [11]

So as long as carbohydrate and protein needs are also met, it is advisable  to add some fat to your diet so you can stop stress fractures with good weight gain. Indeed, weight gain may be the key to healing stress fractures.

Fat intake was the most useful dietary factor in predicting future injury using a logistic regression, which may be of some clinical value to sports nutritionists. Further, the odds ratios revealed that runners consuming less than the commonly recommended 30% of total calories from fat were 2.5 times as likely to sustain an injury compared with runners consuming 30% or more. Interestingly, the highest fat intake of the injured group was 35.8% of total energy. Nine runners in the non-injured group exceeded this (with values of 36 – 47%) and sports nutritionists may want to consider ~36% as a conservative minimum fat intake for avoiding injuries, as long as carbohydrate and protein needs are also met.

I like to hear from the readers so please leave me a comment below to let me know if this post helped you or if you have any questions.

Reference

1.Dowzer CN, Reilly T, Cable NT (1998) Effects of deep and shallow water running on spinal shrinkage. Br J Sports Med 32(1):44–48

2

IANS.

“Underweight female athletes at more risk of injuries.” IANA, 12, June 2017

3

Loudin, Amanda. “Low BMI could lengthen healing time, according to study on athletes  with fractures.” Washington Post. (June 16, 2017): News

4

Kristen E. Gerlach, Harold W. Burton, Joan M. Dorn, John J. Leddy and Peter J. Horvath “Fat intake and injury in female runners”

Journal of the International Society of Sports Nutrition. 5 (Jan. 3, 2008): p1.

5

Guest NS, Barr SI: Cognitive dietary restraint is associated with stress fractures in women runners. International journal of sport nutrition and exercise metabolism 2005, 15(2): 147-159.

6. Gerlach KE, White SC, Burton HW, Dorn JM, Leddy JJ, Horvath PJ: Kinetic changes with fatigue and relationship to injury in female runners. Medicine and science in sports and exercise 2005, 37(4): 657-663.

7

Bennell KL, Malcolm SA, Thomas SA, Reid SJ, Brukner PD, Ebeling PR, Wark JD: Risk factors for stress fractures in track and field athletes. A twelve-month prospective study. The American journal of sports medicine 1996, 24(6): 810-818.

8

Wiita BG, Stombaugh IA: Nutrition knowledge, eating practices, and health of adolescent female runners: a 3-year longitudinal study. International journal of sport nutrition 1996, 6(4): 414-425.

9

Loudin, Amanda. “Low BMI could lengthen healing time, according to study on athletes  with fractures.” Washington Post. (June 16, 2017): News

10

Kristen E. Gerlach, Harold W. Burton, Joan M. Dorn, John J. Leddy and Peter J. Horvath “Fat intake and injury in female runners”

Journal of the International Society of Sports Nutrition. 5 (Jan. 3, 2008): p1.

11

IANS.

“Underweight female athletes at more risk of injuries.” IANA, 12, June 2017

8 thoughts on “How to Stop Stress Fractures With Good Weight Gain

  1. Really nice post. But do you mean as Athletes we should try to gain more weight? would that not affect speed?

    1. Hi Frank,
      I think running underweight will make you faster, but it’s at the risk of suffering bad stress fractures that could sideline you from running any way from several months to a year. If the stress fracture is bad enough, you may not even be able to run again. All this points to a lager topic that I have addressed in previous posts: training error.

      Training error occurs when an athlete trains in such a way that the body undergoes a lot of stress, such as tired muscles not getting rest, and the result is either an injury or a lengthening of time for the injury to recover. When an under weight runner runs, most of the time it’s a woman, they don’t have enough body mass to absorb the shock that is sent to their joints. The result is often a debilitating stress fracture. Most under weight athletes who have gone on to gain the recommended weight, have found themselves healthier and more able to enjoy running.

  2. Really educating post, If we forbid a food, it often makes us want it more. So I have learn to eat all foods, and learn to tune in to what I really want, not just what I think I want.

    1. Hi Vernita,
      I think you make a really good point. Yes, it’s true that if we go overboard in restricting our intake of a particular food we may end up wanting more of it. I think wise advise for everyone, especially athletes, is to eat a balanced meal. For an underweight runner including more fat in the diet can be balanced with more protein and fruit, for example. The point is that your body is fueled and strengthened by different types of food. We have to pay attention to our body when it signals that something is lacking.

  3. Very informative and timely post. I have a daughter who is a very serious runner, and has suffered some stress fractures over the years. I have always suspected that her thinness was a big factor in her injuries.

    Your post has convinced me that I was right. She’s okay now, but I’m going to have her look at this amazing and well written post. Maybe, she’ll finally realize that it’s good idea to add some weight to her small body if she’s going to continue competitive running.

    1. Hi Jamie,
      As Dr. Timothy Miller, assistant professor of clinical orthopaedic surgery and sports medicine, points out: “When body mass index is very low and muscle mass is depleted, there is nowhere for the shock of running to be absorbed other than directly into the bones. Until some muscle mass is developed and BMI is optimized, runners remain at increased risk of developing a stress fracture “ So indeed, your daughter would do well to listen to you to prevent future injuries. I wish you luck in that regard.

  4. This is a very informative post. I really liked the story of Samantha Strong,that former collegiate triathlete and high school runner. I can’t believe that at 22 years old she had eight or nine  stress fractures over her high school and college careers. Each one, she says, took longer than the last to heal. Her story is an important reminder that the body needs enough mass to withstand the pressure that running has on the joints.

    1. Hi Ashley,
      I think Samantha’s own words nicely reinforce your point. “Although Strong admits she is never far from the urges to control her eating and stay at a low weight, she is in a much better place than just a few years ago. “Since getting it out in the open and working with a nutritionist, I’ve had a growth spurt,” she says. “I put on about 15 pounds and grew two inches once I started eating.”
      Even better: She now finds joy in running and is able to maintain about 50 miles per week without injury. “I haven’t had a stress fracture in a full year,” she says. “It’s exciting to be here.”

Leave a Reply

Your email address will not be published. Required fields are marked *