Let’s run! Once you’ve knocked out the principles I covered in the first two blogs (HERE and HERE) in this navicular stress fracture (NSF) series, we move on to the fun part. In this final blog, let’s dive into how to return to running, training, and competition.
I hope I’ve made a good case for a progressive rehab program. Once we’ve progressed through a quality rehab program and are ready to begin running, we need to run some diagnostics. Here’s a simple checklist I expect my patients to confidently check “YES” to before starting a return-to-run progression.
As you start running, monitoring for apprehension, pain, or other concerning symptoms is essential.
I routinely have runners run every other day for the first few months. This allows the fracture site a chance to recover and gives you a chance to monitor how you respond. You can also use a load test (i.e. single-leg calf raises or single-leg hopping) on your non-running day to monitor for any changes in tolerance to loading the navicular. If a non-painful exercise is now painful, you may need to re-evaluate your approach.
How to build a training plan?
When beginning running it’s best to increase your running frequency first, then the duration, and finally the intensity. It’s normal l to feel terrible as you start running. That should be a nice global terribleness and nothing specific. Your body will likely feel stiff, heavy, and inefficient. You don’t want unilateral pain over your navicular that is worse with weight-bearing activities.
The initial few weeks of running should focus on gradually increasing your running time without aggravating your symptoms. All running should take place at a “conversational pace” on relatively level ground, with some brisk walking to warm up and cool down. If the pace on your watch is stressing you out, wear a Timex or use the stopwatch on your phone. Going to fast off the bat is not helpful!
The first 6-8 weeks of running with most stress fractures should be focused on “finding your groove” without aggravating symptoms. After a few weeks of slogging along, you will regain your normal stride.
It takes around a month for runners to build up to running four days a week for 45 minutes, which is around the max volume most runners need during recovery.
NSFs specifically don’t like running on inclines or running faster. If your goals require you to tolerate one or both of those variables, you need a plan for progressing these elements back into your training schedule. I think it’s helpful to pick one (hills or intensity) and have that be your focus over the following few weeks. Then add in the other once you feel comfortable with the initial variable.
Progressing Intensity
When you run faster, you hit the ground harder. Higher loads mean your bones and other structures are under greater demand. If your initial goal requires you to run at faster paces, here is a sample progression I start runners on by implementing strides. They incorporate the prescribed sessions two times per week while continuing to run at around the same volume and progress exercises in the weight room.
Progressing Inclines
Maybe fast running isn’t your cup of tea. You pine for the hills, the mountains, and the solitude of trail running. If your priority is inclines, that becomes our next focus after you’ve built up a few weeks of consistent every-other-day running. I don’t think it’s necessary to have dedicated hill sessions during the rehab process, but it’s crucial to monitor how you progress into more frequent and prolonged hill running. If you live in a flat part of the country with no intentions of entering a mountain race, go ahead and skip this part.
These injuries take much longer than most runners realize. It takes around 12-18 months to return to your previous level of training and competition. Stay patient and slowly build without putting too much pressure on yourself.
I hope you’ve found this blog series helpful. If you’d like to learn more about navigating returning to running after a stress fracture, pick up a copy of my Stress Fracture Guidebook below.
-Nathan Carlson