Joan West was sidelined part of the way through her PCT hike this past July with a stress fracture. For seven weeks she waited as she healed. During that time she learned a great deal about stress fractures … an injury, not surprisingly, among the most common in the long-distance hiking community.
I can testify personally to the accuracy and wisdom of Joan’s advice. My own taste of the world of the stress fracture was very humbling.
I didn’t know anything about stress fractures before it happened to me. It is important to be able to differentiate a stress fracture from other injuries because you cannot heal from a stress fracture by walking on. I learned that the hard way.
I got my stress fracture in the Sierra. (Photo by Arizona.)
Story of my stress fracture
The individual circumstances around a stress fracture and which bone is affected contribute to variability in the severity of the injury and duration of healing. I felt the injury all of the sudden on Muir Pass in the Sierra at mile 840 of the PCT, postholing in snow. I felt a stabbing pain at the top of my foot that didn’t go away even with a maximum dose of ibuprofen. The pain only lessened when I was going uphill or when I rested. While backpacking, I had to concentrate on every step to avoid the shooting pain that felt like a stake was being driven through my foot. Because I changed my gait (i.e. hobbled) to avoid putting more pressure on the ball of my foot, I got several bad blisters. I didn’t recognize this as a stress fracture and instead I kept backpacking for another 100 miles through the snow and rocks of the Sierra. It wasn’t getting better on the trail so I got off the trail at Tuolumne Meadows (mile 940). My injury wasn’t diagnosed as a stress fracture of the metatarsus for another four weeks.
What are stress fractures?
Stress fractures are microcracks in the bone and are often considered overuse injuries. Bones get broken down during activity and are constantly being rebuilt. When there is too little rest they can’t rebuild fast enough and are weakened. Fatigue contributes when the muscles get tired so do not lessen the shock on the bone due to repeated impacts.
What causes stress fractures?
Stress fractures are caused by a variety of factors including increases in distance, weight, speed, or internal factors like inadequate nutrition or hormone irregularities. I believe mine was due to a combination of factors acting together including the sudden increase in pack weight (bear canister, microspikes), altered stride due to walking in snow, increase in pace (due to wanting to get up the passes quickly before postholing conditions worsened), and my change in shoe size (up 1/2 size) at Kennedy Meadows (mile 700) that led to my feet slipping around in my shoes.
Changing to a larger shoe size in Lone Pine/ Kennedy Meadows- big mistake!
Important things to know about stress fractures
-Diagnosis of stress fractures is tricky. The tiny cracks of a stress fracture do not show up on x-rays right after they occur. Only when they start healing can they be seen on an x-ray. The first doctor I went to took an x-ray, didn’t see anything, and then didn’t diagnosis the stress fracture. Then my insurance company spent 2 weeks delaying the MRI which could have shown it. Finally I went to a doctor that deals with athletes and got a second opinion and diagnosis.
-Stress fractures are surprisingly common among runners and backpackers. When I started asking around, I learned that some of my fellow backpackers have recovered from this type of injury. Hearing their personal stories has been incredibly helpful in coping with the pain and frustration of being off trail.
-Rest is required to heal a stress fracture. This is not an injury that you can hike through. If you keep hiking you could break it completely or it could cause other injuries and delay healing for months or even years. I had never heard of stress fracture and was in denial of the severity of the injury. If I’d gotten off sooner, it would have healed faster and I’d likely already be back on the trail right now.
There are several things you can do to promote the physical healing of the bone. Obviously, follow the advice you get from your medical doctor. These are the steps I’ve taken:
-I rested my foot. It was extremely difficult to go from being on my feet for 12-14 hours a day to the level of rest required to heal the stress fracture. On the trail, rest meant sitting for 15 minutes every few hours. After the injury, rest involved staying off the foot 23-24 hours a day and wearing a “walking boot.” The boot took pressure of the injury to speed up healing. I avoided walking even in the boot as much as possible.
-Pain meant the stress fracture was getting irritated. This prevents healing. I DID NOT do any activity or intensity level that caused pain. I struggled with this mentally since I always used to increase my activity until I felt pain and therefore had exercised enough. I used to enjoy post-exercise soreness. Now I am really careful not to do any activity that hurts. And if I do overdo it, I take the next day off and avoid that activity.
-I followed my physical therapist’s suggestions about other forms of activity to keep up my strength and cardio that avoided direct pressure on the foot. I lifted weights, spent hours on a stationary recumbent bike, used an arm bike, and swam with my feet immobilized (using a pull buoy between my knees). Keeping up my cardio and getting my daily endorphins was key to maintaining my sanity and hopefully will allow me to transition more easily back to the trail.
Sweating at the gym.
-Ice often. I iced in the morning, mid-day, evening, before working out, after working out, and lots of times in between.
-Physical therapy may help. Be sure to find a hands-on PT who has experience working with athletes. I had ultrasound and joint mobilizations. It calmed me to talk to the PT about the healing process and to get encouragement from them that I was doing the steps I needed to take to heal.
-Consider stopping taking anti-inflammatories (ibuprofen) which may interfere with bone healing. I followed the guidelines given by my PT.
-I ate really well and completely shifted my diet compared to what I’d been eating on the trail. Veggies, fruits, dairy, lean meats, and a high variety of fresh foods really made me feel better.
High variety of food does NOT mean different flavors of ramen.
Being off the trail and dealing with an injury that forced me to be sedentary have been the most difficult things I’ve faced on my journey. It was agonizing to be away from the trail. I wasn’t mentally prepared for leaving my friends or the awesome life I’d found on the PCT. I felt like a failure. I had to mentally prepare for the possibility that I might not make it to Canada this year. It took a lot of work to view the injury as an opportunity rather than a huge setback. This is what I have done to avoid falling into depression and to mentally heal:
-I had to accept that I couldn’t run back to the trail and needed to be off trail for a long time while I healed. 6-8 weeks seems like forever to a long-distance backpacker. I needed to change my mindset to take a long-term view.
-Realize that you are not alone. Do not keep the injury or your frustration to yourself. Sharing your story is a powerful part of healing and will keep you connected to the backpacking community. A stress fracture (or any injury) does not make you weak. How you cope and what you learn from the experience shows your strength.
-Learn to be patient. Diffusing the pent up energy I had and being still was agonizingly difficult. I wanted to throw the f**king boot down a cliff and go run around. I had to confront the anger and hurt and all the things I’ve always run away from. To heal, I needed to shift mentally from “how do I get back to trail quickly” to “how do I heal completely and avoid re-injury in the future.” I had to make peace with stillness.
-Maintain a positive mental outlook. I was constantly assessing what activities and mental practices made me feel stress and what gave me peace. Meeting friends on the trail was uplifting. But being further from the trail most of the time made it easier to stay still. But I also thought about my foot and bones healing, and visualized myself back out on the trail.
-Redefine your notions of success. I was devastated when I mistakenly thought getting injured meant my hike was unsuccessful. I had to repeat to myself that “the journey is the reward” and I had to expand my notions about what the journey meant. It isn’t just about getting to Canada, or even just about hiking. It is way bigger than that. It is about life, both on trail and off trail, and it is about recognizing the many aspect of that make a journey.
When I first set out on the PCT, my first long-distance hike that I’d been dreaming about and preparing for years, I knew it would change me. I never expected that I would get an injury that would take me off trail. I never would have imagined how being off trail has allowed me to learn so many lessons. In many ways, I believe that this injury has facilitated the self-growth that I was seeking when I set out on the PCT.
Joan was able to return to the trail and was able to walk from Tuolumne to Castle Crags before the season concluded.