Mikael
Staer
Nathan
Elite Triathlete

Fighting the Fractures

How I battled repeated stress fractures for four years and came out on top.

Jul 02 2014

My time so far in triathlon is short – five years – but I have suffered a career's worth of injuries. 2013-2014 is the first year I have not had totally debilitating injuries. Otherwise, every season has been plagued by a complete show-stopper.

Rest? Strengthening? Or...?

Most doctors, physiotherapists and other experts recommend a period of rest to overcome niggles or injury. This often means heavily reduced training or worse, none at all. A series of exercises and stretches is usually prescribed, which, more than anything, tend to give a sense of false hope for speedier recovery. While rest and strengthening exercises are key – they must be a vital part of any training program – they should be done as a preventative measure, rather than solely as a treatment. There is, however, one important aspect that many neglect to consider: nutrition. While there may be muscular weaknesses or imbalances in the body, there can also be deficiencies in the diet that result in injury or illness.

My History with MTSS

I have suffered the same injury four times. It is probably one of the most painful and difficult injuries to deal with: the infamous shin splints, or Medial Tibial Stress Syndrome. MTSS is the most common injury among new runners but the exact cause is unkown. It is often attributed to tight calf muscles, imbalances in supporting muscles in the feet and even further up the chain, with various issues in the glutes, hamstrings and hips.

The First Time

My shin splits developed into full blown stress fractures of the tibia three times, in both legs, at the same time. The first time was in 2008 before I was even a triathlete - I was only swimming and running with a triathlon club. This was the first time I had ever experienced such a serious sports injury, and looking back on it, could probably have been prevented by not running so much so soon, and listening to the signals my body was giving me. But at the time, I was not experienced enough to recognize those signals. There were days that the pain was so excruciating, I would collapse on the floor of my apartment, writhing in pain. I remember one day having to army crawl from my bedroom to the kitchen.

The Second Time

The second time was after a crash on the bike leading up to my first half ironman in 2011. I was in great shape and shrugged it off, forging ahead with my training. Both my coach and I failed to recognize the signals and I started the race with some serious pain in my legs. After completing the race, I couldn't take a single step without fire shooting up my legs.

The Third Time

The third time was in 2012, after an amazing result at the Danish Sprint Nationals. Just prior to that race, I began experiencing tightness in my calves, but it seemed to be under control with some rest and massage. A few weeks later, I raced Ironman Aarhus 70.3 (then Challenge), and while I put together a near-perfect race, I was barely able to walk afterwards, my coach carrying my limping body back to the car. I couldn't walk the 10 steps from my desk to the coffee machine at work; I couldn't even ride my bike without it hurting, which in Copenhagen, is a near death sentence; and even swimming was a sufferfest with all the kicking and flip turns.

Treatment

Throughout the years, I have spent thousands on all kinds of sports therapy, treatments, orthotics and shoes. I have seen and tried it all. I have been to the local chiropractor, the Zen acupuncturist, and even a world renowned sports chiro/acupuncturist who has experience with some of the world's best athletes, and who also happens to be a famous horse healer (he treats big name horses in preparation for big time races). I have tried everything from the most supportive, stability, truck-like New Balances to the sock-like Five Fingers. I think I have five different kinds of orthotics. Nothing has worked.

It's in the bones

Then, one day in late 2012, I was reading an article about injury and optimal nutrition for performance sport, which mentioned stress fractures and calcium intake. Calcium is essential to maintaining strong bones as well as performing other vital functions in the human body. I decided to do a simple test and used MapMyRun to log all my meals over a three week period. It wasn't 100% accurate (inputting all those food labels is a painful process) but it was close enough. It showed a clear lack of calcium in my diet. A calcium blood test can corroborate this.

I immediately went to the pharmacy and picked up a calcium supplement. I also tried incorporating more calcium-rich foods in my diet. Amazingly, my symptoms began to subside. As the stress fractures healed and I was able to run again, I felt like my legs were stronger, bolstered in a way. Before, they always felt brittle. Now, they felt solid.

Running Free

After several months of consistent running and regular intake of calcium, I conducted another experiment. It was risky, but I needed to know. I stopped taking calcium for two weeks. That familiar pain in my tibia started flaring up. As soon as I took the supplement again, the pain disappeared and I could run stress free.

I was told by all the experts that I had issues with my feet due to flat feet and major over-pronation, weak hips, tight IT Bands, knots in my back, wrong footwear, etc. But none of them ever considered my diet. While it is very important to maintain the muscular system and biomechanics, it is equally important to look at the finer points of diet and nutrition, beyond "racing weight" and possible performance gains.

Now, I run in minimal footwear, no orthotics and most importantly, I don't begin each run fearing that it will be my last.