If I knew then what I know now, I imagine things would look a bit different for me...
In my sophomore year of high school, I got my first stress fracture. I took 3 months off of running and then knew nothing better than to get right back to it. I had no one to tell me otherwise. The doctor cleared me and my coach was excited to have me back. However, I never really got back to the level I was before that stress fracture, which came right around the time I really started to develop as a female. If anything, over the next few years, I wondered hopelessly where my running talent and skill had gone. I was lucky enough to have been offered a DI scholarship, but I felt like an imposter. I had been to several doctors and a nutritionist with no real answers.
It wasn't until my Junior year of college, when I got really sick and passed out at practice, that I finally got some answers. I say "some," because I know now that the testing and resources offered to me at this time should have been way more comprehensive than they were. Nonetheless, I found out I had been severely anemic (iron deficient). Judging by the enormous personal bests I set after I started taking iron, I imagine I had probably been iron deficient since that first stress fracture.
I'm not big on regrets, but I do think about what could have been some times. If I had been treated like I would expect someone to be treated now, could I have done better in high school? Could I have run for a bigger DI school? What would my personal bests be? I tell myself that I learned to be tough because I had to work so hard for so long while every cell in my body begged for more oxygen during those tough workouts and 60-mile weeks.
The truth is, my body did take a toll. Like a lot of female runners, I stressed my body in ways the female body should not be stressed while it is at the peak of developing. Many of us end up with athletic careers gone too soon or a constant battle with injuries.
At the time this happened to me, did anyone know any better? My parents? My coach? My doctor? Unfortunately, female athletes are still regularly treated this way. Most of it, I hope, is from a lack of knowledge and not with malicious intent (although, we do hear this sad story too often).
This is why I am so passionate about helping injured runners in ways that go far beyond just getting rid of the pain. A stress fracture, for example, it is more than just an injury. It can be the first sign of relative energy deficiency (RED-S), which comes when the body is using way more energy than you are putting back into it. RED-S can become a very serious issue. This can be caused by many things:
Lack of sleep
Too little fuel
Too little of the right kind of fuel (protein, carbohydrates, iron, vitamin D)
This list is not all-inclusive and it is definitely not always intentional! Too many people just do not know what it takes to keep a female athlete healthy.
This is why I highly recommend that any female runner and anyone in their corner read the book "Roar" by Stacy Sims, PhD. As Stacy puts it, women are not tiny versions of men. There are so many sports performance studies out there, but most of them use healthy men between the ages of 20-30 as the subjects. This is because women's bodies are too variable for most of these studies due to their menstrual cycles and changing hormones. Dr. Sims has studied women and has shown us all how to take advantage of that cycle to perform our best and stay healthy while doing it. For example, did you know that female hormones are most similar to men during their period? Paula Radcliffe ran the marathon world record while suffering from menstrual cramps after she finally got someone in her corner who realized that intentionally skipping her period for a race was not helping her perform her best.
In final words, if you or your athlete has had a stress fracture (or any other repeated health issues), here are some things that should happen before you/they return to running.
Movement Screen/Gait Analysis - What biomechanical issue or movement dysfunction could have led to this issue?
Blood Work - Get blood work from someone who works with high-level athletes. "Within range" might be fine for most people but not fine for a high-performing athlete. Athletes often need more comprehensive blood work than what is usually prescribed by a PCP.
Training versus Recovery - What does training look like? Are there too many hard days? What does recovery look like? Are they getting enough sleep? Is school stressful?
Are you getting your period? - It is never OK or NORMAL for a young female athlete to not have her period! Seek medical advice before training is resumed.
A Return to Run Plan - When you are recovering from an injury, you are not getting stronger. The bones and muscles need a strength training plan and return to run plan to complete the healing process and allow for a healthy return to running.