What part of the body? Metatarsals? Tibia?

You need to do 2 things
1) Let it settle. Really. Bone stress injuries are SLOW, especially if you have them in a high risk area. Poking it sometimes is totally ok, but dont do something like "i've reduced my mileage from 60 mpw to 40, it hasnt helped".
2) figure out why you get these reactions. Something loads up your bone tissue too much. Probably a run gait thing. Low cadence? Wanna run forefoot? Always thin shoes? Something is up, and you need to change it.

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Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede

Thanks for some input. My cadence is generally 175-185 avg & no I probably don't give them enough time to settle like you said. Once I get through IMLOU and recovery, I am set up to have a run gait analysis done with a sport medical physician. Hopefully, I will get healed & properly assessed so next season isn't riddle with this recurrent injury.

First stress fracture was in left tibia which healed well & now I have been struggling with a right mid shift tibial stress reaction.

don't just have them look at your run shoes...bring your cycling shoes and footbeds in as well (or get a reputable fitter to look).

The hours and hours of pressure from cycling with a footbed that cants your foot the wrong way, or a cleat that improperly distributes the weight can also be a cause. Im definitely not trying to diagnose... I'm just saying get a full view of how you stress your legs and make sure that each of those ways is not hurting your health.

^^^THIS!!!

I had a stress reaction in my pelvis and had to take off for six months. Even after the six months ordeal, I had to make a very gradual comeback.

Truthfully, I cannot believe you ask a question about dealing with stress fractures/reactions, and admit to doing IMLOU, at the same time. If you are still having issues, you should've never started training for an IM. And if it restarted during your training, you should've stopped immediately!!!

Stress fractures are too much, too fast running. Or too hard all of a sudden.

You gotta ease it back. You should probaly consult a coach if you can't figure out the problem in your buildup that' causing it.

One surprising thing as well (which you would probably hate, but would likely work) - going to a barefoot/minimalist run style has a good chance of reducing your stress fractures - NOT because it reduces the impact or load, but because it pretty much forces you to have a super slow acclimation and buildup to proper running.

In particular, BAREFOOT running really give you a good, slow buildup, as the buildup starts with foot skin, then achilles tendons, then foot/bone muscles, lower leg, etc. Yes, it's frustrating to feel as if you're learning to run anew, but it changes the run impact forces a lot and redirects them toward the achilles and multifaceted foot bones which are much better to be natural shock absorbers for foot plant impact than the hip or knees. By the time your skin gets used to the running (doesn't take long, believe it or not), you'll be doing a real, solid and slow and safe mileage buildup.

Of course, if you build up too fast with barefoot/minimalist, you'll get injured there, too though!

I'm a pretty minimalist runner now...zero drop & mainly running in OC racers (really no cushion) and more recently the Altra escalate. I did sort of blame my first stress fractures on a newer pair on newtons over a year ago because they had really changed up there running shoe styles so I pretty much abandoned the newtons. I agree that stress fractures are usually due to too much too fast mileage wise but I've really seriously not be doing that the past 8-10 months. Maybe I just really need to be serious about giving my legs the proper time to heal.

I guess we still differ on what's minimalist or not; in comparison with a real barefoot run with nothing on, the Altra Escalante is NOT minimalist. (Sure, compared to a motion control shoe, it's a lot less cushioned, but it's a LOT of cushion compared to barefoot, or a near-barefoot shoe like the Merrell Bare Access or Vibram Fivefingers).

Not sure if the OC racers are Nike On CLouds, but those are definitely VERY cushioned compared to barefoot.

The reason I'm harping on the cushioning for you, is that the cushioning takes away the feedback and force absorption from your foot bones, foot muscles, and achilles, and redistributes the forces higher in your leg. For many, that's fine, but if you're getting stress reactions up higher, it's pretty reasonable to assume that for you, the loss of that foot/lower leg force absorption may be contributing to it. (And anyone who's switched to barefoot/true minimalist really knows how dramatic that force shifting is.) If you remove the cushion, and in particular, start putting your actual skin on the ground as the contact point, it's a lot harder to rush the mileage buildup, and it will also force you to use your foot as the spring it's meant to be, absorbing tons of impact forces before they even go up the leg.

Not saying you have to become a totally unshod runner, but for sure, those true near-barefoot or full barefoot run styles absolutely will force you to build it up slowly, as your skin, then foot bones and muscles will take a beating in advance of the stress injuries of the upper leg areas like the ones you are getting. You still have to listen to your body (esp the feet/achilles!) but for sure, removing the cushioning of the shoes will make it less likely that you'll mask the signs of overdoing by just transmitting them to the upper leg and hip areas. It's not for everyone, but it's certainly worth a thought if you're having recurrent problems even with reasonable mileage with cushioned shoes.

Still, the overarching principle for avoiding stress reactions - avoid too much, too fast. Same holds true in barefoot and cushioned shoes, just that barefoot throws a lot more (constructive) obstacles in your way to slow you down en route to true stable fast running.

get your doctor to do an NTX study - it's a urine sample and measures calcium excretion. Will probably come back normal but might as well check.

are you underweight? male or female? (if female, google Female Athlete Triad).

I had a series of fx in college - it was both too much running too soon, and bad surfaces. Pavement is HARD. Run on dirt, grass, a woodway treadmill.

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maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

I'm 5'4 128# so not underweight. I will look into that NTX study for sure just to rule it out. I think running on the roads mainly has contributed so I need to find some softer surfaces. I love running on the Woodways too :).

No the OC racers are nothing like the Nike's. There really isn't much cushion to them at all. But I get what you're saying as far as barefoot running & minimalist goes. I went to the Altra's so I could try to see if a little cushion helped but I'm not so sure it does. I like to really feel the surface I'm running on and not a bunch of squishy cushion. Thanks again for the feedback.

I dealt with shin splints and stress reactions for a long time. It didn't matter how slowly I built up my mileage. It was always on the inside of right tibia, 4 or 5 inches above the ankle.

Eventually, I found out that I have a collapsing arch in that foot. When I run and land on that foot, my foot rolls inward and puts pressure on the inside of of the tibia. I didn't need orthotics; a relatively inexpensive pair of SuperFeet insoles saved my running.

It's not always overtraining.

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Long Chile was a silly place.

Thanks! Glad you spotted your problem!

My friend had this in his heel bone.. best to avoid running fot a while.. shock absorbing insoles can help too.