18230 Blog Ironman Brazil Blog 1200×675

Training For An IRONMAN Through a Stress Fracture

BY Lesley Mettler

When you've been training hard, injury can strike. Here's how one athlete saved his season despite suffering a stress fracture.

Jeff, one of my athletes, is a very self-determined individual, especially when he has a goal in front of him—and he definitely pushes hard to accomplish those goals. His drive and determination serve him well much of the time, but sometimes he pushes a little too hard and does not quite hear those little voices warning him that his body needs a break.

This drive is what leads us to Jeff’s story of IRONMAN Brazil. One week after signing up, Jeff emailed me that he had pain in his left foot when running, and that he felt it was affecting his stride. The soonest he could see the Podiatrist was three weeks later, so we restricted his running to elliptical workouts, as that did not seem to bother his foot as much. We also kept up his riding and swimming, and any strength work that did not bother his foot.

When Jeff finally made it to the Doctor, the MRI confirmed our worst fear. He had a stress fracture in the head of his second metatarsal with early-onset collapse and separation.  Jeff has extremely high arches, and although he wears orthotics they were still not giving him enough support. He had subsequently developed Hallux Limitus, or locking of the ball joint of the first and second toes, which creates a lever against the metatarsal.

The doctor fitted Jeff with new orthotics that gave him more support, along with a walking boot. He was going to be in the boot for three weeks, so we knew we were going to have to get creative with his training. At least he was allowed to keep riding, deep water running, and swimming (with a single foot wall push off).

Jeff was a really good sport and embraced water running like no other athlete I have had! Deep water running mimics actual running, and it gave him more fitness benefits than just riding and swimming. Of course, anyone that has done deep water running can tell you that it is mind-numbing at best. It really takes fortitude to stick with it.

We started Jeff with 90 minutes of deep water running at endurance effort to allow some adaptation—and eventually started including some intervals. Interval water runs incorporated periods of increased efforts (increased foot turnover in the water) with easy intervals in between. During this time the workouts also increased in duration.

The boot came off with nine weeks to race day, but Jeff’s doctor and I both agreed that the actual running needed to come back slowly. Water runs continued up to 150 minutes and we reintroduced the elliptical with easy efforts. Then we moved to actual running, kind of.

Jeff’s first run consisted of 5 minutes walking warm up, 3 x 4 minutes walk/1 minute run, and 5 minutes walking cool down—all for a whopping total of 3 minutes of running.  Whoo hooo!

Next, we incorporated elliptical with the run/walk sessions as Jeff’s workouts continued to get longer. The actual run portion never exceeded the 10 percent rule, and was very conservative. I had Jeff constantly assessing how his foot felt.  Luckily, we did not have any setbacks.

In the end, we were able to get Jeff up to the equivalent of two 20-milers before Brazil.

  • The first 20-miler looked like this:
  • 30-minute elliptical “run”
  • 4 x4 minute run/1 minute walk
  • 10-minute walk
  • 30-minute elliptical “run”
  • 4 x4 minute run/1 minute walk
  • 10-minute walk
  • pool run equivalent 7 miles.

The last 20-miler looked like this:

  • walk 1.5 miles
  • 4 miles at run 3 minute/ walk 1 minute
  • walk 0.5 miles
  • 4 miles at run 3 minute/ walk 1 minute
  • walk 0.5 miles
  • 4 miles at run 3 minute/ walk 1 minute
  • walk 0.5 miles
  • 4 miles at run 3 minute/walk 1 minute
  • walk 1 mile.

Since Jeff had not run more than 20 minutes continuously before race day, there was a concern that if he ran from the start of the marathon that his legs would not be able to handle the continuous load. So we came up with a run/walk plan for race day that we hoped would reduce the amount of time Jeff would end up slowing down or walking.

He found that running 5 minutes and walking 1 minute worked really well for him. Ultimately, Jeff had a good race and even had a negative split on the run.

According to Jeff, having a coach was the reason he was able to make it to the starting line, let alone finish. He truly believes that if he was on his own that he would have come back running far too quickly, and would likely have injured his toe again, or missed the race altogether.

Even though it was not a PR, Jeff was able to check off another IRONMAN! Success!

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Training Guide

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About Lesley Mettler

Lesley Mettler is a USAT level 2, TrainingPeaks Level 2, IRONMAN University Certified, USA Track and Field level 2, USA Cycling level 1, AFAA Personal Trainer, NASM Personal Trainer with more than 20 years of experience coaching all ages and levels of athletes, in running, triathlon, ultra running, and overall fitness. Lesley has a B.S. from Oregon State University in Sports Science, specializing in nutrition and pre- and post-natal fitness. Lesley has competed in more than 20 marathons, including winning the 2017 Antarctica marathon. Lesley is a 12-time IRONMAN, including Kona twice. More recently, she has taken on ultras, winning her age group in her first 50 miler. Learn more at Coachlesley.com or her TP profile.