Bone Stress Injuries:- Pt2
In our previous blog you learnt a little bit about about bony stress injuries (BSI), who are at risk and what you can do to reduce your chances of developing them. This week, we will talk about how we diagnose you with BSI and what needs to be done to get you back tracking your progress on Strava.
So, to recap, the faster you pick up a BSI the faster your recovery is likely to be. It is one of those injuries that start as a niggle, and if you do not listen to it, it can become a debilitating and long-lasting injury. Occasionally, even surgery is required to help you along!
How do we diagnose you with a stress fracture (BSI)?
During your physiotherapy assessment a thorough history will be taken. We will discuss your running program in detail, ask about your nutrition and other things, like general health, medication, stress levels, sports, work and family commitments.
After we’ve given you the third degree, we have a good look at your injury:
Palpate (touch) the area you are experiencing pain in. Bony tenderness?
Get you to hop a few times or do other specific loading tests (low evidence) especially if the area is difficult to palpate.
There is a high chance that we will refer you for imaging if we suspect that you have a bony injury. An X-ray will be done first, and if nothing shows up on X-ray but your symptoms are in an area that is considered as ‘high-risk’, or if you are still in pain after a couple of weeks, then you will be sent for an MRI.
Did you know that if you are under the age of 16 years your MRI can be bulk billed in Victoria?
A combination of your symptoms, location of your pain and imaging results would result in a diagnosis of a BSI.
I have been diagnosed with a stress fracture or BSI, now what?!
Depending on the classification of your injury we might refer you to a sports physician. If the injury is classified as ‘high-risk’ then surgery will often be recommended.
On the other hand, low-risk BSI generally heals well with modifying your activity levels and gradually returning to running once able. It is also important to address any other factors that might be putting you at risk of developing another BSI in the future. For example, managing your training load, and improving your bones’ ability to take load and correcting your running technique.
Regardless, our first aim is to have you pain free with day to day activities with the use of footwear, a brace, boot or crutches. Eliminate night pain, or pain at rest to avoid the use of pain medication and non-steroidal anti-inflammatories as they can delay healing and mask your pain.
Once that is achieved, you need to maintain your aerobic fitness – yes, you will still exercise! Safe examples include swimming with a pool buoy, deep water running (with modifications), seated cycling. All of these activities need to be pain free for them to be suitable.
At Reload Physio we will ensure the range of motion of your affected joints are not compromised and maintain muscle activation with manual therapy and home exercises. We will work on ‘imbalances’ and biomechanical contributing factors so that it is a smooth transition back to a gradual canter.
You will also be given a tailored return to loading program. It is slow and gradual and will include strength training as well as running. Generally, if you’ve had six weeks off it would take a minimum of six weeks to reload the area. Your patience is key, after all slow and steady wins the race!
Other areas that might need to be addressed include your nutrition and energy intake. A sports dietitian is an invaluable resource and your physiotherapist will refer you to the best in the business if indicated. Your use of medication (especially glucocorticoids and anticonvulsants) might need reviewing, and, in females, your menstrual cycle will need monitoring.
Moreover, it is crucial to have a good support team around you. Your family and friends, as well as a good medical team are essential to get you through the weeks where you are not training, or not training as much as before. Try to catch up with your usual running friends over a cuppa, instead of hitting the pavement!
Physio Carla Bywater is a physio with extensive experience in running, crossfit and other high load sports as both an athlete and a physio.