Bone stress injuries (BSI) are overuse injuries, commonly seen in runners or active individuals. When we exercise, our bones experience some level of microdamage which is then remodelled. A BSI will occur when the bone remodelling cannot keep up with the level of microdamage which then forms a stress reaction in the bone.
It is important to understand why the BSI has occurred. At Complete, we take a thorough subjective examination to understand if there were any training errors, or other lifestyle factors that may have contributed to the injury. Some risk factors for a BSI include the following:
Your physiotherapist at Complete will help you identify any contributing factors to your injury and discuss ways to address and manage these to reduce your risk of reinjury.
Treatment and timeframes for BSI depends on the location, the severity and whether the BSI is deemed low or high risk. This can be determined by physical assessment by your clinician at Complete, alongside imaging to confirm. Most BSI are low risk, and the following general principles apply for rehab.
During this phase, it is important to modify activity and reduce load through the bone that has the stress injury to promote healing. This may include not weight bearing through the area and potentially wearing a camboot, depending on the location of the injury. It is also important to identify and address any potential risk factors that have led to BSI. Strength training of the opposite leg may continue and cross-training that limits weightbearing through the injured leg may be considered here to maintain physical conditioning.
The main goal for this phase is to gradually increase weightbearing through the injured leg and restore muscle function. Continuing strength exercises of adjacent muscles such as calves, hamstrings, quadriceps, and the hip will help prepare the individual for a return to run. A progressive resistance program can be implemented specific to the muscles attached to the affected bone to help with bone growth and build its capacity. Cross-training can continue during this phase.
The final phase is returning to running and/or sport. It is important that certain criteria are ticked off before this phase is attempted, and this can usually be determined by a physiotherapist or sports doctor. A physiotherapist will implement a graduated return to running program tailored for you and your goals. Timeframes to return to running/sport vary between the location and type of BSI. It generally takes 6 weeks for bone healing to occur, so it can take around 10-16 weeks for a return to sport/performance.
It is also important to address any modifiable risk factors above (i.e. risk factors that you can change) upon returning to running and sport to reduce your risk of re-injury. This includes managing your diet, incorporating strength training, and making sure you have adequate rest and sleep.
Addressing some of the modifiable risk factors above (i.e. risk factors that you can change) can help reduce your risk of a BSI.
Diet: It is important that you have a well-balanced diet when exercising and especially when exercising at high volumes. This is to ensure that we have Energy Availability to not only fuel us during exercise, but for other hormonal and metabolic processes that occur day to day.
Strength training: Incorporating strength training into your exercise regime not only helps build muscle strength, but it also helps increase bone strength (by increasing bone mineral density). Studies have shown that increasing your running load will not increase your bone health/strength, and therefore some sort of strength training should be included to help reduce risk of BSI. 4 simple lower limb exercises that you could include to help build strength and improve running performance are the following:
Adequate rest and sleep: Ensuring that your body has time to rest and recover is very important in reducing your risk of injuries and BSI. You should aim to get 7-9 hours a night to allow your body to recover.
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