Bone Stress Injuries

Contributing Factors associated with Bone Stress Injuries

INTRINSIC FACTORS

– Prior stress fracture

– Oligo/amenorrhea (Female)

– Early or late onset age of menarche (Female)

– Low lean body mass

– High fat body mass

– Ages 12.5 – 34

– Low bone mineral density

EXTRINSIC FACTORS

– Low vitamin D intake

– Low energy availability/weight loss

– New or excessive exercise patterns (particularly duration/frequency)

– Biomechanical factors: high longitudinal arch, leg length discrepancy, excessive forefoot varus, foot anomalies

Considerations in the management of Bone Stress Injuries

SHORT TERM

• Decrease bone loading

Management will depend entirely on the location and extent of the injury. For instance, significant bone stress fractures through weight bearing bones, such as the navicular, may require complete rest and non-weight bearing for a period of time. Whereas a bone stress response in the fibula may simply require training modification.

• Address metabolic contributing factors to bone stress injury

Subsequent referral to various healthcare practitioners may be required to assist in addressing the contributing factors to the development of a bone stress injury. For instance, a GP or endocrinologist opinion may be required if there are concerns for hormonal issues or other pathological processes that impair bone remodelling. Referral to a dietitian should be considered if there are nutritional deficiencies.

• Maintain fitness/strength

It is important to continue exercising whilst the injury site is being offloaded to prevent deconditioning. Open kinetic chain exercises can be great for this (i.e. knee extensions for patients with foot stress fractures).

• Soft tissue techniques/dry needling

These modalities can assist with soreness and discomfort in surrounding tissues.

LONG TERM 

• Load management

If excessive load was identified as a contributing factor, then adjusting training volume post injury is vital. This may include scheduling rest days, reducing the frequency of high intensity sessions or programming de-load weeks, ultimately giving bone tissue more time to recover from training. 

• Strengthening/plyometrics

If programmed well, strength and plyometric training are a great way to develop bone mass. Furthermore, this may also address biomechanical factors which predispose athletes to bone stress injury.

• Run technique

There are variances in running technique which may increase load directed through bones. Modification of technique may reduce the magnitude of load going through bones during running.