Bone Stress Injuries & Fracture

Have you picked up your training load recently and just can’t shake that ache irrespective of what you do? Perhaps you’re typically in the camp of persevering with exercise despite those aches and pains… I mean if it hasn’t rendered you incapable of doing so then it can’t be that bad right? If there is one thing we see plenty of as a Physio in Sydney CBD it’s people who are high achievers and driven to see outcomes. When it comes to sport and exercise this is a great foundation, but when it comes to injury this can become a problem. Pain that originates in the absence of trauma tells us that the body has started to accrue load which is disproportionate to the capacity and conditioning of the body. This may be due to several factors including training features (intensity, duration and frequency), muscle capacity (strength, endurance, activation), biomechanics (gait mechanics), equipment (shoes and inserts), and environmental factors (training surface).

As with soft tissue, bone or hard tissue that undergoes stress and loading experiences micro- trauma which results in micro- cracking. When micro- cracking occurs the body directs little bone cells called osteoclasts into the area to help reabsorb the damage before introducing bone creating cells called osteoblasts in to help remodel the hard tissue. It is important to know that micro- damage of the skeleton is completely normal and bone turnover is a necessary process. Normally the resorption phase of bone remodelling will take around 4 weeks, and the osteoblastic (bone creating) activity tends to increase when the osteoclasts have ceased their role. The length of time that osteoblasts take to cycle through their role differs depending on type and structure of bone but can for from between 90 days to 1 year. Consistent excessive loading means that micro- damage and bone resorption will accumulate and too much micro- damage will make the bone soft, porous and prone to fracture. Micro- damage is present from day 1 of exercise and accumulates for as long as there is constant loading without adequate rest, or until cross- training (a variety of sports/ exercises) introducing different demands on the body is implemented. Importantly, people often don’t experience symptoms until at least 1 month after the initial damage is done- remember it takes ~4 weeks for a full cycle of bone resorption. It is important that we identify this presentation early to ensure that the process is halted before further micro- damage occurs and results in a stress fracture. If this happens then there is often a lengthy omission from physical activity to allow for adequate bone remodelling and calcification before incrementally loading again.

If you’re looking for a physio in Sydney CBD who has seen many of these types of injury then look no further. An extensive history will allow us to identify whether there are any other contributing factors which may need further medical intervention and relevant referrals to dieticians, sports doctors or endocrinologists may be recommended. If we are suspicious of bone stress injury, stress reaction and or/ stress fracture we will refer you for an MRI which is the best investigation to assess for changes in physiology. Otherwise, we can quickly identify which internal and external factors may be contributing and modify your loads as well as strengthen or mobilise your areas of restriction in your system to ensure optimal loading is achieved.

Don’t delay any longer, early intervention will optimise your outcomes, reduce your physio costs and prevent further medical intervention and expenditure.

Get In touch with us today.