Understanding Bone Stress Injuries & Stress Fractures
What Are They?
Imagine your bones as living structures that constantly repair and rebuild themselves, especially when you exercise. Bone stress injuries (BSIs), which include what most people call "stress fractures," happen when your bones are put under repeated stress or strain – for example, from running or other activities – faster than they can repair themselves. It's like constantly bending a paperclip; eventually, it will weaken and might even break.
A bone stress injury isn't always a full break right away. It's more of a scale:
Early Stage (Bone Stress Reaction): This is when the bone starts to get irritated and swollen from too much stress. You might feel a mild, general ache that only bothers you when you're active and goes away with rest.
Later Stage (Stress Fracture): If the stress continues, the bone can develop a small crack or fracture. At this point, the pain is usually much stronger, might happen during everyday activities like walking, and could even bother you when you're resting or at night.
Where Do Bone Stress Injuries Commonly Happen?
While they can happen in many bones, they're most common in bones that bear a lot of weight, especially in runners or athletes. Some common spots include:
Hip (Femoral Neck)
Kneecap (Patella)
Shin Bone (Tibia) – often felt as "shin splints"
Small bones in the foot (Navicular, Talus, Medial Malleolus, Big Toe Sesamoids)
Lower Back (Lumbar Spine)
How Do We Find Them?
If a doctor suspects a bone stress injury:
MRI (Magnetic Resonance Imaging): This is usually the best first test. An MRI can spot those early bone stress reactions and swelling that might turn into a fracture later on.
X-rays: X-rays are often not as helpful in the early stages because they don't usually show the problem until a more obvious crack has formed.
CT Scan (Computed Tomography): If a stress fracture is clearly suspected, a CT scan can give a very detailed picture of the fracture itself.
Why Do They Happen? (Risk Factors)
Several things can increase your risk of getting a bone stress injury:
Sudden Increase in Activity: Doing too much, too soon, especially weight-bearing activities like running, without enough rest. Your bones need time to adapt!
Changing How You Move: How you run or move can put extra stress on certain bones. Good, supportive shoes and proper technique are important.
Not Eating Enough (Low Energy): If you're not getting enough calories, your body doesn't have the energy it needs to repair and build bone. This is a big concern for athletes.
Weak Bones (Low Bone Density): If your bones aren't as strong as they should be.
Hormonal Issues: In women, losing your period (secondary amenorrhea) can be a sign of hormonal imbalances that affect bone health.
These last three points (not eating enough, weak bones, and hormonal issues) are part of something called "RED-S" (Relative Energy Deficiency in Sport), which helps identify people at risk.
How Are Bone Stress Injuries Treated?
The main goal is to give your bone time to heal.
Rest from the Stressful Activity: This is the most important step. You need to stop or significantly reduce the activity that caused the injury to prevent it from getting worse and allow the bone to recover. Healing typically takes around 6 to 8 weeks, but it can vary.
Daily Activities: You can usually continue with daily activities that don't cause pain. How much weight you can put on the area will depend on where the injury is and how severe it is.
Staying Fit (for Athletes): If you're an athlete, you can usually keep up your fitness with activities that don't put stress on the injured bone, like swimming, cycling, or water-based exercises (hydrotherapy).
Medication Caution: Try to avoid medications like ibuprofen (NSAIDs) if possible. While they help with pain, they might interfere with your body's natural healing process for bones.
Nutrition: If your bone density scans show you need it, your doctor might suggest calcium and Vitamin D supplements. Ideally, though, you should try to get these nutrients from your diet.
Getting Back to Activity (Rehabilitation)
Once your pain has settled during daily tasks, and the bone starts to heal, you can begin a gradual return to your normal activities. This process is tailored to you, depending on your specific injury, but generally involves:
Gradual Increase in Activity: The key is to slowly and carefully increase the amount of stress on the bone, making sure not to overload it.
Strengthening Exercises: You'll start with exercises to build strength in the muscles around the injured area.
Plyometrics: These are exercises that involve jumping or hopping, introduced gradually.
Return to Running/Activity Program: If you're a runner, this usually starts with a "run-walk" program, slowly increasing your running time and distance.
Throughout your rehabilitation, your physiotherapist will be watching closely for:
No Pain During Exercise: You shouldn't feel pain while doing the exercises.
No Pain the Next Day: It's crucial that you also don't have increased pain the day after your exercise. This tells us your bone is coping well with the increased activity.
If you feel pain, it means you're doing too much, and you need to ease back to a level that feels comfortable. This is very important to avoid re-injuring the bone and disrupting the healing process. If you find it hard to manage this on your own, a good physiotherapist can guide you step-by-step through this recovery journey.
