Welcome to part II of our Bone Stress Injury (BSI) blog. I also posted a Facebook Live video on BSIs and recapped the background info on the specific injury, so if you want to give that a listen then head over to our FB page. Part I talked about the nature of BSIs and how they are considered a repetitive stress injury or overuse injury. It’s less likely to sustain a stress fracture from a traumatic incident. Instead the cumulative stress over a period of time or a period of activity will result in excessive stress on a particular site of bone. So let’s take this a step farther.
The symptoms of a stress injury will usually be gradual onset and diffuse in nature. That’s not to say they cannot be significant and abrupt. In all likelihood, there will be a period of low grade discomfort that can easily be dismissed as insignificant or muscular. This is the risky window because continued activity can lead to a full blown skeletal injury if not addressed. In fact, the early symptoms can often be “worked through” or “sucked up” while the person continues their activity. This is one more reason we suggest early treatment of even seemingly small issues. If you have a very repetitive activity and start to experience low level bug nagging discomfort, then it’s probably a good idea to nip it in the bud instead of playing the risk vs reward game. Generally be on the lookout for diffuse pain that increases with activity and subsides as soon as the activity stops. There may even be swelling associated with early symptoms. If the pain starts to affect mobility, meaning you start to develop a limp then I would suggest an evaluation by a healthcare practitioner as soon as possible.
Common sites of stress fractures are the second and third metatarsals of the foot (the long bones of the foot), the heel, the outer bone in the lower leg (not the shin bone), one of the middle bones of the foot, and the thigh bone. What is the common theme here? Yup, they’re all in the lower body. That’s because some of the highest risk factors associated with a BSI are running and jumping activities or a significant increase in physical activity. People usually target large muscle groups during exercise and complex body movements such as squats and jumps, etc. Working the larger muscle groups means a lot of repetitive stress on the lower body. Consequently, that means more stress on the legs.
There are also two classes of stress fractures known as “High Risk Sites” and “Low Risk Sites.” I mentioned a few of the more common BSIs seen in practice, but the high risk sites are the ones that require a very specific focus and should not be left unattended. Initially, a period of rest is necessary once an accurate diagnosis is made. Once we feel a client may have a BSI we will refer out for imaging. Yes, it is possible to diagnose a stress fracture (any many other injuries) with a thorough clinical examination. Then it is important to pass the baton to one of our trusted physicians in the area and move forward with the other half of the equation. This is usually imaging, blood work, or any other tests or measures that will help paint a complete picture. From here a solid prognosis can be made and treatment can begin.
Bone takes time to heal, but the quicker we pick the low-hanging fruit, the faster the process will be to a safe return to activity. Stay tuned for Part III discussing high and low risk BSIs and what else we might look for.