Understanding and Preventing a Very Different Type of Bone Fracture.

Overuse injuries can rear their ugly heads in a number of different ways. Usually we encounter soft-tissue injuries, tendons, ligaments, muscles, etc. Bones don’t typically make the “overuse” list because bone injuries are often thought of as hard breaks or traumatic injuries. However, stress fractures, or bone stress injuries are another classification of overuse injury often seen in the active population. Although the highest incidence occurs in running and gymnastics, there is an increasing incidence of bone stress injuries seen from recreational weight training and poor programming. Let’s take a little closer look.

When I say Bone Stress Injury (BSI), I mean stress fracture. A stress fracture isn’t a typical fracture from a traumatic incident. Instead, it is a type of stress that bruises the bone and wears away at the strong bony layers over time. This can eventually lead to a surface crack in the bone. Think of repeatedly hitting a piece of wood with a hard object. Eventually, the wood surface will start to break down and crack. This is exactly what happens during a BSI. It is usually seen after a sharp increase in training or activity volume, especially if there are other risk factors present. The repetitive nature of running, or jumping places a high amount of stress on the body which is why we see increased incidence of BSIs with these populations. 

The symptoms can be sharp and localized or more diffuse and general. I know, not very helpful is it? I have seen a number of femoral stress fractures over the past few months and they tend to be more non-specific whereas stress fractures in the foot or shin bone can be much more localized. This is not to say they are more or less painful, just that there can be patterns, and we have special tests useful for narrowing down the type of injury. Symptoms will start gradual and can masquerade as other soft tissue injuries. Their symptoms also tend to get better in the short term with rest from activity, but will increase suddenly when activity resumes. This is sometimes a red flag as many soft tissue injuries will have their symptoms abate with a little bit of rest. The extent of the stress fracture and prognosis will depend on a number of factors, but imaging will be necessary in addition to a full movement screen to evaluate risk factors and maximize healing. 

Factors that can increase the risk of a BSI are definitely overtraining (volume in general), but also sharp increases in activity level in excess of what the body has been used to will place a high amount of stress on the body. Please refer back to my previous blog posts regarding the Acute-Chronic workload ratio, as this can help regulate training volume. In addition to the mode and methods of exercise, critical components such as poor sleep,  inadequate recovery, poor nutrition choices, insufficient calories, and stress levels can all lead to an increased risk of BSI or stress fractures. More often than not, poor sleep, poor recovery, and poor nutrition choices are some of the big offenders in the BSI equation. 

I hope this helps a bit in shining some light on a different type of overuse injury, yet one that is equally as serious. We don’t like to mess around with the bony structure, so please keep this information in mind when it comes to organizing your fitness programming. The cliché sleep and fuel is more than just what shows on the scale. Keeping the bones resilient is of paramount importance. Next post I’ll elaborate on some other modifiable risk factors such as mobility and self tests that can help mitigate risks of BSIs. 

For now, rest up! Happy Training.

Cheers, John.