Bone stress injuries (BSI’s) are injuries commonly seen in the lower limbs, such as the foot and shin, but can also present in the upper leg, hip and lower back. BSI’s are characterised by sharp pinpoint bone pain which worsens with activity and eases with unloading. Clinically, those with a suspected lower limb BSI may have pain with general weight-bearing activities such as walking, squats, calf raises or hopping. Those with BSI injuries in the low back commonly complain of pain during the golf swing or throwing movements such as cricket bowling, but can also be aggravated by regular running.
BSI’s generally occur as a result of a large amount of impact activity which is above what the bone can tolerate. Although bone is the strong, robust scaffolding of our body, it is also a changing structure that responds to the loads that we place on it. The normal response to a gradual increase in load, for example slowly increasing your running, is for the bones of the lower limbs (in particular) to thicken and strengthen. This is a positive adaptation for our body, however we can also see the opposite effect when there is a prolonged period of inactivity, where we can see a relative weakening of the bone stock.
This bone remodelling process is quite slow and as such, if we quickly increase the amount of impact activity that we are doing – for instance going from one 5km run a week to three 5km runs a week, or going from not running regularly to a spur of the moment decision to run a 10km fun run – we can get micro-trauma through the bone matrix which is above what the body can repair in the short amount of time in which it has occurred, resulting in a BSI.
BSI’s are a continuum in terms of severity, and management of the issue is dependent on both where on the continuum the injury sits, as well as the location of the injury. Early stage BSI’s are called a stress reaction (without a true fracture), which if not treated in time can progress to a stress fracture (true fracture). These injuries can also be categorised into low risk and high risk depending on the location. Low risk BSI’s can be managed without a scan or any period of non-weight bearing, where high risk areas may need a period of non-weight bearing or possible surgical intervention.
Conservative rehabilitation for low risk BSI’s can take around 6-8 weeks on average to return to full activity and are guided mostly by symptoms which is good news, as you can remain quite active. High risk BSI’s are a longer rehabilitation and are dependent on the type of management required (surgical or non-surgical). Regardless of the severity and location, physiotherapy should involve identifying any risk factors that may have contributed to the injury developing and developing a plan to train around the injury to keep you as fit and active as possible.
As you can see, Bone Stress Injuries are complex and can be frustrating to manage particularly if you are an active person. A thorough assessment and treatment plan is needed in order to properly rehabilitate BSI’s and reduce the risk of of recurrence. If you think you are dealing with something similar to this, book into the BeFit clinic to see one of our experienced physiotherapists to start you on the path to full health.
