Understanding Bone Stress Injuries

What is a Bone Stress Injury?

Definition: the symptomatic break down of the bone structure due to repetitive submaximal loading. 

It is natural and healthy for bones to be loaded, stress injuries only occur if bone is overloaded and pushed further than the bone can adapt/recovery too. Bone mass, density and how bone mass is distributed influences how bone copes with different forces. This means bones with larger cross-sectional areas cope with tension and compression load better. 

When bone is subjected to loads that are higher than expected the remodelling process is initiated to increase bone mass and density, to make the bone stronger and more capable of coping with higher loads – this adaptation process takes time.

If the bone is exposed to more load during this process -this leads to bone microfractures and symptomatic pain. 

The Bone Stress Response Cycle:

There Are Three Stages of Bone Stress Injuries 

1. Bone Strain 

• No clinical signs or symptoms 
• Bone oedema in the absence of pain 
• Could be part of the normal pattern of loading (osteoclasts)

2. Stress Reaction 

• Clinical symptoms of pain with activity, tenderness on palpation and +ve clinical tests
• Symptoms are subtle and usually present in the beginning of activity which improves/subsides throughout the session, which might return towards the end of the session
• MRI can usually detect active bone pathology. 
• Important to diagnosis at this early stage to prevent stress fracture and allow bone healing. 

3. Stress Fracture 

• Clinical symptoms with the presence of radiologically active bone pathology and a fracture line is confirmed
• Pain is reported with repetitive activity 
• Load management is essential to allow healing of stress fracture, a period of unloading is recommended 

Risk Factors for Bone Stress Injuries 

• Sudden changes in load
• Sustained high volume activity 
• Unfamiliar activity 
• Aerobic threshold levels 

Common Areas for Bone Stress Injuries

• Tibial bones stress – shin splints
• Lumbar spine – spondylolysis
• Pubic bone stress 
• Navicular Bone stress 

If you have experienced any of these symptoms and continue to do so, it is important to get it checked out and ensure you are not doing any more damage. It is also important you have the right people programming and monitoring the loading from week to week.

Want To Know More

If you would like to know more about this topic or Physio related issues in general, we’d recommend booking a session with one of our team, such as Lael Kassem who wrote this article.

How Do I Book An Appointment with Precision Athletica for Help?

We’re taking the health of our clients, members and staff very seriously and our preference would be for you to call to book an appointment so that we can make sure to explain our approach to keeping you safe. You can call our bookings team to schedule a session:

• Customer Support Centre: 02 9764 5787
• OR email us at: olympicpark@precisionathletica.com.au