Feisal Zaw, Physiotherapist (Leeming clinic)
Running has become extremely popular again and this season is well and truly off and… well… running.
Running is an excellent form of cardio. It’s easily accessible and can provide mental and emotional benefits as well. Whether you’re training for your next marathon or have just started your running journey, it’s important to stay on your feet.
Running puts repeated load through your bones. We often focus on muscles, tendons and ligaments but bone is a living tissue that also needs time to adapt.
A stress reaction is the bone telling you that it’s struggling with the demands placed upon it. If we can identify this early, most stress reactions are easily managed. Conversely if they go untreated, they can progress into fractures which can range from weeks to months to resolve
What Causes Stress Injuries in Runner?
When running, there is a repetitive impact force that comes through the ground known as your ground reaction force. When running at a manageable and healthy load, there is microtrauma that happens in the bone. With adequate recovery, the bone adapts by replacing the area with stronger bone. This is so the next time you run, your bones are resilient to these impact forces.
A stress reaction occurs when the rate of bone damage outpaces the natural healing process:
- OVERLOAD
- Too much too soon: increasing running distance and frequency too quickly
- Inadequate Recovery:Not giving the body time to recover after a running exposure
- Increased force due to surface: Changing to a surface you aren’t adapted to such as going from grass to court/concrete can increase the impact.
- MUSCLE FATIGUE
- Losing your ability to absorb shock through the muscle-tendon unit significantly increases impact forces
- BIOMECHANICS
- Running Gait: Certain running gait styles like overstriding or being heavy-footed can increase the stress on certain joints and bones
- Worn footwear – can increase stress on certain areas
- BIOLOGICAL FACTORS
- Low Bone Density: means the bone cannot handle the impact forces as well as higher density bone tissue. Hormones can also play a big factor here with low oestrogen (in women) and testosterone (in men), which can slow down production of bone and accelerate bone loss.
- Low Calorie Intake: links to poor recovery. If you aren’t eating enough calories to fuel your runs, you deprive your body of the ability to repair bone.
- Nutritional deficiencies: Low calcium and vitamin D intake takes away the essential building blocks for bone production.
THINGS TO LOOK OUT FOR:
- Pain that worsens with activity- progressively more pain as you do more activity.
- Localised tenderness- when pressing on a specific spot/ bony prominence
- Night pain/Resting pain – pain that lingers around when you aren’t even on your feet.
Treating Bone Stress Injuries
- De-load and rest
These injuries need time more than anything. Have some time off your legs and let the bone repair itself. Gradually resuming your load over time will be the way to go.
- Physiotherapy
Guide your rehabilitation to strengthen and lengthen the right muscles involved in running. This can help address any biomechanical issues or weaknesses that could have contributed to the injury in the first place.
- Refer onwards
If ‘conservative management’ is not successful or the stress reaction is more severe (ie. A stress fracture) then referring for imaging and potentially a sports doctor would be the next steps. Your physiotherapist should be able to guide you on this.
To wrap up
Bone stress injuries and fractures can be a scary thought. However, these are easy to manage if you can catch them early. Look out for those early signs above and always make sure to increase your training load/intensity in a gradual fashion.
Our physiotherapists can assess your biomechanics, running gait and mobility to identify any deficits that could be contributing to your pain. If you’re stuck or unsure about your symptoms, reach out to the team at Physio73.
