As athletes strive to improve themselves and their performances, they often push themselves to the point of injury.
The inherent cross training by multisport athletes can decrease the number of injuries, but unfortunately it does not eliminate them. Overuse bone injuries occur primarily during the running phase of training and racing and are more common with high running mileage and in individuals training for long course events.
Overuse injuries to bone encompasses a spectrum, from bone inflammation (stress reactions) to small fractures on one side of the bone (stress fractures), to breaks all the way through the bone. Stress fractures are a result of accumulative micro damage to bones from impact, which can lead to small or large breaks.
Bone is dynamic tissue with constant bony absorption and deposition stimulated by bone stress. Micro damage is a normal process that occurs with activity and is correlated with intensity and the amount of impact.
The body usually heals the micro damage before it can accumulate, and during the healing process, the body lays down extra bone to strengthen and prevent future injuries. This process is how athletes can improve their bone density. Unfortunately, there are times when athletes overwhelm their body’s ability to heal the bone stress and the damage accumulates to the point of localized inflammation or fracture.
The factors that are correlated with increased bony damage include: high running mileage, training errors, low bone density, high ridged arches, inappropriate foot wear, leg length discrepancies, and other malalignments. The most common of these factors that I see in the office are training errors, too much too soon, and inadequate recovery time, but all of them need to be considered.
The most common sites for stress fractures in runners are the shin (tibia) and foot bones (metatarsals and tarsals). Stress fractures typically present gradually but can also start with sudden pain.
Athletes sometimes are confused when a stress fracture presents acutely. Early inflammation and stress reactions can be pain free until the fracture occurs. Localized bony pain and tenderness is the hallmark of stress reactions and stress fractures. The area of pain is typically small and about the size of a half dollar. This localization is in contrast to shin splints, where the pain is over a much broader area such as the size of a dollar bill.
Complete USAT post here