Anatomy of a stress fracture – Triathlete

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When it comes to running or overtraining triathlon injuries, stress fractures (or orthopedic stress injuries) are often the scariest, with good reason, as they can quickly shut down the season. It seems to be especially prevalent in the triple world this year, like everyone Lucy Charles Barkley to me Lynsey Corbin They had stress fractures. But it’s not just professionals who are affected. up to 30% Among all the injuries associated with running are orthopedic stress injuries, marginalizing age groups for weeks and months. So what are stress fractures, and how can you avoid them?

Related: Why are so many triathletes injured this season?

What are stress fractures?

Bone stress injuries are overwork injuries that occur when repetitive mechanical stresses on bones Cumulative partial damage At a rate that outpaces bone remodeling and repair, resulting in collapse and micro-fractures. Normally, with loading activity initially, the cells are called osteoclasts broken bone. If rest is sufficient, cells called osteoblasts repair the damage and strengthen the bones. If not, osteoclasts outgrow osteoblasts, and osteoclasts weaken.

Stress fractures vs stress reaction

There are stress injuries to the bone via a continuum. In the early stages, small damage accumulates and pathological changes may occur, but the athlete may not have symptoms yet. If the upload continues to outpace the redesign, an infection can develop into a file stress reaction, which is characterized by edema (swelling) within the periosteum (the outer lining of the bone), or the bone marrow (the inner filling of the bone). Stress reactions can develop into stress fractures, where a clear fracture line also appears on imaging with disruption of the bone’s dense outer shell, called the cortex.

Where do stress fractures occur?

Not surprisingly, most orthopedic stress injuries in runners and athletes occur in the lower extremities. Usually the shin bone or the shin bone Most popular site With the metatarsal, femur, navicular, fibula, and sacral bones following. The lumbar spine or pelvis may also be affected. The long bones (tibia, femur, fibula) tend to be the most affected in distance runners due to loading patterns associated with the backhand styles of the foot, while the forehand styles associated with higher velocity for shorter distance runners tend to load the bones of the foot (metatarsal, marine) to greater degrees. Individual biomechanics and loading patterns vary, so orthopedic stress injuries must be considered across the board.

(Photo: Getty Images)

Risk factors for stress fractures

Exacerbating risk factors for orthopedic stress injuries can be categorized as endogenous (internal athlete characteristics), or exogenous (athlete exogenous factors). Intrinsic risk factors are usually related to the ability of the athlete’s bones to resist load, and anatomical or biomechanical characteristics.

Factors that may predispose Athlete to bone stress injury by weak bones include genetics, some metabolic bone disorders, High cortisol levelssome medications (which are corticosteroids) are low in vitamin D and calcium levels, and (a big drug in the world of triathlon and long-distance running), Low energy availabilitywhere calorie intake is not proportional to expenditure.

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Females are more susceptible than males, especially females whose first menstruation is late, irregular menstrual cycles or absent periods. Low testosterone levels In males it can also be a risk factor. Unfortunately, when it comes to stress fractures, many athletes will not be one: Previous History Orthopedic strain injuries are a strong risk factor for one in the future.

emphasis anatomical and biomechanical Factors that may alter bone loads have been linked to the risk of bone stress, including discrepancies in leg length, flat or high-arched feet, and smallest leg muscle measuring. From a biomechanical standpoint, runners with knees that tend to collapse during midway or higher load rates on initial contact (as in those who overstep their stride) may also be at greater risk.

Externally, many Training related factors It has been suggested to contribute to orthopedic stress injuries. As expected, they often develop after increases in training, especially running load. Large volumes increase bone loading cycles, while high speeds increase forces acting on bone. In addition, with fatigue of the muscles, their ability to cushion shock decreases and changes occur, which leads to a higher stress transmission to the bones. For other factors, evidence of running surfaces and shoes generally mixedBut some studies I showed Increased risks associated with harder training surfaces and worn running shoes. Interestingly, while higher training loads increase the risk of bone stress, a longer history of physical activity may be protective against them, as bones may have strengthened in response to chronic loads over the years.

How is a stress fracture diagnosed?

Orthopedic stress injuries are successfully treated as they are detected early. What might be suspicious? At first, the symptoms may be vague and easy to confuse with other, less sinister diseases. Pain Most often during activity, especially running, that does not subside as running progresses, is usually the first sign, followed by pain that persists after activity or with any weight bearingAnd, finally, at rest or at night too. In certain areas where the bone is more superficial (tibia and foot), there is a localized area of ​​tenderness over the bone, while deeper injuries (ie, in the thigh bone) may cause more diffuse pain.

Several rapid self-exams can help indicate a bone stress injury. The single leg hop test, Performed just as it sounds, it has shown great success in the self-diagnosis of orthopedic stress injuries. Basically, pain upon landing impact may indicate a stress injury to the bones of the lower extremities. The fulcrum test, which includes placing the forearm under the suspected thigh, applying pressure to the knee, and assessing pain is useful for identifying potential femur stress injuries. Self-diagnosis is difficult, however, and imaging will be needed to be sure.

Related: What provider should I see for my injury?

How long does it take to heal a stress fracture?

If you think you may have an injury due to bone stress, stop the severe and provocative impact (She is running), and call your doctor – you can’t “train” a bone stress injury. An X-ray is often the first imaging test done, although it is done low sensitivity To detect orthopedic stress injuries, only more advanced injuries with distinct fracture lines or spikes will appear. orthopedic examinations Sensitive to detect activity in bone, but they are unable to visualize the degree of injury directly. MRI, then, is the gold standard for imaging bone stress injuries, as it can show periosteal reactions, bone marrow edema, and fracture lines, and can help determine the severity of the injury. Bone stress injuries can be assigned ‘scores’ based on MRI findings, which can help Determine the general prognosis And recovery time as well.

Recovery time, degree of training, and activity limitations for orthopedic stress injuries vary based on the location and severity of the injury. Some areas where the bones are either under high tensile pressure and/or have insufficient blood supply are considered “high risk,” meaning they are prone to displacement, delayed healing, or nonunion. these areas It includes the femoral neck, the anterior tibia (the front part of the tibia), the medial malleolus (inner ankle bone), the patella, and, in the foot, the navicular bone, the sesamoids, and the base of the fifth metatarsal. less risk The areas include the lower and posterior part of the tibia, fibula, and the rest of the metatarsal. Injuries involving Pelvis, sacrum and thigh It tends to fall somewhere in between. a reconsidering Across all types of orthopedic stress injuries, the mean time to return to play was found to be about seven weeks for the lowest grade of injury, 10-12 weeks for the intermediate grade, and 14 weeks for the highest grade, where fracture lines are. So, in general, plan for 6-8 weeks for those low-grade, low-risk injuries, and anywhere from 4-6 months for high-grade, high-risk injuries. Unfortunately, some high-risk fractures require additional medical intervention (surgical fixation, bone spurs, medications) to resolve, further delaying healing time.

Athlete in walking shoes and crutches wondering can I train with a stress fracture?
(Photo: Getty Images)

Can I train with a stress fracture?

The first line of treatment for orthopedic stress injuries is activity modification, and in some cases where standing and walking are also a concern, unprotected or unprotected weight bearing. Universally, high-impact activity (such as running) should be avoided until the injury has healed, and the area is pain-free. Otherwise, the degree of activity restriction will depend on the degree and location of the bone stress injury. Low-grade, low-risk fractures (ie, tibial stress reaction) may require restriction from running while swimming and bike training. can be preserved.

For moderate-risk injuries, or low-risk injuries of higher grades, cycling may need to be restricted, as you can still put pressure on the bones, although there is no effect, while water training can continue (swimming, running in the water) . Anyway, pain must be used As a sign of increased pain during or after activity, it indicates too much bony loading for the recovery phase. High-risk fractures often stop training completely. Muscle tensions or any movement at the fracture site is risky, which means that complete rest is needed, most likely including immobilization and/or no weight bearing (hello, crutches!) on the affected limb.

Another consideration is energy balance. When a lack of energy is implicated in the development of a bone stress injury, priority should be given to rebuilding the body’s reserves and reversing the deficit over trying to be a cross-training champion, digging the hole deeper. Other influencing factors (vitamin D deficiency, Menstrual disorders) should also be addressed by appropriate medical professionals before resuming training, and deficiencies in biomechanics and strength should be evaluated. Also remember that the above healing timelines are intended to be guidelines for bone healing, not to “jump straight back into normal training” – as a rule, plan for a week of gradual return To the full training load for each week it takes the bone stress injury area to become pain-free.

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Unfortunately, orthopedic stress injuries occur frequently in athletes and runners, and are a source of much wasted training, racing, and physical and emotional pain. Through proper identification of risk factors, early detection, training modification, and a gradual return to activity, though, they can be successfully overcome, or – even better – prevented in the future!

Related: Injury Guide for Triathlon Athletes

Jenny Hansen He is a physical therapist. Iron Man Championa USAT Level 1 Triple Instructor with QT2 systems. Hansen has a background as a college and professional runner, as well as a number of professional triathlon platforms. She has been in the sport for over a decade.