Bone Stress Injuries - Diagnosis

Bone Stress Injuries - Diagnosis

Diagnosis is an obvious, but critical step in the management of bone stress injuries.

In our last post, we looked at what bone stress injuries were and why they occur. If you missed this article, its a good place to start.

Clinical Suspicion

So how as an athlete or coach working with an athlete, how do you know if you have a bone stress injury? The short answer is that there are no perfect clinical test.

Often the development of pain is what drives an athlete to review with a clinician. However pain is far from unique to bone stress injuries. As a clinician, coach or athlete, diagnosis will usually commence with a clinical suspicion. The suspicion for a bone stress injury will be higher if you have:

  • reproduction of pain with touching or loading a bony region
  • pain described as a deep or achy at rest, which increases with loading
  • had an increase in training volume or intensity
  • a reduction in factors that promote recovery – such as sleep, increased stress, increased fatigue or illness
  • a reduction in energy intake, especially where this has affected regular menstrual function.

While answering yes to the above clearly does not mean you have a bone stress injury, it would suggest it.  It would also suggest that it is time to review with a Sports Physician or a Sports Physiotherapist.

Diagnostic Imaging

Diagnosis of bone stress injuries can be confirmed by the use of medical imaging such as CT, MRI or bone scan. However, the use of these modalities needs to be considered on a case by case basis. In instances where a diagnosis can be made confidently without imaging, where the results of imaging will not change management, or where for various reasons imaging is not appropriate, it is often possible to manage these injuries without imaging.

High-risk stress fractures such as those of the femoral neck, of the front of the tibia use of imaging represents best practice due to the propensity of these areas to progress to overt fracture and a positive finding would often drive on referral to an orthopaedic specialist as surgical intervention is sometimes necessary.

In short, making a diagnosis of these injuries is not always straight forward, but if you have symptoms, it is best to review with a health professional to discuss the best way of getting an accurate diagnosis and establishing a management plan.

Next week we will take a brief look at high and low-risk stress fractures and how this can affect management.

Michael Hedger