In our last post, we looked at what bone stress injuries were and why they occur. So how as an athlete, or as a coach working with an athlete, do you know if you have a bone stress injury?
It is important to realize that there is no perfect clinical test for assessing bone stress injuries. However, your suspicion for a bone stress injury should be higher if you:
- have a reproduction of pain with touching or loading a bony region
- have pain, usually described as a deep or achy at rest, which increases with loading
- have had a recent increase in training volume or intensity
- had a recent reduction in factors that promote recovery - such as sleep, increased stress, increased fatigue or illness
- Have had a recent reduction in energy intake, especially where this has affected regular menstrual function.
While answering yes to each of these does not mean you have a bone stress injury, positive answers should increase your level of suspicion.
Diagnosis of bone stress injuries can be confirmed by the use of medical imaging such as x-ray, 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 presumptively.
In instances of high-risk stress fractures such as those of the femoral neck, of the front of the tibia 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 orthopedic specialist as often surgical intervention is indicated.
In short, making a diagnosis of these injuries is not always straight forward, but if you have symptoms as described, it is best to review with your Physiotherapist 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.