Discomfort in some form is inherent in sport and physical pursuits. We are not strangers to exercise-induced soreness, but at what point does the crossover occur between training through discomfort of soft tissue injuries and pushing into injury?
As a performance physical therapist, it is always my goal to keep runners running – in the majority of cases, “stop running” is the worst thing you can do when dealing with a soft-tissue related injury. A runner’s training often needs modifications, not an all out red light. Unfortunately, runners don’t usually find their way into my treatment room until they have blown through all the warning signs and are dealing with an injury that could have been avoided. When it comes to endurance sports, we see this most commonly as bone stress injuries or stress fractures. Up to ⅓ of runners will experience a stress fracture over the course of their career, and over half of those runners will be women (Hart, N H et al, Sept 2017).
So what is a stress fracture? A Bone Stress Injury (BSI) is not a true “fracture” in the sense we traditionally think of a broken bone where there is a clear line that has broken or cracked. A BSI is a weakening of the bone due to overload, and especially in earlier stages can often be missed on X-ray. Stress fractures occur on a spectrum of severity ranging from mild to severe, and if training is continued without medical attention, can become an actual “break”.
In the case of a bone stress injury, training needs to take a hard stop. Do not pass go, do not collect $200. Running through stress fractures can have serious consequences for long term bone health and should not be taken lightly.
So how do we identify a potential bone injury? Recognizing these common characteristics is a strong “red light” to stop training until you are evaluated by a medical professional:
– Pain does not get better with short term rest
– Aching, diffuse discomfort that may be hard to “pinpoint”
– Pain does not “warm up” or get better when you start exercising
– BSIs are often correlated with menstrual irregularities in female athletes
I want to clarify that I am not giving the “green light” to train through any injury that does not follow these patterns. If you are experiencing pain with running outside of normal muscle soreness, it’s in your best interest to get help from a professional sooner rather than later to keep from being sidelined. However, BSIs that are ignored have serious long-term impacts on the health and quality of bone tissue and should be respected and addressed immediately. If you are suspicious or unsure about your injury, err on the side of “BSI until proven otherwise” and remember that bone injuries warrant a training red light. Starting with a physical therapy consult is an excellent way to tease out where your symptoms are coming from and differentiate a “green light” from a “red light” to get back on track to healthy training. If you are experiencing any of these symptoms or are looking for a health care ally, request an appointment here!
Source:
Hart, N.H., Nimphius, S., Rantalainen, T., Ireland, A., Siafarikas, A., Newton, R.U. Mechanical basis of bone strength: influence of bone material, bone structure and muscle action. Journal of Musculoskeletal and Neuronal Interactions. 2017 Sept; 17(3): 114-139.
