Being in a state of low energy availability for even 5 days appears to negatively affect the balance of bone resorption and bone formation (4). When compared to athletes who are not training in a state of low energy availability, physically active individuals in a state of low energy availability tend to eventually present with lower bone mass, altered bone metabolism (favoring bone resorption), reduced bone strength and increased risk for BSIs. Sometimes, runners purposefully restrict food intake with hopes of losing weight in order to to look a certain way, or with the hopes that they will perform better. Sometimes runners don’t realize just how much they need to eat in order to support their activity level. The following conditions must be in place in order for healthy bone remodeling to occur:Īdequate energy availability: To put it very simply, this means eating enough calories to support your workouts AND your vital body functions. When the body systems are functioning appropriately, the additional loading is good for stimulating bone growth and remodeling, resulting in a bone that is rebuilt stronger and more acclimated to higher loads. When a bone experiences stress via either external loads (impact of your body contacting the ground) and/or internal loads (the force applied to the bone by the contraction of the muscles that attach to it), load-induced microtrauma occurs. Bone will also remodel specifically in response to being loaded. This is called skeletal homeostasis and occurs in all individuals, even those who are not exercising. In a healthy individual, bone rebuilding occurs at approximately the same, or even higher rate than it is being broken down. Your body is continually borrowing from the bone calcium stores by breaking down the bone (resorption), and then rebuilding it. Calcium is essential in many vital bodily functions such as muscle contraction, blood clotting, enzyme function, and heart rhythm. In addition to providing structural support for your body, bones are an important calcium storage system. Although we think of bones as solid static structures, on a microscopic level, your body is continually breaking down and re-building your bones. Why do bone stress injuries occur?īone physiology is extremely complex, but it is important to understand the basics in order to fully respect why a BSI may occur and how to address the underlying cause. Although they are often referred to as “stress fractures,” these injuries occur along a pathology continuum ranging from a “stress reaction,” involving inflammation of the periosteum and bone marrow, to actual stress fracture where distinct fracture lines are present (2). Simply put, a BSI occurs when a bone is unable to withstand the repetitive loading that is being applied to it. Readers should come away with a better understanding of when they might need to seek help from a qualified medical professional so they may return to running as soon as possible. The goal of this discussion is to provide a summary of the risk factors, classic symptoms, common locations, and importance of appropriate diagnosis of BSIs. I know too many stories of runners who have unsuccessfully tried to run through bone stress injuries, either because they held off too long on seeking diagnosis and treatment, or because their healthcare provider misdiagnosed the injury. BSIs are quite common among athletes, comprising over 10% of all sport-related injuries, account for up to 20% of all injuries treated in sports medicine clinics, and account for up to 30% of all running related injuries (1-3). The topic of bone stress injuries (BSIs) is very complex, and research continues to investigate these injuries so they can be better prevented and appropriately managed.
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