Bone health in runners: Stress fractures of the leg

After the recent easing of lockdown restrictions, I have been seeing an increasing number of patients in my clinics – both in person and also by video consultation. When the lockdown started, many people (including myself) started to exercise more – through a combination of more available time and also to increase fitness. We know that lack of fitness can be a risk factor for COVID-19 illness severity plus a whole array of more chronic health conditions. However, in some cases the extra exercise along with other factors may lead to an injury to our bones.

I have seen several patients with stress fractures and I am going to expand on why these happen and how we can manage them.

What is a stress fracture?

Normally, bone is in a healthy balance with cells that break it down and other cells that lay new bone. So in normal states, our bone lives in a healthy equilibrium. A stress reaction in the bone can happen when this balance is disturbed – when this leads to a break in the lining of the bone we call this a stress fracture. Generally speaking this can happen in one of two situations. Firstly, the bone is healthy, but the cumulative loading of the bone through exercise leads to injury. The other scenario is where our bone has less density – we may call this osteoporosis (or osteopenia as a milder loss of bone density). In such cases, the bone can be injured with much less overall activity levels.

Stress fractures can occur in any bone, but with running as an example, we normally see them in the shin bone (tibia), the foot (metatarsals) or even the hip (femoral/pelvic stress fracture). An MRI scan usually confirms the diagnosis.

How can we manage stress fractures?

The first decision is how to treat the specific injury, wherever it has occurred. It follows that if the injury is due to too much exercise, then rest will usually allow the injury to improve. Therefore stopping running, and perhaps cycling or swimming instead, can help recovery and maintain fitness. For some foot injuries, if you are limping then we may need to supply an aircast boot and crutches to further protect the bone. As a general guide a stress fracture may need between 6-12 weeks to heal overall.

If there is no clear history of excessive exercise and/or risk factors for bone health issues, then we would further investigate as needed. A DEXA bone scan involves taking X-rays of your lower spine and hip. It allows us to compare your bone density with the normal population; we can identify whether your bone density results are in the normal range, or whether they indicate osteopenia or osteoporosis. Blood tests may also be taken to look at calcium and vitamin D levels. Treatment may be needed, including dietary advice, to ensure adequate calories are being ingested. An overall assessment of whole health is also performed, including menstrual health in females as we know that this is closely linked to bone health.

This article is for information only and should not be used for the diagnosis or treatment of medical conditions. myHealthSpecialist makes no representations as to the accuracy or completeness of any of the information in this article or found by following any link from this article. Please consult a doctor or other healthcare professional for medical advice.

Dr Michael Burdon, Consultant in Sport and Exercise Medicine (and runner!)

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