Dr. Laura Barreca Engel, PT, DPT
Are you having aches & pains with running that just are not adding up? Sometimes these odd pain presentations can be correlated to bone stress injuries. Bone stress injuries can occur when repetitive loading exceeds the bone’s ability to repair itself– bone then breaks down. There is such limited research on bone stress symptoms in the running population; this information is across case studies throughout our clinic here at Custom. If you are looking to understand how these injuries form and some risk factors, take a read through one of my prior blogs.
And back to some of these odd signs & symptoms, let’s dive into it. Oftentimes, stress fractures can ‘warm-up’ throughout a run. Pain will begin at run onset and will often reduce as the run continues on. These signs and symptoms vary across different bones. For example, this is a symptom that is commonly associated with bone stress injuries at the femur. In another example, bone stress at the tibia will present as worsening/progressive pain across the run. Anecdotally, this ties into different loading patterns at varying bones in the body as well as different running mechanics across individuals. Running faster/speed workouts can also be associated with these injuries ‘warming up’ or feeling better. This is because there is reduced ground contact time/loading through the bones. Interesting, onto the next.
Another odd presentation associated with bone stress is pain when off-loading to the opposite leg, often characterized as a “dull ache/throb”. A great example of this is after completing single leg stance or a single leg squat and then off-loading to the opposite extremity. Pain may pop up not during the movement itself (indicating muscle involvement) but after the movement is complete and the muscles have relaxed. This is often common in bone stress injuries at the femur or the pelvis. To add to off-loading, bone stress injuries typically improve with rest and upon returning to running, pain symptoms immediately come back. So if you take a week off and think that you are getting better, think again– going back out for a run will most likely result in the same pain you were experiencing beforehand. At this point, it is absolutely time to see a provider.
Lastly, night pain, a symptom almost always associated with bone stress injuries. This can occur in any bone and typically pops up after loading the bone throughout your day to day life and then off-loading at night. Symptoms may feel like a dull sensation, aching, throbbing or pulsing. Night pain occurs when we are sleeping because cortisol levels drop (which is an anti-inflammatory hormone). With less inflammation surrounding the bone, pain is more present (Kauvery Hospital).
The biggest indicator of bone stress is pain that does not follow a muscle group/muscle action or has an odd presentation/just isn’t adding up. Consult with your local physical therapist, specifically a running physical therapist if possible! (we see these all day every day). Allow your provider to do a full assessment to tie together all moving pieces and guide you to the next steps if this is something you are experiencing so these don’t get missed. Bone stress injuries are extremely important to catch and the sooner you catch them the better; for both healing purposes and your long-term health!