Bone stress injuries in endurance athletes:
BSI (bone stress injury) is a common occurrence in both elite and recreational athletes. Too much training load, too quickly without adequate recovery and adaption periods can result in progressive bone overload and bone swelling which is a precursor to bone stress fractures.
Intrinsic and extrinsic factors: bone stresses have intrinsic factors – age, sex, biomechanics of your running style, foot arch profile, knee joint angles, injury history, training history/ fitness levels, hormonal status, nutrition and sleep just to name a few. Extrinsic factors include things like – type of training- frequency, intensity and duration, type of environment- trails, tarmac/ terrain, and shoe type/style/wear. All need to be considered when assessing BSI risk
Nutrition– an obvious component to bone health and recovery. Pre and post exercise rehydration and refuelling cannot be minimized. Adequate nutrient dense calories, calcium and Vitamin D (especially in Ireland), is essential to hormonal function and bone health
Sleep a lack of adequate sleep compromises the crucial recovery element of the classic training-response cycle. Sleep also provides an additional protective measure from injury as studies have shown that disrupting the normal circadian sleep rhythms which uncouples the bone remodelling process resulting in inhibition of bone formation
Balancing Training and Non-Training Stress Learning to balance and compensate for extraneous stress factors will help keep you on the road to health and wellness, there may be a need to adjust training and periodization plans to include a reduction in either total weekly distance, less intense interval workouts, or both in order to help better balance the training stress with the non-physiological stressors. Consider your base line level of fitness, and adjust your training load to build gradually with no larger jumps than 10% a week.
Meaningful but Manageable Goals so much of an athletes’ success revolve around performance target setting and meaningful but manageable goals that are both qualitative and quantitative. It is important to have smaller stepping stone attainable goals to help you feel like you are on the road to success to a bigger maybe long term goal
Respect Training age– Building endurance capacity occurs slowly over countless hours of uninterrupted training time. Trying to rush the development of this success invites injury, and very commonly bone stress injury if load is introduced cumulatively too soon without adequate time for bone/ tendon/ ligament adaption.
Supplemental exercises and professional advice- These exercises will differ with each athlete but it is important to identify key exercises that address area of weakness. Biomechanical faults can contribute to abnormal loads to bones and add to bone stresses. These biomechanical faults are intrinsic factors that need to be considered and corrected where possible. Corrective exercises can help, but also proper footwear and environmental considerations are important factors to keep in mind.
It is also essential as part of a training program to include exercises such as core strengthening, lateral hip and groin strength, foot/ ankle and lower leg strength all of which will contribute to better movement/motor control. When trying to minimize additional bone load, they can all be accomplished without putting high-stress rates on already possibly overloaded lower extremities. Endurance athletes really need to consider engaging in supplemental training. The most common supplemental training activities include strength training (described above) but also in a controlled environment plyometrics which may include single-leg hops, power skips, and other high intensity, bounding activities. Even bodyweight plyometrics can increase the force and stress on a bone by two-three-fold more than the typical foot strike of running but must be managed carefully and not during a time of high mileage running.
Unfortunately, there is no physical assessment or physiological calculator that can predict a significant stress injury is about to occur. Recognizing which athletes are more susceptible to injuries and adjust training programs to be individualized accordingly to balance the non-physiological stressors seems prudent. While we cannot control all of life stressors, we need to take into account all stressors in life and factor this in to training loads and training cycles. In some cases, training less may add up to improved physical and mental health and better, injury-free, performances.[wdi_feed id=”1″]