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When we undertake an ambitious training plan or progressively increase (in the best case) the volume or intensity of the sessions, we tend to worry about take care of our muscles and tendons, but we are rarely aware that the impacts also cause microtrauma in our bones and joints, and we should not assume that, because they are the hardest structures of the musculoskeletal system, they are exempt from suffering injuries important.
Our bones are alive and in a continuous process of formation and reabsorption, so that, like any tissue, they need the proper nutrition and rest environment to be healthy. Long bones have a spongy part – or ‘trabecular’ – inside and a cortical part, harder and denser, in its peripheral area.
The excess of load cycles in a bone can cause small lesions that end up becoming a fracture line, which in these cases we call ‘stress fractures’ (refers to the mechanical stress received). If there are biomechanical alterations, such as excessive pronation, inadequate footwear, training on hard ground or not absorbing energy, the chances of these lesions appearing is greater.
And the risk is still higher in runners that have lower bone mineral density, osteopenia or osteoporosis, which is relatively common in postmenopausal women or young athletes who train at a high level and have amenorrhea (absence of the period) or energy deficit.
Explained all of the above, it is understood that in the preparation of long-distance asphalt races (marathon, medium or greater), it is not uncommon for stress fractures to appear in bones such as metatarsals, tibia, fibula or sacrum, for Cite some of the most frequent. Over the years we have treated fractures of almost all the bones of the lower limb – calcaneus, femur, iliac … – and in almost all cases neither the patients nor the professionals who made the first consultations had suspected a diagnosis of fracture of stress.
If you think about them, they are lesions very easy to diagnose: pain appears in the race and does not usually occur in alternative activities, such as swimming or bicycle, and for this reason these are usually allowed and recommended at the time of diagnosis to not completely stop training and maintain cardiovascular work. To confirm them, magnetic resonance imaging is usually used, since initial simple radiographs are not usually detected.
When they appear it is essential to perform an analysis of all the factors that have led to their appearance. On a preventive level, rest and recovery measures are useful, especially rest, physiotherapy, nutrition and adequate supplementation, not forgetting that weight training or resistance is the one that will help strengthen our bones without risk. The runner must have a correct career biomechanical analysis and consult a podiatry specialist who can provide orthopedic aids as templates.
Almost all stress fractures they improve and heal easily following the correct loading guidelines, but it is inevitable in all of them to stop running for periods between 6 and 12 weeks. There are some of the highest risk, such as the tarsal scaphoid or the femoral neck, in which, sometimes, even surgical intervention is necessary.
* David López Capapé is a specialist in sports traumatology and orthopedic surgery.