As a sports medicine physician, I see a lot of athletes and patients who are just taking up a new sport.
I see many athletes who develop overuse injuries. The human body has a remarkable capability to heal itself, to make itself stronger and adapt to change.
While it has a remarkable ability to do this, there are certain limits. The more we stress our body, the more our bodies react to strengthen muscles tendons, ligaments and bones. When activities increase gradually, our bodies can easily adapt.
However, the mind sometimes forces our bodies to do things that our bodies cannot keep up with. The classic example of this and probably the worst case scenario, but probably the best example of an overuse injury, is a stress fracture. The word fracture means break in continuity of a bone, and it can range in severity from being “shattered” into many pieces to a few pieces, to just one specific crack or break. Those are all easily seen on X-rays.
A fracture can even occur at the microscopic level where it cannot be seen on a plain X-ray.
That is what a stress fracture is. To simplify things, think about it this way: everyday normal activities, such as walking, running or playing sports, we cause microscopic cracks or breaks in our bones. Our bones have a hard outer shell called the cortex and a softer inner matrix called cancellous bone, which looks similar to coral. The cortex is perhaps similar to a very hard coral, and the inner part is more similar to a porous coral.
When we rest or go to sleep at night, our bodies react by taking away the old “bad” bone and repairing the microscopic cracks in it by laying down new bone. Not only laying down new bone, but laying down even a little bit more to react to the stress put on the bone thereby strengthening it. That is why weightbearing activities, such as walking or running, build bone strength.
As long as we gradually increase our activities the body keeps up and makes the bone stronger. If we increase the activity faster than our body can keep up, i.e. break down more bone than the body has the ability to replace, then the bone starts to get microscopically weaker. As it starts to get weaker, pain can develop. It is analogous to when you take a paper clip and bend it several times. That area that is bent is weaker, however if you hold the paper clip far away from you, you cannot always tell that is a weak area. That is analogous to when we sometimes take an X-ray in a patient whose is symptomatic with a stress fracture and it does not show anything abnormal.
However, there are studies such as a bone scan and/or an MRI, which are almost analogous to “looking at the paper clip” or the bone with a “magnifying glass.” A bone scan is a study where radioactive dye (no more radioactive than a chest X-ray usually) is injected into the bloodstream.
It tends to concentrate in areas of increased metabolic activity. An area of the bone where there is a fracture tends to be more active, therefore more of the radiographic contrast concentrates in the area of a stress fracture. The resulting images after the body is scanned show increased activity in the area where the stress fracture may be.
An MRI is a very sensitive test, and it not only shows increased signal in the bone where a stress fracture may be, but it also shows the soft tissues, i.e. tendons, muscles, ligaments, etc. So normally you would get more information and be able to tell if it is “just tendinitis” versus a stress fracture.
Sometimes there is a fine line and the MRIs are so sensitive that it will show increased signal in the bone, but it is not necessarily a stress fracture yet it is a precursor to a stress fracture, i.e. “a stress reaction.”
Many athletes are in that category where they are asymptomatic, they are stressing their bones, but the body is able to keep up. It would show up on an MRI, but it would not necessarily be a stress fracture.
The same can be said for other overuse injuries such as tendinitis, bursitis and things such as shin splints which is a periostitis (inflammation of the surface lining of the bone).
Basically the same thing happens where, for example, every day in a tendon our body breaks down little microscopic portions of the tendon, however, at rest and at night our body repairs damage.
I will talk more about treatment and prevention of stress related injuries in my next column.
Dr. Marc P. Pietropaoli is a board certified/fellowship trained orthopedic surgeon/sports medicine specialist and is president of Victory Sports Medicine & Orthopedics in Skaneateles.
While it has a remarkable ability to do this, there are certain limits. The more we stress our body, the more our bodies react to strengthen muscles tendons, ligaments and bones. When activities increase gradually, our bodies can easily adapt.
However, the mind sometimes forces our bodies to do things that our bodies cannot keep up with. The classic example of this and probably the worst case scenario, but probably the best example of an overuse injury, is a stress fracture. The word fracture means break in continuity of a bone, and it can range in severity from being “shattered” into many pieces to a few pieces, to just one specific crack or break. Those are all easily seen on X-rays.
A fracture can even occur at the microscopic level where it cannot be seen on a plain X-ray.
That is what a stress fracture is. To simplify things, think about it this way: everyday normal activities, such as walking, running or playing sports, we cause microscopic cracks or breaks in our bones. Our bones have a hard outer shell called the cortex and a softer inner matrix called cancellous bone, which looks similar to coral. The cortex is perhaps similar to a very hard coral, and the inner part is more similar to a porous coral.
When we rest or go to sleep at night, our bodies react by taking away the old “bad” bone and repairing the microscopic cracks in it by laying down new bone. Not only laying down new bone, but laying down even a little bit more to react to the stress put on the bone thereby strengthening it. That is why weightbearing activities, such as walking or running, build bone strength.
As long as we gradually increase our activities the body keeps up and makes the bone stronger. If we increase the activity faster than our body can keep up, i.e. break down more bone than the body has the ability to replace, then the bone starts to get microscopically weaker. As it starts to get weaker, pain can develop. It is analogous to when you take a paper clip and bend it several times. That area that is bent is weaker, however if you hold the paper clip far away from you, you cannot always tell that is a weak area. That is analogous to when we sometimes take an X-ray in a patient whose is symptomatic with a stress fracture and it does not show anything abnormal.
However, there are studies such as a bone scan and/or an MRI, which are almost analogous to “looking at the paper clip” or the bone with a “magnifying glass.” A bone scan is a study where radioactive dye (no more radioactive than a chest X-ray usually) is injected into the bloodstream.
It tends to concentrate in areas of increased metabolic activity. An area of the bone where there is a fracture tends to be more active, therefore more of the radiographic contrast concentrates in the area of a stress fracture. The resulting images after the body is scanned show increased activity in the area where the stress fracture may be.
An MRI is a very sensitive test, and it not only shows increased signal in the bone where a stress fracture may be, but it also shows the soft tissues, i.e. tendons, muscles, ligaments, etc. So normally you would get more information and be able to tell if it is “just tendinitis” versus a stress fracture.
Sometimes there is a fine line and the MRIs are so sensitive that it will show increased signal in the bone, but it is not necessarily a stress fracture yet it is a precursor to a stress fracture, i.e. “a stress reaction.”
Many athletes are in that category where they are asymptomatic, they are stressing their bones, but the body is able to keep up. It would show up on an MRI, but it would not necessarily be a stress fracture.
The same can be said for other overuse injuries such as tendinitis, bursitis and things such as shin splints which is a periostitis (inflammation of the surface lining of the bone).
Basically the same thing happens where, for example, every day in a tendon our body breaks down little microscopic portions of the tendon, however, at rest and at night our body repairs damage.
I will talk more about treatment and prevention of stress related injuries in my next column.
Dr. Marc P. Pietropaoli is a board certified/fellowship trained orthopedic surgeon/sports medicine specialist and is president of Victory Sports Medicine & Orthopedics in Skaneateles.
