Unit 2 Week 6: Rehab of Bone Injuries
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pathophysiology of bone injuries?
imbalance between bone damage and remodelling
what is bone bending dependent on?
age, which bones, loading cycles, etc.
osteoblasts
build new bone
osteoclasts
remove old bone
low risk bone stress injuries in runners
posteromedial tibia fibula/lateral malleolus femoral shaft pelvis calcaneus diaphysis of second to fourth metatarsals
high risk bone stress injuries in runners
femoral neck anterior cortex of the tibia medial malleolus talus (lateral process) navicular proximal diaphysis of fifth metatarsal base of 2nd metatarsal great-toe sesamoids
factors modifying load
biomechanical factors (ground reaction forces, running-gait kinematics) training factors muscle strength and endurance training surfaces and terrain shoes and inserts
factors modifying the ability of bone to resist load
genetics diet and nutriiton endocrine status and hormones physical activity history bone diseases medications influencing bone (glucocorticoids and anticonvulsants)
what is RED-S
a comprehensive model depicting a low-energy status in physically active persons • decreased glycogen stores, muscle strength, endurance, performance, training response, coordination, concentration • depression, irritability, impaired judgement • increased injury risk
principles for bone rehabilitation
• relative rest • early mobilization • early strengthening
best practice recommendations for low-risk bone stress injuries
achieve pain free gait pain relief promote bone healing maintain aerobic capacity promote MSK fitness return to running address future risk
what is treatment based on with bone stress fractures
symptom based, not time
what is the goal of relative rest
• pain free gait / ADLs (partial WB: footwear/ambulation aid/immobilization prn) • pain model 0/10 during, after, and 24hrs after • duration of the phase is symptom based
what level of pain is recommended with bone stress fracture healing
recommendation is no pain (more conservative than other tissues)
what are important things to consider with relative rest?
• avoid stressing injured tissues • maintain health/fitness/function • non WB cardio training • 0/10 pain • may require technique modification to avoid stressing site
importance of early mobilization phase
goal: restore/maintain mobility mobility - consider joint mobility required for gait pain monitoring model 0/10
importance of early strengthening phase
goal: restore/maintain strength - strength (considering propulsive muscles required for gait (anti-gravity muscles)) - pain 0/10 (may require technique modification)
example of treatment in early strengthening phase
restore walk –> jog tolerance - build to 30 min walking - conservative walk/job programming - pain model 0/10
why is it important that runners continue novel stimuli despite their resumption to running?
When runners only run and stop doing their rehab or strength work, their bones adapt less effectively. Reintroducing varied or novel types of exercise keeps the bones responsive and strong, lowering the risk of future injuries.
why is it important to increase load tolerance as part of bone rehab?
avoid recurrence transition from strength to power so the muscle generated > ground reaction forces
how would you program bone loading into a week?
jog and run the same day to give optimal rest - jog 3x a week (48 hours rest between) - run 2x a week
what factors affect adaptation?
contextual factors, age, health, injury, medical history, lifestyle behaviours, activity tolerance, activity demand
how do you determine appropriate loading for client?
• Identify clients’ floor (current capacity) • Identify clients’ ceiling (desired capacity) • Identify clients’ factors affecting adaptation (see TEP – Plan) • Plan progressive loads within clients’ tolerance • Monitor clients’ response
how should low risk BSI be managed?
using optimal loading approach guided by client presentation and goals