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Hello fellow runners,
Any thoughts on intramedullary rodding for recurrent tibial stress fractures?
This is my 3rd stress fracture in < 3 years in the middle of my posterior left tibia. The most recent happened after being cleared by PT to start run/walking, I was only in week 3 of couch to 5k with 80% treadmill running. My bones are in a great shape per the specialized endocrinologist, bone density was good and the multiple vials of blood haven't revealed an underlying reason for the fractures. My physical med and rehab doc referred me to ortho surgery to discuss having a rod inserted into my tibia and an friend who is an ortho surgery said this is the next step/best option to run.
What hasn't healed it so far....
Months and months of physical therapy
Getting expertly fitted for sneakers
Any insight is greatly appreciated!
What I did not see on the list of interventions is "gait analysis". The manner in which an individual runs has been shown to be a signficant factor in the developmen of stress fracture. Running with too long a stride, running in a manner which there is a high rate of impact loading has been shown to contribute to stress fractures. Do a browser search using terms running form and stress fracture, or rate of impact loading and stress fracture you should find a wealth of information.
Damien Howell PT, DPT, OCS
Early in your post you said 3 stress fractures, and then happened to say "healed it" prior to listing the various things you've done. Is it one fracture site that keeps getting reinjured? Or is it different sites, or even different bones?
I've heard diet can play a big role. Not sure if the blood work you reference would catch issues there but might be something to consider.
I've heard bone stimulators have a low success rate. So the fact that didn't do much doesn't shock me.
You didn't say what sort of PT you've done. Was it the same PT doing the same things or did you try different PTs? Like every profession there are good ones and bad ones. The great ones tend to assess the whole body - or for running issues at least up to your upper chest/core. I think you can spot a bad one if they only focus on the area where the pain is. So if your PT focused on just your lower leg I would look for another PT.
"Kick off your high heel sneakers, it's party time."
-- From the song FM by Steely Dan
This post underscores what bothers me about the conventional medical approach to sports injuries. Sure, you can have a rod inserted into your bone to make it more fracture-proof, so too speak, but as Damien mentions, what is going on to apply sufficient stress to fracture your bone, is more important than continually healing it. It often falls on Physical Therapists (as Jim recommends, the great ones) to supply that common sense approach to the medical process. Therefor, the gait analysis, when you are ready for it, is the place to start before this problem happens again.
There are also types of fractures for which a rod would do no good. An avulsion fracture, which is a type of stress fracture in which the surface of the bone is separated from the underlying matrix by stress frommusculotendinous attachments, would still happen, rod or no rod. Once again, this should focus your providers' attention on the biomechanics in play.
What I am most curious about, is what may be wrong with the composition of your bone that fractures would occur so easily. If you've been competitively running for less than three years, who is to say your bones are dense enough for this kind of stress? Density and mineralization of bone do not improve overnight, and it could take years of regular exercise to reverse bone loss. There may also be underlying medical reasons for softening of bone or brittle bones, and this could be due to anything from dietary deficiencies to hormonal imbalances. Have all of these things checked out before getting used to patching things up with rubber bands, duct tape, or rods.
After I posted, it occurred to me there is some distance between popular approaches to bone health and what we know now. You've already invested in exercise as a way to improve your health, skipping past the old myth that running is bad for your bones. You probably have modified your diet to enhance your athletic performance, but there is so much to know about the relationship between diet, exercise, and health, it always helps to discuss and dispel some popular notions about nourishing your bones.
Calcium has been added to so many foods, you'd think there was a good reason for this mineral, for which bone is your primary reservoir, to be ingested in bulk. They put it in everything from bread to orange juice. It turns out that most people can get enough from a normal diet alone without supplementation. The problem is that most diets aren't "normal." The average modern diet is so heavy in acid-forming foods, that there is a greater demand for calcium to be leached from bone to act as a buffer. If your diet is heavy in meats, grains, and sugars, it's not how much calcium you eat that is the problem, it is how much calcium you lose when eating these foods.
More important than calcium itself, is the ability of your body to absorb and distribute it properly. Vitamin D is another popular supplement that can aid in the absorption of calcium, but the best form of D is what you get from direct exposure to the sun in the middle of the day. Not much chance of that in the average lifestyle, and impossible in higher latitudes. For most of us, especially behind UV tinted glass and wearing sunblock, about all we'll get from the sun is UVA damage and no vitamin D production. Same for running in the morning and evening, which most runners tend to do, with or without sunblock. Too little D, and poor absorption of calcium is the result. I wish supplements were the answer, but most calcium and D on the market is of a very poor quality. There is no substitute for good food with an abundance of other minerals also required to build bone, and for unfiltered sunshine when most of us are indoors or behind UVB blocking glass.
Ever see somebody who eats healthy, but has indigestion and a bloated abdomen? Good food is of far less value when it can't be dissolved or absorbed, and popular stomach meds actually make this problem worse by interfering with hydrochloric acid production in the stomach. On the other hand, popular artificial sweeteners can kill off enough gut flora to interfere with the important end of the digestive process, when these bacteria are critical to breaking down our food well enough for vital nutrients to enter the bloodstream.
Ironically, healthy gut flora also produce another vital component in the body's management of calcium, vitamin K. Unfortunately, this by-product of fermentation is then eliminated rather than absorbed. It is fat-soluble, and the large intestine absorbs water. The lesson though, is that vitamin K2 is plentiful in certain fermented foods, which few people consume these days. This is one important item that may only be realistic for most people in supplement form.
Which ever way you choose to nourish your bones, it is only one aspect of maintaining your health and fitness for vigorous exercise like running. Body systems are about way more than what you put in. Several pathologies exist that can interfere with healthy bone growth and maintenance. Without a fully functioning endocrine system, the other body processes such as digestion can malfunction. If I were you, I would get back to my docs with some questions about your fundamental health before submitting to a patch job.
Message was edited by: James Johnson LMT