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Integrative Therapeutics: Bone Health

Runners take a strong interest in their overall health. They run mile after mile in all kinds of weather from the hot and humid conditions to the chilling sub zero temperatures. Some are interested in being strong and fast and others are happy with slow and steady. They value the health of their bodies to be able to continue their daily or weekly runs. One area that is often not considered is bone health. Bone health is multifaceted. Like muscles, bones must continue to remain strong to be able to run mile after mile. As we head into the winter months with snow and ice covering roads and trails, it is an important time to consider the health of our bones and consider ways to improve bone health.

Bone Stress Injury is a failure of the bones of our skeleton to withstand sub maximal forces being applied to it over time. Bone stress injuries cause edema in the bone marrow, structural fatigue, and can be noticed with localized pain, tenderness and sometimes swelling at the region. This can lead to stress fractures or full bone fractures. Bone Stress Injuries make up 20% of injuries in sports medicine clinics. There is growing evidence that Bone Density Tests should be ordered at much younger ages as the Bone Stress Injuries are increasing in much younger ages. Biomechanical, biological and anatomical factors contribute to overall bone health and potential risk for injury. Genetics contributes to peak bone mass. Dietary factors and essential vitamins are important. Lack of sleep is another contributing factor as it is associated with increased bone turnover, which is detrimental to bone health. There is research that shows bodies excrete more calcium when a person is not obtaining adequate sleep. Training history and quick changes in training (i.e. quick ramp up of running mileage or significant increased hill work) can increase risk of Bone Stress Injuries. Other examples of these could include training too much without sufficient recovery time, increasing strength training workouts too quickly, running on new surfaces or with different shoe wear.

Physical Therapy: A physical therapist (PT) will look at the strength/stability, flexibility, and biomechanics of a person’s body to help determine factors that may have, or, are still contributing to undue strain to the bones of the skeleton. It is important to find a physical therapist that has advanced knowledge in training of biomechanical problems that feed in to strain to the kinetic chain when running.

Biomechanical issues that could be sources of problems to bones are:

o Elevated rates of loading on a lower extremity that is aligned correctly

o Normal rates of loading applied to a lower extremity that is not well aligned

o Combination of above 2

o Structural alignment that cannot be altered

A PT can help identify risk factors to help you identify what may be causing strain to the bones if you are currently experiencing a bone stress injury. One could also choose to work with a PT prior to an injury developing to address the same risk factors that could lead to a problem and stop the problem before it leads to pain and having to stop running. The biomechanics of one’s musculoskeletal system are very important. A running gait assessment and gait retraining can be very helpful in correcting movement patterns that may not be efficient in healthy running contributing to bone stress injury.


Correct nutrition is essential for bone health and helping to either prevent or heal bone stress

injuries. Food is the preferred way to intake sufficient levels of the recommended vitamins. An athlete

could need up to 2500-3000 kilocalories per day to maintain adequate energy intake vs. output.

Important vitamins for bone health include: Calcium, D, Magnesium and K. Many physicians and

dieticians recommend between 1000-1500 mg/day minimum for bone health. The body can only absorb 500 mg of Calcium at one time and therefore one should try to space out the 1500 mg throughout three separate times during the day and it is also recommended to be taken with food. Milk can be an easily accessible way to achieve this. However, there are many people that are lactose intolerant or have a dairy allergy. Therefore, another option may be trying green pea milk that is said to have 50% greater calcium.


Another contributing factor to reduced bone mass may be the amount of Cortisol present in one’s body. Cortisol is the primary stress hormone that naturally occurs resides in our bodies. It interferes with the osteoblast formation which decreases bone building. For many, these levels have significantly increased with the happenings of 2020.

The following can be used when trying to determine if a pain a person is having is due to bone versus

soft tissue injury, such as tendon:

Physical Exam:


o Localized pain

o New pain

o Pain worsens with activity

o Tenderness with direct touch to the area

o Pain with hop test

o Fulcrum Test (femur)

o Squeeze Test (calcaneus)

o Tenderness with direct and indirect percussion


o Diffuse discomfort

o Pain improves with activity

o Pain has been present for awhile

o Symptoms increased with contraction of muscle

Diagnostics used to determine bone stress injuries:


o Bone Scan

Bodies are fascinating machines of bones, muscles, and ligaments. Correct interactions by each of these are important to perform efficiently. There is a lot under the skin that plays a huge role in how one can enjoy moving, exercising and running. Focus on this multifaceted machine can facilitate the healthy living style you may be seeking. Physical therapists focused on running can help you identify the correct areas to address in order to continue a long and enjoyable running career. Whether you are currently dealing with a bone stress injury, or, looking to prevent one, we are here to assist you.

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