Friday, October 12, 2007


Defn: Is generally considered to be an overuse injury that produces an inflammatory reaction and pain, usually along the border of a bone. Most authors agree that the pain is associated with bony periostitis, rather than the previous theory of musculotendinous inflammation

Etiology: Most studies suggest that excessive pronation, foot instability, along with a change in activity, such as type of shoes, or running surface causes increased stretch and eccentric contraction on the tibialis anterior muscle. This causes increased traction forces at the periosteal-fascial junction resulting in periosteal oedema or microfractures of the cortical bone.

Clinical features: Recent studies using MRI scans have revealed what the majority of authors thought - that periostitis occurs prior to the formation of a stress fracture (Anderson, et al., 1997; and Fredericson, et al., 1995). This therefore makes it extremely difficult to differentiate clinically between the two, because of the similar signs and symptoms.

Symptoms: It a condition also exaggerated by exercise and relieved by rest. The pain description can vary from a dull ache to severe pain, especially with prolonged activity. The patient will nearly always confirm that the pain is along the border of a bone.

Treatment: Since most authors agree that periostitis precedes most stress fractures, the treatment is basically the same. The patient must be aware of the implications of developing a stress fracture if activity is not modified. The treatment relies heavily on rest followed by gradual resumption of exercise. Rest can be considered a relative decrease in the offending activity to a level which is comfortable. In the acute phase cryotherapy, ultrasound and physiotherapy are recommended, while the chronic stage involves the use of massage, heat, trigger point therapy, ultrasound, shoe modification, and taping procedures. Orthotics should be prescribed to assist athletes with excessive pronation or abnormal subtalar mobility. Should these conservative measures fail, anti-inflammatory drugs and steroid injections may be of benefit.

Ok, lesson over....

I had a bone scan yesterday and the diagnosis is periostitis. Better than a stress fracture I guess though looking at the treatment, I can't really see the difference! I can try some 'running' ie 90sec jogging followed by walking and repeat this several times. The sports doc looked at me very firmly as she was saying this and then, to add insult to injury, ended her lecture with "so don't go out tomorrow and run for 30min". *sigh* She knows me too well....

If, in a fortnight's time, it is still sore, then I am to have a cortisone injection. Ouch.....

So what have I been doing in the meantime to compensate for no running?

Well, there was a trip to Merimbula last weekend for a spot of whale watching - unreal, amazing, incredible. The weather wasn't great and it was very windy and the ocean was very choppy but to our credit, no-one in our little group threw up. We must've seen around 20 whales - it really was sensational. There was also a visit or two to Truffles, a chocolate cafe. And highly recommended is a little cafe in Nimmitabel called CJ Harveys - and no, I don't have shares in it! But it serves great coffee and food - the toasted chicken panini was to die for. We stopped there for lunch on our way back to Canberra last Sunday.

I visited KokoBlack here in Canberra a fortnight ago - the first time since it opened in June this year. Here is the link: drooling permitted!: *And girls (and boy), and you know who you are (!),* I'm going there again this Sunday for afternoon tea with friends AND again in a fortnight's time for morning tea with another group of friends! So texting me while I am in my sick bed to tell me you are at KokoBlacks did not have the desired effect of making me jealous....well, ok, a teensy little bit!

So, no running but a lot of chocolate consumption! I'm morphing from Fit CJ into Fat CJ!!!!

Until next time.......

ps Congratulations to everyone who ran the Melbourne Marathon - you did well, given the circumstances some of you experienced. Well done guys, I'm very proud of you.


beartoes said...

You need to be careful with any of these types of injuries. REST is the biggest reliever to most problems. Take it easy for a bit, then you can get back to doing your activity in earnest. Tendonitis Symptom

2P said...

Chocolate is a little known but highly effective anti-inflammatory so go for it CJ ;-)

You will be back to your best in no time.

TA and the Gnome said...

Ahh, that explains the silence. I hope it improves and don't worry about the cortisone. It may hurt more for a couple of days but then it gets better so quickly.


Ewen said...

Strange... the Etiology didn't include "dramatically sudden and excessively long, hilly runs with 2fruits". Good that it's not yet a stressie. Do what the quack says CJ - we want you back doing long runs over summer.

Strewth knows who she is?

Tesso said...

A KokoBlack in Canberra - dang! And Katy and I thought we were being soooooo smart. Oh well, back to the drawing board. Expect more texts soon!

Two Fruits said...

I have retired from coaching, is it coincidence the pupils develop stress fractures. Too much stress for me too.

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