Perma Performance

Liam, keen endurance runner, came to see us following a femoral neck stress fracture and difficultly returning to running.

Proximal stress fractures are ‘high risk’ bone stress injuries (BSI), and can be a marker of underlying issues in bone health associated with relative energy deficiency (RED-S).

BSI occurs when load consistently outpaces the bone’s capacity to adapt. Whilst training load is an important consideration, each individual’s capacity is determined by their physiological environment i.e. energy availability, hormonal status, sleep etc. RED-S impairs bone remodelling (amongst other things), meaning training load that would ordinarily bring about positive adaptation to bone can become injurious due to its reduced capacity. This is why it’s important to look beyond training load and consider contributing factors.

Through a strength lens, we know that improving the qualities of the muscle-tendon unit is vital to a successful BSI return to run. On ground contact during running, we experience forces of upwards of 2-3x bodyweight. The tissues act as the primary regulators of how these forces are transmitted to bone.

Stronger muscle-tendon units improve the ability to tolerate and redistribute force during ground contact, reducing the relative mechanical stress experienced by bone during repetitive loading. Improvements in strength also enhance economy and fatigue resistance, meaning this capacity to attenuate load can be maintained for longer throughout a run rather than deteriorating as fatigue develops. Lastly strength training also helps the bone positively adapt with appropriate strain, as plyometrics are often contraindicated initially due to high strain rate.

Using force plates allows us to look force time characteristics in key tissues and benchmark, helping us move away from time based criteria, which is a poor marker of rehab status. This is especially important when you consider the gap that occurs between offloading the limb initially, and the forces experienced when running.

No stone left unturned, back to running well. Huge improvements in force profiles over the last 8 months and recently hit a 5k PB 🤝

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