nutrition

When is too much exercise a problem?

by

exercise problemExercise plays an important role in assisting in the management of mental well-being. Research exists that agrees with the idea that if we are regularly active the symptoms of depression may improve (Click here to read our previous blog on exercise and depression). If we then exercise harder, it sometimes makes us feel even better and this good feeling can both mentally and physically become addictive.

A recent practice article from Heather Hausenblas and James Smoliga in the British medical journal discusses ‘addiction to exercise’, where exercise is an essential element to every day. The discussion surrounding the difference between healthy regular exercise and an addiction to exercise is important especially when injury occurs, as a reliance on exercise is difficult to overcome.

Having a physio practice in a gym based environment means we have seen clients with a reliance on exercise to the point of it being an addiction. As a general observation it is more common now than 10 years ago, but a greater number of people have a level of awareness of their need to exercise. The greatest time of concern with exercise addiction relates to when injury occurs and the ability to exercise has decreased.

Managing an unhealthy reliance on exercise involves starting with reflecting on the motivation or reasons for needing to exercise. What are your goals for exercising? If an exercise addiction is present, then we do not need to stop exercising, but rather understand the reasons and work towards a healthy exercise routine with less risk of injury and improved health benefits. Hausenblas refers to it as reducing the rigidity of an exercise routine. If you are over-reliant on running, then we may try to change the exercise routine initially and replace a run with a swim. Gradually work towards a healthy volume of exercise is the goal.

If you are reliant on exercise and don’t feel you can stop then discuss it with your GP or a psychologist. Alternatively give us a call and we can discuss your exercise routine. We will not ask you to stop but can assist with strategies to start moving towards a healthy exercise routine.

Housenblas H, Shreiber K, Smoliga J. (2017): Addiction to exercise. The British Medical Journal. http://www.bmj.com/content/357/bmj.j1745

Stress fractures in runners – 3 minutes of what, why & when

by

female runner

 

What is a stress fracture: Normal bone responses to repetitive stress can be divided into: normal response, stress reaction, and stress fracture.

Normal response: Osteoclasts are bone cells that remove bone tissue known as ‘bone resorption’. Whilst osteoblasts are cells that create ‘bone formation’. Bone is a dynamic tissue that is constantly being reshaped by osteoblasts and osteoclasts working in balance.

Stress Reaction: Repeated bone stress without appropriate rest causes osteoclastic activity to outstrip osteoblastic activity.  This osteoclast / osteoblast imbalance initially results in microfractures which when investigated shows bone marrow oedema.
 
Stress fracture: A stress fracture is when the repeated stress and imbalance continues and the microfracture progresses into a true break in the cortical bone.
 
How are they diagnosed: A clinical examination of factors such as training loads, biomechanics, location of pain, and bony tenderness, will indicate whether a bony stress reaction / fracture is a possibility. Following this various imaging options are MRI (which can show bone marrow oedema in stress reaction stages and microfractures once stress fracture develops); CT scans (not as sensitive as MRI and have associated radiation as per an XRay); Xray (which frequently doesn’t show up stress fractures in the early stages – up to 3 weeks); and bone scans (very good at detecting stress fractures but are time consuming, nonspecific and are a poor choice to monitor recovery).
 
Who is most at risk: The female athlete triad is a combination of low bone density, nutritional issues, and menstrual irregularities. Together these represent the highest risk of developing stress fractures in the female runner. However any one of these alone can also lead to a stress fracture when combined with running.
 
What else increases your risk:

  • Rapid increase in running distances
  • Lack of rest / recovery time during a period of running training
  • Inappropriate footwear relative to the foot type of the individual
  • Nicotine smoking

What to look out for:

  • Pain during or after running / exercise
  • Bony tenderness
  • Nutrition – how balanced is your diet
  • Training – running distances per week and speed of increases
  • Bone density – do you know yours? (especially if you are female and run a lot)
  • Shoes – despite the debates surrounding ‘support’ vs ‘free’ shoes, the right type of footwear is important for a lot of people!

Management: If you have pain with running organise an assessment as soon as possible. The best management is prevention but if they occur the treatment depends on which bone it is. Some stress fractures have greater risks associated and need orthopaedic specialists involved, whilst others are lower risk and can be managed conservatively. The most common strategy is to immobilise the area and often to remove any weight bearing stress through the bone.

McCormick et al (2012), Stress fractures in runners. Clin Sports Med, 31.