#745 How to tell soft tissue vs bone injury in a runner - DOC

#745 How to tell soft tissue vs bone injury in a runner

What are the key differences between a soft tissue injury and a bone injury in a runner? Well, that’s what we’re talking about today on the Doc On The Run Podcast.



All overtraining injuries are difficult and the problem, of course, is that you’re in a race against time trying to not lose your running fitness, but giving it enough of a rest and it can actually heal. And a runner asked me an interesting question the other day, he actually said, “Okay, if I have bruising and swelling, does that mean I’m more likely to have a bone injury or a soft tissue injury?” And the truth is, is no, it doesn’t unfortunately, it doesn’t give you an indication.

A couple of exceptions to this and I thought it might be useful to talk about it so you can understand a little bit more about the difference. The first thing is, is that when you get a lot of swelling, it means you’ve had a lot of tissue damage and you’re getting a lot of fluid accumulated.

That can happen for two reasons. The swelling can happen either because let’s say you tore the joint capsule on your ankle and ankle joint fluid is actually leaking out into the soft tissue and causing a huge amount of swelling. That’s one way you can have a similar thing where you tear a tendon sheath or the tube that goes around the tendon, and that fluid leaks out into the soft tissue causes a lot of swelling.

Anytime you get torn tissue, you’re going to get bleeding and so if you tear a ligament, you tear a tendon, you tear a joint capsule, any of that stuff, it’s going to actually bleed. And the bleeding under the skin is what you see is the discoloration of forming a bruise. This also happens with bone, much of the time, the bones tend to bleed a lot.

So, if you have a whole lot of bruising, it may make your doctor think that you probably have a bone injury or are more likely to have a bone injury because the bones really do bleed a lot when they crack. And so, if you had a traumatic injury, rather than just a stress fracture, like you roll your ankle or you step in a pothole or trip over a root or something and your foot’s really black and blue. Well, you definitely want to think about a bone injury.

But when you’re evaluating that it’s not just X-rays, many of the times you can figure this out on your own. So obviously if you’re pushing around on your foot, and you push on the hard bone and it doesn’t hurt at all, well it’s probably not broken. But if you stretch or stress the tendons, the ligaments and you have a lot of pain on the soft tissue that you’re pushing on or stretching or straining, well then it’s more likely to be soft tissue.

But unfortunately, the amount of swelling and the amount of bruising doesn’t always give you the real answer. It’s really about what happens when you stress the bone and try to determine is it actually a fracture or is it a stress fracture, is it a stress reaction in the bone or just maybe a stress response that’s actually trending into injury. Or is it the other soft tissue injury like a tendon or ligament but when you stretch and compress that tissue, the soft tissue, then it’s causing pain.

So, that’s really the big difference is it’s more specific to the exact structure and actually making sure that you’re only stressing or straining that one structure that’s been injured and if that one thing causes the most pain, then that’s what’s probably bugging you.

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