Osteoblast versus osteoclast, the battle that’s rebuilding bone after a stress fracture. That’s what we’re talking about today on the Doc On The Run Podcast.
When you get a stress fracture, you obviously want the little bitty crack in the bone to heal. And how do you do that? Well, you do a couple of things. Number one, you have to actually leave it alone and stop bending or torquing or twisting the bone in a way that actually led to the crack in the first place and then you have to let the healing process take place.
At first you have inflammation and then after the inflammation goes away and you get some collagen stabilizing the bone forming what we call a bone callus, you start to get ossification of the bone where it turns into hard solid bone that you can run on. And that happens through a combination of two different types of cells in the bone called osteoblasts and osteoclasts, one with a B one with a C.
One of them builds bone and the other one takes away bone and you have to have them together. Why? It’s really simple. When you get the soft callus and you have ossification starting, you get woven bone or sort of looks kind of like sponge like that actually forms in all different directions in a web that creates a little scaffold and it’s fairly stable and it holds it more stable than the soft callus. However, you have to make it really solid when you have something like a metatarsal stress fracture, and that comes through the remodeling process.
Basically, what you have with the osteoblast cells and the osteoclast cells working together is that you have one cell that goes down a row and actually eats away this disorganized bone and then another comes behind it and lays down bone in a linear fashion that’s very rigid and stable. And if you look under a microscope, at a bone that’s cortical bone, and you look at the structure, but you’ll see these circles all lined together, like bundles of pipes lined up together, all of those linear tubes of bone are called haversian canal systems, and they actually make the bone significantly stronger. And you really want that string if you want to run on it and not have a crack again.
Having that is allowing these two cells to work together. Sometimes there are things that you can do that will change the actual rate at which that happens. For example, when we do surgery on somebody, we put an external fixator frame on their foot that holds everything still. Once it starts to hear we actually loosened it up and that changes the balance of the osteoblast and osteoclast cells through micro motion. You can also use a bone stimulator. A bone stimulator actually creates negative potentials that change the balance of the osteoblast and osteoclast cells within the bone to change the remodeling process.
That’s one of the things that is sometimes recommended if you’re starting to get what we call a non-union where the bone is not actually healing. But if you understand that you have to really pay attention so that you don’t get to the point where it’s not healing, is really the important part. A lot of times runners will say okay, well doesn’t hurt that much so I’m going to run out and start running out but it’s swelling. That’s a bad sign.
If you do that you’ve got something going wrong and you’re actually backtracking and you’re in a bad way changing the balance of the osteoblast and osteoclast cells. So, you’ve got to pay really close attention to your foot. The name of the game with a stress fracture is not waiting for the next doctor’s appointment. It is not waiting for the next x-ray. It’s making sure that you understand how to watch and pay attention to the pieces of the puzzle that you actually can monitor yourself as an athlete who learned how to basically do the same thing when you were training.
I can teach you more about that in the stress fracture masterclass which you can get free a. www.docontherun.com/stressfracturemasterclass. It’s a deep dive into all these things related to stress fractures that help you understand the strategies and the framework that I actually use with runners who have stress fractures and want to get back to running as quickly as possible. So, go check it out, www.docontherun.com/stressfracturemasterclass and I’ll see you inside.