November 6


Aching Bone Pain with Iyad Salloum

By Wil Seto

November 6, 2023

leg pain

Mark: Hi, it's Mark Bossert. I'm here with Iyad Salloum of Insync Physio in North Burnaby, BC, Canada, and we're going to talk about aching bone pain today. How are you doing, Iyad? 

Iyad: I'm doing well, Mark. How are you? 

Mark: Good, good. So can I just ignore it when my bones ache?

Iyad: I mean, it depends what that means. So let's talk about examples that we see in the clinic. So somebody who started running and they've been putting on some miles and they've been loving it and getting really good at it. And after about a month to 6 weeks of stuff, they start to feel, for example, pain in their shins. 

So, most often what I see is then people kind of go online, try to find some stretches and exercises, and then they try them. They don't really move the needle in either direction. They start to look up a little more on WebMD. They try to figure out what else it is, and then they're like, Oh, look at this, the bone could be one of the causes. So then they'll consult their family doctor, they get an x ray, x ray is negative, and then, well, the x ray is fine, it's probably not my bone.

So then they just go and run again, and then they're still sore, and then eventually after that whole circle of life, they end up in our office trying to find a better solution because most people think it's due to the way they run. Maybe it's like a control issue. Maybe their knees are caving in. They're just not sure. 

So, what I would say the short answer is no, they can't ignore that. Especially if you feel some aching of the bone and you have a negative X ray, that's not enough for us to say that your bone's not affected. 

Mark: So is this like shin splints or like a stress fracture that won't necessarily show up on an x ray?

Iyad: Yeah, so the shin splints a very broad term because there's a lot of different contributors to that. So you could have anywhere from a limb threatening injury that could be in the compartment in front or it could be the bone reacting like you said, like in a stress reaction, not even a stress fracture yet.

So it could be like the early phases of that. Because there's 5 phases of injury for the bone from stress, and only, I think, stages 4 sometimes will show up on x ray, but stages 5 is for sure when they'll show up on x ray when it's completely fractured. You could easily have that, but there's some other muscular components that are also at play. 

So, shin splint is a general term. So, yeah, for sure. It could be all kinds of stuff like that. And that's where if we just assess with the x ray, it might not give us the full picture. So we would need to kind of do a proper clinical exam. And the clinical exam isn't just physically touching things, but also taking in that history of how it started, what it felt like, what's the pattern like? Does it start from the beginning of the run? Does it start continuously throughout the run? So all of those factors really help us figure out what it is. 

And then sometimes based on that, we can recommend better, let's call it diagnostic testing and then also better care. Do you persist with running or do you just have to take a break and do something else for it? And I think all of these options exist, depending on what the injury is, how severe it is and where it is too. 

Mark: So, if I've been feeling shin pain for a week. I guess my question is when's the ideal time? How long am I experiencing it when it's the best time to come in and see a physio so that I can get on a proper program to have this go away?

Iyad: So, I feel like if you notice it more than on 1 occasion, and it's been pretty consistent in terms of pattern. I feel like that's definitely a good time to come in. Even if you had it once or twice, and you're just curious, I think just coming in for an assessment, at least you can understand what it's not. Feel like that's just as important as knowing what it is. Because if it's not any of the, let's say, more dangerous long term recovery related issues and we can at least give proper advice on how to continue running with the injury. 

As far as somebody who's had it for, let's say, more than a week, and it's been consistent and it's same in the morning the 1st, few steps feel like you know, a slow burn, like, very painful. I mean, that's a very appropriate assessment that needs to come in. And then 1 of the other things we could do as part of that, besides doing the bed exam is to actually get somebody on the treadmill and see what they're doing potentially that could be contributing to this. 

And part of that's also assessing the training program, because it might not be appropriate for that person. 

Mark: Generally sooner you get in the better and faster your recovery is going to be?

Iyad: Yes think about this, five stages of bone injury as per one of the main classifications that we use. If we have five grades, if I catch you on grade one, which is basically just inflammation of the outer covering of the bone. I would say, there's how much less there is to heal from than if we catch you at a complete fracture or stress fracture line. You know what I mean?

So that in itself kind of informs that, yes. If I intervened early, I also have less time missed from training. I see this mostly now with people starting to do their marathon training for the spring. You have to start about six months away sometimes, especially if you're not a consistent runner.

Well, that's exactly where we'll start to see this kind of big spike in runners getting injured. And then they kind of try to dilly dally for two months. I've seen way too many runners in the month of the race, where it might just be a bit too late. Because, you know, even with all the gate modifications and the footwear modifications and the corrective exercises. Well, your tissue still needs to heal because, you know, we're doing 42 kilometres of like regular impact. So that's in itself something that you have to adapt to.

Mark: You're having aching bone pain in your legs. You started a running program. Get in to see the physiotherapists at Insync Physio. You can book online at, or you can call the North Burnaby office at (604) 298-4878. There's also a Vancouver office at (604) 566-9716. Get help sooner and get back training faster. Thanks, Iyad. 

Iyad: Thank you.

Wil Seto

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