Why Athletes Get Bone Stress Injuries with Dr Nick Birch

Nick, just to set the scene a little bit, how do you explain Bowen Health to your patients or your clients in fairly simple terms? And what does having a strong bone actually mean?

So, bone health is the totality of the way that your skeleton functions and the things that attach to the skeleton.

So there's gonna be muscles and ligaments.

You know, you're a physiotherapist.

You don't just deal with somebody's medial collateral ligament of the left knee.

You will deal with the whole knee.

And so you're looking at things really very much more holistically.

And I think the problem that we have developed in this time we've got to has been focusing too much on one thing.

So if you say to somebody, well, you've gone and had a DEXA scan and you've got a T score, which is a certain number, and that then defines what treatment you should have.

And by the way, you can come back and see me again in five years time when you take the treatment, have another test.

That's a really reductionist way to look at bone health.

So we think about bone strength and that then informs the discussion about bone health.

What makes up bone strength? Well, there are five different groups of things that make up bone health, two of which are mechanical, two of which are effectually dietary, and the third of which is then hormonal.

So mechanical, We know that bone density has some predictive value for

whether your bones are strong or not, but it's not the be all end all.

So Nick, just to backtrack ever so slightly, that's related to the T-score that you mentioned just a second ago.

Or the Z-score, Simon.

So we use T-scores for postmenopausal women and for men over the age of 50, and we prefer Z-scores for premenopausal women and men under the age of 50.

So when we're looking at those numbers, that gives us the bone density, but you all will be aware that only about a third of women who have a fertility fracture have osteoporosis.

two-thirds have either osteopenia or normal bone density and the biggest number is actually in those with osteopenia so if that's the case which is frightening stats if you

if you stop and think about it

yeah it is but if that's the case then then hang on a second that means that the density is not particularly good at predicting who's going to fracture and the reason for that is because density is only part of the story the other part of the story needs toughness and and It's a bit like if you have two rods, one made of steel, one made of glass, they weigh the same, they've got the same volume, therefore they'll have the same density.

But if you drop them on a concrete floor, they'll behave quite differently because

the

glass will shatter and the steel will bounce.

Nick, just to set the scene a little bit, how do you explain Bowen Health to your patients or your clients in fairly simple terms? And what does having a strong bone actually mean?

So, bone health is the totality of the way that your skeleton functions and the things that attach to the skeleton.

So there's gonna be muscles and ligaments.

You know, you're a physiotherapist.

You don't just deal with somebody's medial collateral ligament of the left knee.

You will deal with the whole knee.

And so you're looking at things really very much more holistically.

And I think the problem that we have developed in this time we've got to has been focusing too much on one thing.

So if you say to somebody, well, you've gone and had a DEXA scan and you've got a T score, which is a certain number, and that then defines what treatment you should have.

And by the way, you can come back and see me again in five years time when you take the treatment, have another test.

That's a really reductionist way to look at bone health.

So we think about bone strength and that then informs the discussion about bone health.

What makes up bone strength? Well, there are five different groups of things that make up bone health, two of which are mechanical, two of which are effectually dietary, and the third of which is then hormonal.

So mechanical, We know that bone density has some predictive value for

whether your bones are strong or not, but it's not the be all end all.

So Nick, just to backtrack ever so slightly, that's related to the T-score that you mentioned just a second ago.

Or the Z-score, Simon.

So we use T-scores for postmenopausal women and for men over the age of 50, and we prefer Z-scores for premenopausal women and men under the age of 50.

So when we're looking at those numbers, that gives us the bone density, but you all will be aware that only about a third of women who have a fertility fracture have osteoporosis.

two-thirds have either osteopenia or normal bone density and the biggest number is actually in those with osteopenia so if that's the case which is frightening stats if you

if you stop and think about it

yeah it is but if that's the case then then hang on a second that means that the density is not particularly good at predicting who's going to fracture and the reason for that is because density is only part of the story the other part of the story needs toughness and and It's a bit like if you have two rods, one made of steel, one made of glass, they weigh the same, they've got the same volume, therefore they'll have the same density.

But if you drop them on a concrete floor, they'll behave quite differently because

the

glass will shatter and the steel will bounce.