Bone Marrow Edema question

[Dirt Gallo]

Have any of the QP's or other respected readers here had experience with bone marrow and soft tissue edema in the tibia above the ankle? After a couple weeks of pain that hasn't diminished and is preventing me from running, I had an X-ray and MRI that revealed I had no fractures but identified mild-moderate distal tibial bone marrow edema centered about 6-7cm cranial to the tibotalar line....and mild nonspecific soft tissue edema along the the distal-most medial tibia(centered below the bone marrow edema described above).

Now I can almost distinguish what this says, but, I still am unsure as to how I may have received this injury and how other active people have successfully dealt with similar injuries. I wasn't given clear recovery instructions other then avoid activity that make the pain worse. I am a regular runner and lift quite often. How I'd develop this 'bone bruise' that is preventing me from running and making me walk with a limp is confusing me. It was during a slow 2.5 mile run with a friend who hasn't run in a long time that this was aggrevated to the point that it is now.

I am here presenting this is because I respect the views coming from the military community more than I do most of the civilian physicians I've met. I look at the soft, pale, high-brow diagnosing me and wonder if they would give me the same advice if they themselves lived a more physically demanding lifestyle. The first words uttered when it comes to an injury associated with a joint involve immobilization and no weight bearing for 6-8 weeks and I get a little resistant to the idea. I am sure I am being a little prejudiced and stubborn, but, honestly, I don't want to regress physically. Winter is over here and I was just starting to make plans for the rest of the year. This could postpone a lot if staying off it is the recommended method of recovery.

If necessary I can type out the MRI report to clarify or answer any unanswered details.

Thank you for reading this wordy post.

[swatsurgeon]

I have personally never heard of bone marrow edema....would ask an orthopedic surgeon or hematologist. Maybe have another radiologist read the MRI. Edema would signify inflammation but of an isolated area of bone marrow? I would think that that happens with violation of the bone (fracture, insertion of an intraosseous needle, etc.).

ss

[craigepo]

My wife is an emergency medicine physician, and she's never heard of it. Here's a link to what Johns Hopkins says about it.

http://www.hopkins-arthritis.org/ask-the-expert/general-arthritis-008/bone-marrow-edema-on-mri-wha-1131.html

[PedOncoDoc]

I'm a hematologist and have never heard of it. There can be soft tissue edema in response to stress fractures and other lower extremity injuries (periosteal inflammation, etc.) - but not in the bone marrow - at least, not to my knowledge.

[TOMAHAWK9521]

My last MRI conducted by the army indicated an edema in my left patella. The army doc was the one who said it, not me.

[PedOncoDoc]

My last MRI conducted by the army indicated an edema in my left patella. The army doc was the one who said it, not me.

It might be good to have your doc chat with the radiologist who made the report - he might be able to clarify things a bit.

[wandering_idiot]

PedOncoDoc PM inbound

[olhamada]

Agree with SS - see an Orthopod. Bone marrow edema is usually post-traumatic or from overuse and may or may not present with pain. But it can also occur in other types of marrow disorders.

If it is secondary to "microfractures" or "bone bruise", you may need some time off or just may need to cut back a bit for a while and use other aerobic activity to compensate - Nordictrack, swimming, low-impact activity, etc....

Have you had a recent CBC? (Complete Blood Count). Might want to check that before further assumptions.

[TOMAHAWK9521]

It might be good to have your doc chat with the radiologist who made the report - he might be able to clarify things a bit.

More fun with the knees. VA doc found out I had torn almost all of my left ACL when he performed an arthroscopic lateral release of the left patella back in Jan. I figured out the time line that I had torn it on a freak landing at Ft. Campbell in August 1988 while in 2/75. The docs didn't see any bones sticking out or blood spurting so they gave me motrin, ice and 2 weeks light duty. Guess sports medicine wasn't big in the army back in those days.

That is in addition to having to deal with the cartilage under the knee caps degenerating to bone-on-bone grinding. Feels like an ice pick stabbing down through the left kneecap and a jagged blade being shoved under the right.

Working on getting a consult with Steadman/Hawkins Clinic in Vail, CO.

[craigepo]

The docs didn't see any bones sticking out or blood spurting so they gave me motrin, ice and 2 weeks light duty.



Waist up-Motrin
Waist down-foot powder

[Blitzzz (RIP)]

Marrow is not a like tendon, ligament, or muscle tissue and is not likely to swell as such, however a traumatic injury with enough will cause a"Bleed"/ bruise in the bone. Much like a shin split where the Connective tissue is inflamed the pain is terrible. Tendon inflammation will cause tendon swelling which in turn will increase pressures on the bone in that area and helped with a heavy step on an uneven surface could likely cause the bone to bruise.
General rule in ICE, Ice, Baby, and elevate and decrease usage. Lots of reps of the ankle without resistance will help move the fluids out of the area.
as mentioned above Motrine. Good luck, hope you can get it fixed before you really need it.

[Boomer-61]

Agree with the above to see an ortho man and make sure the read is correct and that it is probably a stress type injury and not a tumor of some sort. Having said that, the training mode of choice would be low to no impact: running in the deep end of the pool with a floatation vest on, pool aerobics, standard swimming, bike, rowing machine etc.
Good luck.
Boomer

[GenRep]

I am aware that this post is old, but I had the same problem happen to me recently. I am hoping for a few alternate responses on treatment or training substitutions. My case differs slightly because I am pretty sure what caused the injury. I apologize for this lengthy story before hand. Here is the specifics to how I received this injury:

In the past year I have been training hard on my running, since running is my most hated event. In the last year I completed the Navy 10 nautical miler, Army 10 miler, and countless 5/10k runs. I also took up bicycling and worked my way up to 40+ mile daily rides.

I had no problems doing any of this so I got cocky and started training for a marathon. Training went flawless and I was reaching 40+ miles a week running plus another 40+ a week cross training by bicycling.

On race day, I ran and had no problems until roughly mile 20. When I hit mile 24 I could no longer walk. I had to drop out of the race with only 2 miles left and less than 5hrs on the clock. I went home afterwards, proud of my attempt.

It took roughly a week for me to walk normal again. I took about 2 weeks off before I started lightly running again. I started with 1-2 SLOW miles. About 4 weeks later I tried a moderate 5 mile run and around mile 2.5 it felt like someone stabbed me in my left knee. I tried to push through it like a normal pain, but I realized this pain was unlike anything I have ever had.

After limping back to the car, I sat down for about 30min before I could drive home (I didn't have enough strength to push the clutch down). About 2 hrs after I got home the pain was gone, like nothing happened. The next day I tried it again figuring it was a fluke and it was the same thing. I slowed back to my 1-2 miles for another week and tried again... The pain would always happen between 2-3 miles, so I stopped running all together until I knew what was wrong.

I also do crossfit, so I shared my story with the gym trainers. I could squat all day and throw up weight without problems. The only thing that provoked pain was running. They recommended a few stretches concentrating on my IT band and glutes. I did some online research on common running injuries and it seemed to fit the IT band description.

Even so, I really needed to know exactly what was happening so I asked my doctor friend to check it out on the side and he got me in for an MRI. I have the results and video/picture images on a CD if it helps.

In short, the results were bone marrow bruising in the left knee with some inflammation due to overuse and abuse. The MRI was taken after I stopped running for 10 days. I have consulted with him and a sports doctor. Both have told me to stop running, and that it would heal with time.

They gave me a broad 6-12 month timeframe for complete recovery, but there is no way I can STOP running for that long. I have combined everyone's recommendations and have come up with a happy medium formula that has been working so far, which also takes into account my need to run. Here is what I'm doing so far RELIGIOUSLY 3 times a week:

1. Lightly jog 1 mile 3-4mph

2. IT band/Glute stretches, PNF stretching, and lower body mobility wods (crossfit term)

3. Run. I've worked up from 3 slow miles to 5 fast miles on a treadmill at 8-9mph. I'm scared to do more than that.

4. 1 mile cool down & stretch as in #2

5. Cool to cold shower followed by ice on the knee for 15-30 min

6. 800mg Ibuprofen

7. meal plus 2000mg glucosamine daily

Hopefully this routine helps someone. For me all the extra stretching was key, especially the PNF.

My question is for the medical experts. Is there anything else I can do to lessen my chances of further injury? I was also recommended to run with a brace, but it causes too much friction for a serious run.

I have read up on Myofascial Release massages and have considered it, but don't know if it would be worth the money. Tricare doesn't cover them so I would have to dish out the change for it.

I am also open to other running suggestions or alternate exercises. Can anyone overwork the mind of a fellow Soldier? I will put in as much effort into any logical suggestions.

I guess after 12yrs of Army training and abuse, something was bound to mess up. If you've read up to this point, thank you for your time and attention. :munchin

-Angel

[Dirt Gallo]

GenRep,

The edema that I dealt with last year resulted with me wearing a walking cast for almost 8 weeks and restrictions on running for a period of time after that. Looking back on it and have fully recovered from it, I realize now that it was indeed from overtraining/overuse. I was training with rather heavy weights and increasing my mileage and intensity of my runs both at the same time with little regard for the recovery required from such a training schedule. Going from no cardio to pushing hard to get back into 14:00 2mile times while also working around 500lbs squatting and deadlifting did not end up being the smartest approach to my goals.

I was very resistant to follow the physicians instructions, but, staying off it was necessary and did the trick. Good luck.

[PedOncoDoc]

Your pain seems to be coming from impact exercises - this is why squats and other exercises do not aggravate the injury. This could be due to any combination of the following: lack of recovery, not replacing shoes when they are getting worn (or poorly fitting shoes to begin with), poor running form and chronic/old injuries and/or abuse.

Motrin, physical therapy and appropriate rest/recovery are needed. You may want to try and find a physical therapist or athleitc trainer who cann assess your running form and provide corrective feedback.

With an injury such as yours, time is needed for recovery - I know iti s frustrating, but muscling through will more than likely lead to further/chronic injury.

If you have not gotten your running shoes from a place where the staff are knowledgeable in helping find properly fitting shoes I would also do this once you have sufficiently recovered and are getting back into running - this has been covered elsewhere on the site.

Are there any physical therapists with experience with similar issues willing to chime in?

HTH...