Is bone marrow edema (BME) seen on an MRI of a leg in a runner significant or not? A recent study done in the Netherlands questions the importance of these findings. The authors evaluated by MRI the both pubic bones, hips, knees, and ankles of sixteen professional runners over the course of a season. They found that (BME) most commonly seen in the ankle and foot fluctuated during the running season and did not really correspond to the few complaints that these athletes had. In conclusion almost all asymptomatic athletes showed (BME), with more than half of the lesions fluctuating during the season. These data suggest that the incidental finding of a BME lesion on MRI of professional runners should not immediately be related to clinical complaints or lead to an altered training program.
This is an interesting study, however, they studied runners that had no complaints of pain. Frequently I see athletes both younger and older that present with back pain, hip pain or leg pain that started while playing a sport or training for a half or full marathon. These athletes initially try to train or play through the pain but eventually it just becomes too much and they stop. An MRI of the painful area in such a person can show BME that DOES represent injury. Another term used for BME is stress response. The MRI will show a bright area in the bone and this represents the bone’s attempt to heal itself. If this goes on long enough an actual fracture can occur.
These types of injuries can be detected in the spine in an area known as the pars interarticularis. If the area fractures it is considered a spondylolysis or a break in the bone of the spine. Runners can develop BME in their hips or leg bones making it difficult to walk and almost impossible to run. If a person develops any type of stress response in the bone a period of rest of at least 2-3 months is necessary in order to allow healing to occur. Return to sports should be gradual and if pain reoccurs then play must discontinue and the painful area reevaluated.
A. BME or stress reaction in the tibia B. Stress response in the pedicle