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Sports Medicine

Bone Marrow Edema in Gymnast

12/29/2010

Question:

I coach gymnastics and a female athlete has an injured ankle. The original injury took place nearly 6 months ago. Xrays showed no break or fracture. The athlete went to rehab with a physical therapist to strengthen the ankle and to regain range of motion. She was out of all gymnastics activity for 7 weeks. Once released she participated at a low level and slowly increased skill and repetition to a normal workout. Her ankle was monitored closely, but would swell on occasion. Ice and rest would allow for swelling to reduce, but some pain would still be present. A recent MRI shows that there was tendon damage that seems to be nearly healed, but bone marrow edema was found. She does see an orthopedic in a couple of weeks. At this time she has been taken off of all activity.

I am understanding what bone marrow edema is by searching the internet. However, limited to no information is found on the treatment, rehabilitation, and possible risk factors of continued activity. As a coach, I would like to be as informed as possible and was hoping for some additional information.

Answer:

Your athlete's physician and/or the orthopedic consultant should be able to discuss whether or not her bone marrow edema (BME) is clinically significant and whether it correlates with her clinical picture.

Treatment/rehabilitation of BME needs to be directed at its cause, which will also help determine risk factors of continued activity. If her BME is located adjacent to/beneath the area of "tendon damage", it could then be regarded as a secondary condition, and ongoing treatment of the tendon problem would be expected to help resolve this BME. Alternatively, BME in an area other than beneath the tendon damage could have resulted from the initial injury, such as compressive force, in which case it can remain present for longer than six months despite the absence of ongoing bone stress, versus due to ongoing injury, in which case treatment would need to take into account the cause of this, such as insufficient strength or endurance of the relevant muscle-tendon units, suboptimal technique, premature resumption of a level of activity leading to overuse/overload, etc.

Persisting joint pain and swelling are certainly not desirable, for which reason there may be a need to cut back on/modify activities, modify the rehabilitative approach, etc., all of which can be discussed with her physician and/or the orthopedic consultant.

For further information, consider performing a search of this website using the term "Bone Marrow Edema" which currently yields 28 results.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University