Bone Marrow Edema

I would like to look closely at the article written by Elias et al., 2008. What I found worthy of note is the prevalence and the incidence of stress fractures commonly seen in ballet dancers (Smith, et al., 2015). Growing up, I have enjoyed dancing and even entered local and national competitions. Of all the dances that I have been partial to, ballet was never my cup of tea. I enjoy watching ladies dancing gracefully en pointe but if I would be tasked to perform the said dance, I would opt out straight away. Training in ballet is a rigorous practice. The gracefulness is not without a physical cost. So, I would just slip back as a spectator on this one.

As a physical therapist, I am inclined to learn more about the injury. From the study, it was presented that MRI is the best tool to establish the presence of bone marrow edema (BME) in the ankles and its clinical relevance (Elias et al., 2008). MRI can clearly visualize the normal anatomy and any fraying or tear of the ligament. Even more, it presents a clear image on soft tissue injury and its extent of injury and can detect injuries in the bony structures due to alteration in bone marrow structures (Sardineni, Pasumarthy, Bellapa, & Velicheti, 2015).

BME is frequently seen in MRI results and has extensive diagnostic variance that consists of trauma, avascular necrosis, osteochondral effect, tumors, and other conditions (Elias et al., 2008).

It has been evidenced by extensive research that constant stress on the ankle and foot can lead to BME, which is a common sight with ballet dancers who frequently executes plantar flexion (Elias et al., 2008). Bone Marrow edema seems to be a specific MRI finding which is attributed with biomechanical stress reaction due to their repetitive dance strategies and positions. the results indicated in the study, truly grabbed my attention was that there was no gender preference and no occult fracture could be diagnosed (Elias et al.,

2008).
Athletes or professional dancers are exposed to intensive training that requires the use of their lower extremities specifically their ankle joints which are predisposed to stress and eventually injury that can be debilitating. As part of their work of ballet professionals, various positions and strategies that place overload on their ankle both female and male may have an impact on different factors (Elias et al., 2008).
It is critical to identify any stress injury at an earlier onset as well as its predisposing factors can help prevent aggravating the condition that eventually augment to stress fractures and can be debilitating to the patient. It is imperative to know the signs and symptoms of stress injury to most patients especially individuals who are inclined with high impact activities. With early detection and proper use of MRI imaging can be beneficial to the patient as it can prevent fracture or serious injuries to the ankle that is already exposed to biomechanical stresses.
This article also has continued to piqued into my interest especially with the said sport even more so learning that there has been little research done on ballet injuries and physical therapy management. I would look into learning more about the injury and with my skills in dancing it might help contribute to my practice given the uniqueness of the sport. It is also important to provide a focused one-on-one attention to the patient which is quite rare in a typical PT setting. It would also be essential to provide a comprehensive home exercise program tailored to the specific needs of the individual and an expected outcome to observe optimal results.
Do you think MRI is the sole treatment available to best determine a diagnosis of the injury? Given that direct access has been granted to physical therapy services, would you opt to specialize on such injuries?