Bone pain or tenderness can have several definitions depending on the individual. Poor bone health is a major problem in Australia as over 1 million people have osteoporosis (bone weakness).[1] For this article, bone pain and tenderness will describe pain along a boney area, such as the shin or elbow.
Bone pain is different from muscle pain as the tenderness cannot be felt on the flesh. On the other hand, it should not be confused with joint pain as bone pain describes discomfort along bones and not between bones.
This article will describe some possible causes, the symptoms, diagnosis and what treatments (e.g. physiotherapy, medications) may be available.
Top 8 Causes of Bone Pain
1. Fractures
Fractures describe a crack, break and/or separation of the affected bone. Usually, traumatic accidents such as falling or car accidents can cause fractures. According to the latest report by the Australian Institute of Health and Welfare, it is the most common reason for hospitalisations.[2]
How fractures are managed will depend on the injury’s severity. Factors, such as location, the size of the crack and the specific bone is considered. Bone pain can usually be felt immediately after the injury has occurred. Those with poor bone health, such as osteopenia or osteoporosis have a higher risk for fractures.
Symptoms of Fractures
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Bruising
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Swelling over the fracture
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Visible bone separation
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Pain when moving or putting weight through the bone
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Crushing and grinding across the bone.
2. Bone Bruising
Similar to a fracture, a bone bruise is an injury to the bone either due to repetitive stress or direct impact. However, it is comparable to a microfracture as most of the trabeculae (the spongy material inside the bone) is unaffected. Instead, most of the damage will occur along the cortex (hard outer coating of the bone).
Symptoms of Bone Bruising
The pain from bone bruising occurs from the swelling and small cracks along the outer parts of the bone. They are typically managed with rest from activity. However, other treatments, such as ice, compression, elevation and medications can ease symptoms.
3. Stress Reaction and Fractures
Stress reaction injuries represent a wide range of injuries, ranging from periostitis (inflammation in the thin layer of tissue around the bone) to a complete break in bone. They occur with constant loading onto the bone, such as running or repetitive sports movements. Those with poor bone health, such as osteopenia and osteoporosis are more likely to develop these injuries. Unlike traumatic fractures, these tend to gradually worsen overtime.
Symptoms of Stress Reaction and Fractures:
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Swelling
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Bruising
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Pain that appears during movement
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Pain that disappears when rested
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Tenderness over the injured location.
How these injuries are managed will depend on the severity. Smaller inflammatory reactions may only need a period of rest. Larger or complete fractures may need bracing or sometimes even surgery.
4. Ligament Sprains
Although ligaments are different structures compared to bone, injuries to these connective tissues can seem like bone pain. Ligaments are small and thin pieces of connective tissue that help hold bone together. Ligament sprains occur when the ligaments overstretch and/or tear. They are classified into grade 1, 2 or 3 depending on the injury’s severity.
As they are closely located near bones, sprains can seem like pain is coming from the bone. They typically occur during quick movements where the joint and ligament moves beyond its usual range. Common examples include rolling the ankle or twisting the knee.
Symptoms of Ligament Sprains
Most mild to moderate sprains can be managed with physiotherapy. Temporary rest or bracing may be needed for some time to allow the ligament to recover. More severe sprains or complete tears may require a consultation with a specialist.
5. Arthritis
Technically, arthritis is a condition of the joint rather than the bone. It is a gradually worsening injury which causes inflammation and narrowing of the joint. Much like sprains, joint pain can be confused for bone pain as joints are made up of the ends of two bones. Arthritis will only cause pain at the end of each bone but never during the middle section.
Symptoms of Arthritis
There are many different types of arthritis, including osteoarthritis and rheumatoid arthritis. During the earlier stages, physiotherapy can help significantly reduce pain within 6-12 weeks by 36%.[3] More severe symptoms may require further treatment, such as injections and even surgery.
6. Osteomyelitis
Osteomyelitis is caused by a bacterial infection of a bone. Bacteria can enter the body through a wound, during surgery or even an infection at another body site. These infections can block blood flow to the bone which causes it to continue spreading and the bone can die.[4] Bone pain and tenderness can be felt in the infected area along the bone.
Symptoms of Osteomyelitis
A doctor needs to be involved as soon as possible if osteomyelitis is suspected. They will be able to provide you with the appropriate medication and a specialist referral if it is required.
7. Sickle Cell Anaemia
Sickle cell anaemia is a condition that affects the red blood cells. This is a condition that can be inherited from relatives. Unlike healthy red blood cells that are round, they flatten out into the shape of a sickle. As a result, these cells can block blood flow around the body,[5] especially to the bones which can lead to conditions, such as:
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Fractures
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Osteomyelitis
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Necrosis (bone death)
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Spinal conditions
Consulting a doctor will be important for a formal assessment and treatment plan. Although this condition can not be cured, there are medications that can ease symptoms.
8. Cancer
Cancer is a condition which leads to uncontrolled growth of cells that spread around the body. Bone pain can occur when the cancer has entered the bones. Bone cancer and leukaemia (cancer of the red blood cells) are the most common variants that can lead to bone pain. However, cancer can also spread from other areas, such as lung and breast cancer.
Symptoms of Cancer
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Unexplained weight loss
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Fatigue
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Swelling around the body
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Night pain.
If cancer is suspected, please consult a doctor immediately. Further tests, treatment and referrals to specialists may be necessary.
Diagnosis of Bone Pain
If you are experiencing bone pain, please visit a relevant health professional (e.g. doctor, specialist, physiotherapist). They will be able to perform a physical assessment and refer for further investigations for a diagnosis. Examples of investigations, include:
When to see a Physiotherapist
Physiotherapists will regularly have patients reporting bone pain. They will be able to perform a physical examination, diagnose and develop a treatment plan to help manage it. An important part of the plan will usually be rehabilitation to help restore the strength and movement of the injured area.
Conditions such as bone bruising, fractures and stress injuries may need a period of rest and immobilisation (e.g. bracing, slings) before starting the rehabilitation process. Other related conditions, such as sprains and arthritis can usually start immediately.
When to See a Doctor
If you have bone pain, you should also consider seeing your GP or family doctor. They will be able to help diagnose, investigate and also develop a treatment plan.Additionally, doctors can also prescribe medication to help reduce pain and manage the condition. Doctors will collaborate with physiotherapists to help ensure the best possible outcome.
Visiting your doctor is especially important for some of the medical conditions discussed, such as osteomyelitis and cancer. Specialist doctors (e.g. orthopaedic surgeons, rheumatologists) may also need to be involved depending on the condition causing the bone pain.
Key takeaways
There are several causes of bone pain and tenderness. Some conditions are more obvious, such as fractures and sprains. Others may warrant further investigations, such as osteomyelitis and stress injuries.
Visiting a relevant health professional, such as a physiotherapist or doctor is essential for getting the best outcome. A prompt diagnosis can ensure that the appropriate treatment is received.
Physiotherapy and rehabilitation is an important part of the process for physical injuries, such as fractures and sprains.
