Don’t Sleep On Sleep: A Case Study Of Stress Fractures In A Heptathlete

HISTORY: During the initial months of COVID-19, she quickly began having pain in her lower leg compartments as she increased preparatory training for her first NCAA Division I cross-country season. Initially, she "toughed it out" and continued to practice/compete till Oct 2022, when an athletic trainer noticed tears in her eyes while performing box jumps. See Figure 1 for timeline details. PHYSICAL EXAMINATION: 1. Feb, 2022 - MRI and x-rays confirmed bilateral medial tibial stress syndrome (MTSS). 2. Mar to Aug, 2022 - Discovery that the athlete's sleep quality and quantity were poor (<3 hrs/night). Her heart rate would increase to 130 bpm with her sleep anxiety and sleep disturbances continued to worsen into the summer.3. Research laboratory visits for sleep, dietary, and skeletal health assessments in Aug and Nov, 2022 and May, 2023. DIFFERENTIAL DIAGNOSIS: 1. MTSS2. Severe sleep disturbances TEST AND RESULTS: •Lower limb radiographs (Team Doctor): Bilateral tibial and fibular stress fractures.•Sleep analysis (Team psychiatrist): Sleep-induced anxiety disorder•Sleep and dietary quality survey (Research Team): Clinically poor sleep but adequate diet. •Dual-energy X-ray Absorptiometry scans (Research Team): Clinically normal bone density but below ideal thresholds for athletes FINAL/WORKING DIAGNOSIS: 1. Bilateral MTSS2. Sleep induced anxiety disorder TREATMENT AND OUTCOMES: 1. Alternated immobilization of the lower legs.2. Return to limited training impact via aqua jogging, biking, unweighted footwork, and rowing.3. Sleep hygiene implementation includes: strict sleep schedule (no naps), limited screen time before bedtime/blue light glasses, hard workout schedule to cause physical exhaustion, and limited caffeine. 4. Slow return to training volume, but sleep hygiene remained the priority. 5. To date, the athlete has not experienced MTSS pain since the successful intervention and is now back competing for podium spots at each meet with frequent PR’s.