Athlete Injury Profile: Lucy Charles-Barclay
Some big news coming out of the triathlon world is that part-time mermaid and reigning Ironman 70.3 World Champion Lucy Charles-Barclay will be out for a good chunk of the season with a bone stress injury (BSI), specifically what appears to be a stress fracture in her femoral neck (we’ll get to that later).
This injury marks Lucy’s first major setback in her meteoric career. Today we will break down what a BSI is, how to spot it, and what this likely means for Lucy’s season, or lack thereof.
What is a bone stress injury?
Our bones are constantly being remodeled through a break down/build up response to the load we place on the body. A BSI can happen when the break down of bone outpaces the rate in which it is being built. This can initially present as a stress reaction where the bone becomes swollen and tender. Continued loading on the area can result in a crack in the bone, which we refer to as a stress fracture.
What are the risk factors?
Rapidly increasing your training volume. This is generally a bad idea and often leads to injury. JUST DON’T DO IT. If you need guidance with your training, find yourself a mentor or coach (shameless plug).
Low Energy Availability (LEA) that causes you to be in a more catabolic (breakdown) state
Relative Energy Deficiency in Sport (RED-S) which encompasses LEA but also includes disordered eating, amenorrhoea, hormonal imbalances, decreased bone mineral density to name a few
Hormonal or endocrine abnormalities
Having low bone density or bone disease
Being in a chronically fatigued state due to poor sleep and/or stress, which can negatively impact biomechanics
Participating predominantly in non-weight bearing physical activity in pre-pubescent years. Stressing the skeletal system by incorporating impact activities during these years can be a good thing and lay the foundation for solid bones.
BSIs are generally more common in females than men
But what about femoral neck stress fractures specifically?
Your femur is a long bone that connects your pelvis to your knee. The femoral head is the top of the femur that makes up your hip joint at the pelvis. The femoral neck runs between the femoral head and the shaft of the bone. Though BSIs here are not common, when you DO get one in the femur, it most likely will happen at the neck. Of note, a stress fracture here can become so severe that it could cause necrosis of the femoral head. This type of BSI is often due to repeated overload, notably running. Typical symptoms include vague hip and/or groin pain that becomes progressively worse with activity and weight bearing. This differs from a tendon or muscle injury, which might be painful to start, but then warm up and feel manageable.
How do you treat it?
Stress fractures can be managed conservatively with a lot of time spent on crutches to offload the leg and reduce tugging from the muscles around the area. A severe stress fracture can require surgery. Either way, you are looking at a very lengthy recovery and rehab process.
What does this mean for Lucy?
There are a few interesting takeaways from this case. For those that aren’t triathlon nerds, Lucy was a national champion swimmer and Olympic prospect before transitioning to triathlon in her early twenties. Those pre-pubescent years were spent doing one of the most non-weight bearing sports out there - swimming. In terms of history, she had a femoral stress fracture back in 2016, the year she turned pro. It is possible that she ramped up her training that year and overloaded the area. It would be interesting to know if that is indeed the same side that is currently injured. *
There is a saying in triathlon: “Bike for show, run for dough” which essentially implies that a strong run will win you races. Though Lucy is a stellar runner, she can be caught during longer races by those that are faster on two legs, like when Anne Haug passed Lucy on run at Kona (2019) to deny her the Ironman Championship. It isn’t a long shot to imagine that given the massive 2022 Lucy had planned (2x Ironman Championships, 1x 70.3 Championship, a sub-8 hour Ironman attempt, the list goes on), that she was running perhaps extra hard, and overtrained.
At the end of the day, this is such a bummer for Lucy. She certainly is a fan favourite for many reasons and we will miss watching her race this season!
*Note: As I was reviewing and finalizing this post, I saw that Lucy actually posted a YouTube video explaining the ins and outs of her stress fracture. What a coincidence! You will see that she notes a lot of what I have highlighted in this post.
