Step by Step: Preventing and Treating Bone Stress Injuries in Running


Breaking Down Bone Stress Injuries: Stages and Strategies for Management

Bone Stress Injuries are an overuse injury that are most seen in repetitive, sub-maximal
loading sports such as running. Bone stress is broken down into stages, with the first
stage known as a stress reaction. This is when the bone has stopped remodelling as it
should after activities and becomes bruised (and symptomatic). Bone bruising can
progress to a stress fracture and potentially a full fracture if not managed appropriately.
Management of these stages usually involves rest or training modification of some
description. This is to correct the imbalance between bone resorption and formation
following excessive loading.

Runners' Alert: Early Signs of Bone Injuries and How to Recognise Them

  • Focal tenderness over the bone
  • Pain that increases with load or weight bearing (e.g., pain worsens during the run) and improves with rest
  • True night pain (the irritated bone aches in the night)
  • Initially, the pain may be subtle and only present during exercise, but as the injury progresses, it can become constant and affect daily activities.

From Symptoms to Solutions: Physiotherapy and Bone Disorder Diagnosis

When diagnosing a bone stress injury, it involves a combination of taking a thorough
patient history, physical examination, and imaging studies. X-rays do not detect stress
reactions, with MRI the imaging choice to detect these injuries. MRI is especially useful in
the early stages when symptoms may be subtle.

Getting Back on Track: Running After a Bone Stress Injury

Bone stress injuries require a period off running to allow the bone to heal. The duration of
rest required depends on the location and severity of the injury. Your treating clinician
may send for a secondary scan to check the bone has healed adequately before returning
to activities. During time away from running, it is imperative to complete a period of
strength training appropriate to your injury. This will not only assist with bone healing but
will also reduce your risk of future bone stress injuries, as increasing muscle mass helps
offload the absorption loads during running.

7 Key Strategies to Prevent Bone Stress Injuries

  • Periodise training and take a “down week” every 3-5 weeks
  • Monitor your training load and increase volume gradually
  • Allow enough time between sessions to allow the bone to respond to loading. A good place to start is day on, day off.
  • Build duration before intensity – increase in intensity creates greater internal loads on the bone than increasing duration. Only increase one variable at a time (i.e., avoid increasing speed and mileage in the same week)
  • Strength training – Muscle act as a shock absorber around the bone which reduces excessive loads being placed on the bone. Both impact exercise (plyometrics) and heavy resistance training are important for increasing bone strength
  • If tired or fatigued, it is a sign a session may need to be modified
  • Ensure you are fuelling adequately for your training – seek help from an advanced sports dietician

Holly Pointon 
Melbourne CBD Physiotherapy and Sports Medicine Clinic

Holly Pointon is a highly regarded physiotherapist at Melbourne CBD Physio­therapy and Sports Medicine Clinic. An avid distance runner herself, Holly possesses a profound understanding of the demands and joys runners face. She focuses on collaborating with her team to ensure patients are reintroduced to their activities safely and swiftly. The goal is always a seamless and efficient return to action.

Tags :

Bone, Blog, Running

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