At our Inner West clinic, we often see runners who thought they were just dealing with a sore shin, irritated foot, or something that would settle if they pushed through. Sometimes that works with other running aches. Bone stress injuries are not usually one of them.
What is a bone stress injury?
A bone stress injury sits on a spectrum. Bone is a living tissue that responds to load. When training load is appropriate, the body adapts. When load exceeds the body's ability to recover and remodel, the bone can start to become irritated.
The continuum is often described as moving from:
- bone stress reaction
- bone stress response
- stress fracture
The earlier along that continuum you identify the issue, the easier it generally is to manage.
Common areas in runners
Some areas are more commonly affected than others. These include:
- the tibia
- the metatarsals
- the femoral neck
- the navicular
- the pelvis
Some of these are considered higher risk than others, which is why early assessment matters.
What should runners look out for?
The early signs can be subtle. Common features include:
- pain that comes on with running and eases with rest
- a specific, localised pain rather than a vague ache
- pain that becomes easier to provoke over time
- pain with hopping or impact
- tenderness over a small, defined area
As the issue progresses, symptoms may start earlier in a run, linger longer afterwards, or appear with walking and daily activity.
A general rule: if the pain is becoming more localised, more predictable, and more reactive to impact, it is worth taking seriously.
Why do bone stress injuries happen?
They are rarely due to one thing alone. Common contributors include:
- sudden increase in training volume or intensity
- change in running frequency
- insufficient recovery
- poor energy availability
- reduced strength capacity
- history of previous bone stress injury
- change in surface, shoes or training environment
This is why a good assessment should look at more than just the painful area.
What should you do if you suspect one?
The main mistake is continuing to test it. Most runners want to know whether it is 'just tight' or whether it will warm up. Bone stress injuries often do not behave well when you keep probing them.
Early management usually involves:
- modifying or pausing running load
- reducing impact exposure
- assessing strength and capacity
- reviewing training history
- considering nutrition and recovery factors
In some cases, imaging may be needed, especially where the site is higher risk or symptoms are progressing.
How physio can help
Physiotherapy is not just about telling you to stop running. The role is to work out why the issue developed, manage it appropriately, and help you return to running with a better plan.
This might include:
- load modification and return-to-run planning
- calf, hip and lower limb strengthening
- review of running history and progression errors
- screening for factors such as RED-S
The key point
Bone stress injuries are usually much easier to deal with when picked up early. If your running pain is becoming more localised, more impact-related, or less likely to settle, it is worth getting assessed before it progresses further.
If you are a runner in Marrickville, Newtown, Stanmore, Enmore or the wider Inner West and are worried about a possible bone stress injury, early assessment can make a large difference to how long you are out for.
Links:
RED-S |
Running Assessments |
Dietitian
