Bone Stress Injuries: What Every Runner Should Know

Should shoulder exercises be painful?
Some mild discomfort during rehabilitation is often acceptable, but exercises shouldn't cause severe or progressively worsening pain.
How often should I do my shoulder exercises?
This depends on your injury and stage of recovery. Your physiotherapist will prescribe a program suited to your individual needs.
Can resistance bands replace weights?
Resistance bands are excellent for early rehabilitation, but many people eventually benefit from progressing to free weights or gym equipment.
Should I copy exercises from YouTube?
Not always. Exercises that are appropriate for one shoulder condition may aggravate another. It's important to know what you're treating before beginning rehabilitation.
Why Choose The Addison?
At The Addison Physiotherapy, we believe rehabilitation should be individual - not generic. We assess your shoulder, identify the underlying cause of your symptoms and prescribe exercises based on your goals, lifestyle and stage of recovery.

Whether you're aiming to return to the gym, sport or simply everyday life without pain, we'll help you build a stronger, more resilient shoulder.

A bone stress injury doesn't necessarily start as a fracture.

It exists on a continuum.

Bone is constantly adapting to the loads placed upon it. When training and recovery are balanced, that is a positive process.

When repeated loading exceeds the body's ability to recover and remodel, problems can develop.

The bone stress continuum

This may progress through:

Bone stress response → stress reaction → stress fracture

The terminology can vary, but the important concept is that identifying the problem earlier is generally preferable to allowing it to progress.

Warning signs for runners

Pay attention to pain that becomes:

increasingly localised
predictable with impact
painful with hopping
progressively worse during running
present with walking
tender directly over a small area of bone

Why did it happen?

We need to look beyond the painful bone.

Potential contributors include:

rapid training progression
inadequate recovery
previous bone stress injuries
strength and conditioning
energy availability
nutrition
hormonal factors
RED-S
sudden changes in running environment

Why nutrition matters

If energy intake isn't sufficient to support both training and normal physiological function, bone health and recovery can be affected.

This is why recurrent bone stress injuries may warrant input beyond physiotherapy alone, including sports medicine and dietetics where appropriate.

The Addison's existing RED-S content specifically highlights the relationship between inadequate energy availability, impaired bone health and recurrent bone stress injury.