bone stress injuries and running 101

Ever been halfway through a training block and you begin to experience pain in your hip, leg or foot? Has it resulted in pain with walking and inability to progress your training? It may be time to get it checked out and assessed by a Physical Therapist (no referral required!) or a Medical Doctor who works with endurance athletes. 

What is a bone stress injury (BSI)?

Bone stress injuries can range from a stress reaction to a stress fracture. A stress fracture from running is generally a fatigue fracture due to a local failure of bone caused by repetitive forces and can be categorized as low-risk and high-risk. The risk of bone stress injuries occur when the runner’s system falls out of balance, resulting in a reduction in bone remodeling and strengthening in response to repetitive stress. 

Factors that may increase our risk for bone stress injuries include:

• underfueling/low energy availability

• previous history of bone stress injuries

• hormonal changes i.e. low testosterone or amenorrhea 

• overall total body health

• previous history of physical activity

• training mistakes

• medications (prolonged use of corticosteroids or anti-inflammatories)

• bone diseases

• genetics

How do I know if I have a BSI?

The gold standard for diagnosing bone stress injuries is an MRI. Typically your Medical Doctor will initially order an x-ray. X-rays are not sensitive enough to rule out bone stress injuries, especially in the early stages. This means the x-ray may be normal, but you could still have a stress reaction or fracture. If your physical therapist is highly suspicious of a BSI based on your story and objective testing and your x-ray is normal, getting an MRI would be the next best step.

How do I recover from a BSI?

Depending on the location and grade of the fracture, there will be a period of offloading (not putting weight through the leg) which can last for 8+ weeks.  If any of the above risk factors are present, it is imperative to work with a Dietician, BSI Specialist and/or an Endocrinologist to ensure a healthy return to running. 

Once you are cleared to walk, it is important to start progressing walking duration and bodyweight exercises. This can be progressed to weighted exercise with the goal of walking for 60 minutes. The next phase of training is to progress to plyometrics and then to a (very) conservative return to run program. 

Since there is a high risk of developing a second BSI within a year after the initial BSI, physical training along with addressing the above risk factors is vital for full return to sport. As you progress within your return to run program, it will be important to still engage in strength training on non-running days. This will stimulate bone remodeling, which will help bone to become more fatigue-resistant and more resilient. Lastly, communication within your support team (physical therapist, dietician, coach, etc)  is key to ensure you are staying on a healthy path towards full recovery.

Got specific questions or want to chat more? Feel free to shoot us an email!