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  • Writer's pictureChristian Kubas

Understanding and Preventing Bone Stress Injuries in Runners

Running is an excellent way to stay fit, boost mental health, and enjoy the outdoors. However, as with any physical activity, it's not without risks. One common issue runners face is bone stress injuries (BSIs). Understanding, preventing, and treating these injuries can keep you on track and out of the physio/doctor's office.

What are Bone Stress Injuries?

Bone stress injuries are overuse injuries that occur when bones are subjected to repetitive stress without adequate recovery time. These injuries range from stress reactions, which are early signs of bone fatigue, to stress fractures, which are small cracks in the bone. Common sites for BSIs in runners include the tibia (shinbone), metatarsals (foot bones), and the femur (thighbone).

Causes of Bone Stress Injuries

Several factors can contribute to the development of bone stress injuries in runners:

1. Training Errors: Sudden increases in mileage, intensity, or frequency of runs can overwhelm the bones, leading to stress injuries.

2. Poor Running Technique: Improper form can place undue stress on certain bones and joints, increasing injury risk.

3. Inadequate Footwear: Worn-out or inappropriate shoes can fail to provide necessary support and cushioning.

4. Nutrition Deficiencies: Insufficient intake of calcium, vitamin D, and other nutrients essential for bone health can weaken bones.

5. Biomechanical Issues: Conditions such as flat feet or high arches can alter running mechanics, placing extra stress on bones.

Symptoms to Watch For

Recognizing the symptoms of BSIs early can prevent more severe injuries. Common signs include:

  • Persistent pain that worsens with activity and improves with rest.

  • Swelling and tenderness at the injury site.

  • Pain that starts as a dull ache and becomes sharp with continued activity.

Prevention Strategies

Preventing bone stress injuries involves a combination of proper training, nutrition, and recovery practices:

1. Gradual Training Progression: Increase your mileage and intensity gradually to give your bones time to adapt.

2. Strength Training: Incorporate exercises that strengthen the muscles around your bones to provide better support.

3. Proper Footwear: Invest in quality running shoes that match your foot type and replace them regularly.

4. Cross-Training: Include low-impact activities like swimming or cycling in your routine to reduce repetitive stress on your bones.

5. Balanced Diet: Ensure your diet includes adequate calcium, vitamin D, and other nutrients essential for bone health.

6. Listen to Your Body: Pay attention to any signs of discomfort or pain and adjust your training accordingly.

Treatment and Recovery

If you suspect a bone stress injury, it's crucial to seek medical advice promptly. Treatment typically involves:

  • Rest: Avoid activities that cause pain to allow your bones to heal.

  • Medical Evaluation: A healthcare provider can diagnose the injury through physical examination and imaging studies like X-rays or MRIs.

  • Physical Therapy: A physiotherapist can design a rehabilitation program to help you recover and prevent future injuries.

  • Gradual Return to Activity: Once healed, gradually reintroduce running, paying attention to any signs of recurrence.


Bone stress injuries can be a setback for runners, but with the right approach, they are preventable and treatable. By understanding the causes, recognizing symptoms early, and following best practices for training, nutrition, and recovery, you can enjoy a long and injury-free running journey. If you're experiencing persistent pain or discomfort, don't hesitate to consult with a physiotherapist or healthcare provider to get back on track safely.

For personalized advice and treatment, visit your local physiotherapist near you for an in-depth assessment and treatment plan.



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