Bone stress injuries can interrupt an athlete’s season and return when recovery is rushed.
In this episode of The Art of Prevention podcast, host Dr. Nick welcomes Tyler Kemp, DC, a chiropractor practicing north of Cincinnati, Ohio, to discuss bone stress injuries (BSIs). Tyler discusses identifying, managing, and preventing these injuries. The conversation also explores Dr. Nick’s personal experience as a runner who sustained recurring tibial stress fractures.
What Are Bone Stress Injuries?
A bone stress injury develops when the stress placed on a bone exceeds its ability to repair and remodel. When training load increases too quickly or recovery is insufficient, damage can accumulate.
BSIs exist on a spectrum. A stress reaction is an earlier stage involving changes in the bone and surrounding tissue. A stress fracture involves a crack in the bone’s outer layer, while a complete fracture is a more serious progression.
Why Do Bone Stress Injuries Happen?
A common factor is doing too much too soon. A sudden increase in running mileage, intensity, or training frequency can place more stress on bone than it can tolerate.
Symptoms may not appear immediately after a training change. Tyler explains that several weeks can pass between increased loading and the onset of symptoms.
Recovery matters just as much as training. Poor sleep, inadequate nutrition, and low energy availability can interfere with the body’s ability to repair tissue.
Why Can Stress Fractures Come Back?
Previous injury, a rushed return, and unchanged training or recovery habits can increase the risk of recurrence.
Dr. Nick shares how he continued training hard on a bike while recovering from an earlier tibial stress fracture, then developed another injury. This shows that maintaining fitness is not the only goal; the bone needs time to heal and overall load must be managed.
Diagnosis and Returning to Running
Bone stress injuries are grouped as high-risk or low-risk depending on their location and potential to progress. The conversation identifies the femoral neck and anterior tibia as high-risk areas that require attention.
MRI is described as the preferred imaging method for assessing and grading suspected injuries. A clinician can help determine whether symptoms require imaging, activity modification, or referral for further medical evaluation promptly.
Returning to running should be gradual and guided by symptoms, clinical advice, and the injury’s location and severity. Tyler describes first ensuring an athlete can walk continuously for around 30 minutes without pain during the walk, afterward, or the next morning. A clinician may then introduce carefully planned walk-run intervals and progress them as tolerated. Timelines vary, so athletes should follow individualized guidance.
Building Stronger Bones Through Training and Recovery
Tyler recommends managing training load, building strength, and including variety in an athlete’s activities.
Strength training at least twice a week can help when appropriately programmed. Exercises may include squats, lunges, deadlifts, single-leg work, and suitable hopping or plyometric drills. Introduce new exercises before training volume rises, not during a demanding season.
Nutrition and sleep also support bone health. Athletes need enough overall energy, along with adequate protein, calcium, and vitamin D. Seek professional guidance for concerns about low energy availability or disordered eating.
Manage training load, include varied physical activities, and support recovery with adequate nutrition and sleep.
Frequently Asked Questions
Can you run through a stress fracture?
Running through a suspected bone stress injury can allow it to worsen. Pain that persists after exercise or affects walking deserves assessment. Avoid aggravating activity and seek professional advice.
Will a stress fracture show up on an X-ray?
Not always. Early bone stress injuries may not be visible on X-rays. MRI can provide more information about the injury’s location and severity.
How long does a bone stress injury take to heal?
There is no single timeline. Healing depends on the injury’s location, severity, and individual circumstances. High-risk injuries may need longer and specialist care.
How can athletes help prevent another bone stress injury?
Build training gradually, avoid sudden increases in mileage or intensity, include appropriately timed strength training, and prioritize sleep and adequate nutrition. Follow a carefully planned return to sport after an injury.
Get Back to the Activities You Love with Synergy Sports Clinic
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