Runners are constantly putting strain on their bodies. When the bones cannot withstand the repetitive loading, runners may develop bone stress injuries. These common injuries occur at a rate of 20% annually, with higher instances in females. Biological and biomechanical factors are at play. When runners are experiencing pain due to an injury, they require a thorough evaluation from a healthcare provider that includes their medical history and a physical examination, and they may be referred for imaging such as an X-ray or MRI. Timely evaluation is crucial for runners, as delayed diagnosis and treatment of bone stress injuries can lead to further injuries such as stress fracture and complete fracture. 

Managing Bone Stress Injuries in Runners

The primary treatment goal for runners experiencing bone stress injuries is to return them to their pre-injury functioning and running in the shortest time possible. However, we don’t want to risk further tissue damage or recurrence. Thus, runners with BSI need management strategies to reduce load-bearing in the future. Three steps for managing BSI in runners are identifying risk factors, activity modification, and physical conditioning. 

1. Identifying Risk Factors

Identifying risk factors is the first step to managing BSI. Look at training factors such as frequency, duration, and intensity of running, as well as changes such as new shoes, different running surfaces, and new physical activities outside of running. Dietary considerations such as calcium or vitamin D deficiencies are also risk factors for BSI, so runners may benefit from working with providers such as nutritionists to optimize diet.

2. Activity Modification

The next step in managing a BSI is to work on activity modification, which may involve temporarily decreasing the frequencing, duration, and intensity of running to give the body time to rest and heal. During initial recovery, the goal is to be pain-free during activities of daily living. In cases of more severe or significant BSIs, patients may need to temporarily use assistive devices such as canes, crutches, or braces.

3. Physical Conditioning

During rehabilitation, the injured runner can gradually reintroduce physical activities for maintenance. Patients should begin low-impact cross-training such as cycling, swimming, or antigravity treadmill training as soon as possible. Conditioning is an essential step towards a return to running, as it helps the body build muscular strength and endurance required for a high-impact activity such as running.

Prevention of Bone Stress Injuries

Bone stress injuries can have recurrence rates higher than 20%. So, once a patient has fully recovered, it is essential to have an injury-prevention plan in place. Each runner will need an individualized training plan to maintain gains while preventing injury. Increasing bone-loading cycles too quickly can lead to re-injury. When developing prevention measures, runners need to consider the impact that shoes, shoe inserts, and running surfaces can have on their running mechanics. Harder surfaces such as asphalt create a higher risk of BSI than soft surfaces like grass or rubber.

Nutrition also plays a role in bone injury prevention. For example, calcium increases the rigidity of bones, and vitamin D promotes calcium absorption. A study published in Physical Medicine and Rehabilitation found young female runners with high calcium and vitamin D consumption had significantly more bone mass density than those with lower dietary consumption. 

Developing a Training Program

Proper training is the key to preventing bone stress injuries in runners. When athletes increase training too quickly, they raise their risk of injury. Still, there is no “one-size-fits-all” algorithm for developing a running program. Considerations include multiple, complex factors such as training frequency, duration, and intensity as well as running surface, shoes, technique, and so on. At Churchill Orthopedic Rehabilitation, our individualized runner’s program provides one-on-one support to get athletes back on their feet with optimal recovery and maintenance. To make an appointment, call our office at 201-833-1333.