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Bone Stress Injuries, Shin Splints or Stress Fractures, Help! I am so confused!

Mar 26, 2025

 

Understanding Bone Stress Injuries and Stress Fractures in Runners: Causes, Symptoms, and Safe Return to Running

Bone stress injuries (BSIs) are common overuse injuries in runners and athletes. These injuries occur when repetitive stress on a bone exceeds its ability to adapt and repair, resulting in microdamage that may lead to full fractures if not managed properly.

At The Jersey Sports & Spinal Clinic, we regularly support athletes through recovery and return to sport following BSIs using evidence-based physiotherapy and rehabilitation techniques.

What Are Bone Stress Injuries?

BSIs develop along a continuum:

1. Bone Strain

  • Increased bone turnover and microdamage, often with no symptoms.
  • May resolve with adequate rest.

2. Bone Stress Reaction

  • Microscopic damage with localised pain during activity.
  • MRI shows early signs (e.g. bone marrow oedema); X-rays often normal.

3. Stress Fracture

  • A visible crack in the bone.
  • Persistent pain with activity.
  • Requires longer rest and often immobilisation.

4. Complete Fracture

  • Final stage if not addressed.
  • Severe pain and loss of function.
  • May need surgery or extended immobilisation.

Bone Response to Load and Recovery

Bone constantly remodels in response to load. Repetitive stress without recovery can disrupt this balance, making bones more vulnerable to injury:

  • Microdamage builds up with repetitive impact.
  • Resorption weakens the bone temporarily.
  • Formation of new bone tissue follows but lags behind.
  • Inadequate rest increases injury risk.

Common Sites of Bone Stress Injuries

  • Tibia
  • Femur
  • Metatarsals
  • Fibula
  • Navicular
  • Pelvis

These areas are particularly vulnerable due to their role in absorbing repetitive impact during activities like running and jumping.

What Causes Bone Stress Injuries?

Multiple factors contribute:

Training Errors

  • Sudden increase in training volume or intensity.
  • Lack of rest days or recovery cycles.

Biomechanics

  • Gait issues (e.g. overstriding, excessive pronation).
  • Muscle imbalances (especially glutes, calves).
  • Poor core stability.

Medical & Nutritional

  • RED-S (Relative Energy Deficiency in Sport).
  • Low calcium/vitamin D.
  • Menstrual dysfunction in female athletes.
  • Low bone density.

External Factors

  • Inappropriate footwear.
  • Hard or uneven running surfaces.

Signs and Symptoms to Watch For

  • Localised bone pain during activity.
  • Pain that improves with rest but returns with activity.
  • Tenderness to touch over a specific bony area.
  • Possible swelling.

Diagnosing Bone Stress Injuries

At The Jersey Sports & Spinal Clinic, we work closely with local imaging providers to facilitate accurate diagnosis. We may recommend:

  • MRI (most sensitive for early-stage injuries)
  • CT or bone scan
  • X-ray (useful for later stages)

How Physiotherapy Helps Recovery

Physiotherapy plays a crucial role in both recovery and prevention of bone stress injuries. At The Jersey Sports & Spinal Clinic, we provide tailored rehab plans that include:

🦵 Load Management & Activity Guidance

  • We’ll help you reduce stress on the affected bone while staying active through cross-training options like swimming or cycling.

🏋️ Strength & Conditioning

  • Targeted strengthening for glutes, calves, and core to improve load distribution during running.
  • Resistance training enhances bone density over time.

🦶 Gait & Biomechanical Analysis

  • Assessment of your running technique to identify and correct inefficient movement patterns.

🧍 Flexibility & Proprioception Training

  • Improve control, balance, and body awareness to support safe return to running.

🧠 Education & Lifestyle Advice

  • We educate you on proper training progression, footwear selection, and nutrition for bone health.
  • Where needed, we may collaborate with nutritionists, sports doctors, or coaches.

Safe Return to Running: Our Physiotherapy Framework

  1. Initial Recovery Phase
    • Cease running; introduce low-impact activity.
    • Address nutritional and hormonal issues.
  2. Rehabilitation Phase
    • Gradual strengthening and movement retraining.
    • Resolve imbalances and gait issues.
  3. Return-to-Running Plan
    • Structured walk–run progression tailored to your sport and goals.
    • Monitor pain and adapt accordingly.
  4. Long-Term Prevention
    • Periodised training plans.
    • Ongoing strength and movement work.
    • Regular check-ins to manage training load.

Need Help?

If you’re dealing with bone pain or suspect a stress injury, early intervention is key. At The Jersey Sports & Spinal Clinic, our expert physiotherapists will assess your condition, guide your recovery, and help you return to sport stronger and more resilient.

📞 Book a consultation today to take the first step towards safe and effective recovery.