5 keys to prevent bone stress injury in runners

Bone stress injury occur when bone stresses applied during activity, like running, exceed bone's tissue tolerance.  This can also be known as bone strain. It is very common among runners, especially due to the repetitive loading with long distance running.

Main symptoms which indicate that you have a bone stress injury

• Bone pain that worsens with weight-bearing or repetitive use, particularly impact
• Sudden pain during or after exercise
• Localised swelling that is getting worse – this is seen on superficial bones such as in the shin and forefoot, but difficult to ascertain in the femur for example
• Localised tenderness
• Persistent pain at rest or at night
• Pain increases with activity unlike tendinopathy which tends to decrease with activity

Risk factors

• factors that alter the load applied to the bone
• factors that influence the bone's ability to withstand load, thus minimising damage.

 Bone stress injury in runners

 Our bones experiences stress through external loads (ground reaction force) and internal loads (force caused by muscle contraction). Such stress results in load-induced micro trauma.

 How do we prevent BSI’s in runners?

BSI’s are multifactorial, but here we’ll focus on 5 key training considerations to decrease BSI risk:

1. Avoid major spikes in loading

 As mentioned earlier, bone can remodel and adapt if loads are progressively increased.

The sedentary individual that begins running. In a study of military recruits, those with 1 month or less of running experience had an increased risk of suffering a BSI in basic training.

2. The track athlete during preseason. Research shows that collegiate level athletes have a 43% increased risk of BSI during the preseason, since they may be ramping up training too quickly after taking time off from their sport.
3. Increase volume, then intensity

The workload placed on a bone is related to the volume (number of loading cycles) and the intensity (magnitude and/or rate of load).

Rest periods from running- To allow adequate recovery and adaptation, we want to include regular breaks from the repetitive loads of distance running.

4. Monitor environmental changes

 Different environments imply a different direction and magnitude of loading.

5. Modify running technique

Technique can significantly impact the magnitude and direction of lower extremity loads in running. A relatively easy and effective technique modification is to increase step cadence by 5-10%. 

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