{"id":218506,"date":"2025-06-27T16:37:19","date_gmt":"2025-06-27T16:37:19","guid":{"rendered":"https:\/\/wandsworthphysiotherapy.co.uk\/?p=218506"},"modified":"2025-10-05T16:03:10","modified_gmt":"2025-10-05T16:03:10","slug":"bone-stress-injury-and-return-to-running","status":"publish","type":"post","link":"https:\/\/wandsworthphysiotherapy.co.uk\/bone-stress-injury-and-return-to-running\/","title":{"rendered":"Bone stress injury and return to running: 5 symptoms of BSI"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">At&nbsp;<strong>Wandsworth Physiotherapy<\/strong>, over the last 6\u201312 months, we&#8217;ve seen a noticeable increase in clients presenting with&nbsp;<strong>bone <\/strong><a href=\"https:\/\/www.vennhealthcare.com\/shockwave-therapy-for-bone-stress-injuries-in-runners\/\" target=\"_blank\" rel=\"noopener\"><strong>stress injury and stress fractures<\/strong>, particularly among runners<\/a> and young, slim, active females\u2014though we\u2019re seeing this in males too.<br><br>Stress fractures are common in runners and often occur due to a mix of training errors, inadequate nutrition, and insufficient recovery. It&#8217;s important to understand that there are&nbsp;<strong>high-risk and low-risk sites<\/strong>&nbsp;for these injuries. High-risk areas like the&nbsp;<strong>anterior tibia<\/strong>&nbsp;or&nbsp;<strong>neck of femur<\/strong>&nbsp;require special attention.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Resting bone stress injury until it feels better isn&#8217;t enough.<\/strong>&nbsp;Most people stop running and then return once the pain has settled. But without proper assessment and rehab, this may&nbsp;lead&nbsp;to recurrence. A structured return to running\u2014especially following&nbsp;<strong>high-risk stress fractures<\/strong>\u2014is critical. We recommend a&nbsp;<strong>repeat MRI<\/strong>&nbsp;around 2\u20133 months post-diagnosis to assess healing. X-rays are not usually sensitive enough to monitor stress fracture recovery effectively.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"819\" height=\"1024\" src=\"https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/06\/High-risk-stress-fracture-819x1024.png\" alt=\"Bone stress injury\" class=\"wp-image-218507\" srcset=\"https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/06\/High-risk-stress-fracture-819x1024.png 819w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/06\/High-risk-stress-fracture-240x300.png 240w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/06\/High-risk-stress-fracture-768x960.png 768w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/06\/High-risk-stress-fracture.png 1080w\" sizes=\"(max-width: 819px) 100vw, 819px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Grade of bone strain injury<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">On MRI the following characteristics are seen to help diagnose the grade of bone strain injury.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Grade 1: mild bone swelling<\/li>\n\n\n\n<li>Grade 2: periosteal bone swelling with mild bone marrow swelling<\/li>\n\n\n\n<li>Grade 3: extensive bone swelling without a fracture line<\/li>\n\n\n\n<li>Grade 4: stress fracture<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Of bone strain injuries, somewhere in the region of 80% are stress reactions and 20% of stress fractures. <\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Management of bone stress injury to resolve<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Here are the&nbsp;<strong>5 key components<\/strong>&nbsp;for a safe return to running after bone stress injury:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">1.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<strong>Resolution of Bony Tenderness<\/strong><br>There should be&nbsp;<strong>minimal<\/strong> tenderness over the affected area after a bone stress injury or stress fracture\u2014at rest, with palpation, or during day-to-day activity. Any lingering pain suggests incomplete healing.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">2.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<strong>Pain-Free Walking and Activities of Daily Living<\/strong><br>Before you return to running, you should be able to walk&nbsp;<strong>30\u201345 minutes pain-free<\/strong>&nbsp;and complete your normal daily activities without symptoms. This should be sustained for at least&nbsp;<strong>five consecutive days<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">3.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<strong>Radiological Evidence of Healing<\/strong><br>A follow-up&nbsp;<strong>MRI<\/strong>&nbsp;is crucial for high-risk sites. X-rays often miss healing indicators, especially early in the process. MRI provides clearer insight into bone recovery after bone stress injury or stress fracture and helps avoid premature return.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">4.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<strong>Passing Strength, Function &amp; Loading Tests<\/strong><br>We aim for a&nbsp;<strong>limb symmetry index of &gt;85%<\/strong>&nbsp;before restarting impact loading. At Wandsworth Physio, we use&nbsp;<strong>force plates and dynamometry<\/strong>&nbsp;to assess strength, including&nbsp;<strong>run-specific isometric tests<\/strong>&nbsp;for the quads, hamstrings, and calves, as well as single-leg hop tests to ensure safe load capacity.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">5.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<strong>Addressing Individual Contributing Factors<\/strong><br>Factors like&nbsp;<strong>Relative Energy Deficiency in Sport (RED-S)<\/strong>&nbsp;can play a major role. For many, especially females, this involves exploring&nbsp;<strong>menstrual health<\/strong> and ensuring adequate&nbsp;<strong>fuelling around exercise<\/strong>. We often refer clients for&nbsp;<strong>sports nutrition consultations<\/strong>&nbsp;to optimise recovery and prevent re-injury.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"819\" height=\"1024\" src=\"https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/06\/Low-risk-stress-fracture-819x1024.png\" alt=\"\" class=\"wp-image-218508\" srcset=\"https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/06\/Low-risk-stress-fracture-819x1024.png 819w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/06\/Low-risk-stress-fracture-240x300.png 240w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/06\/Low-risk-stress-fracture-768x960.png 768w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/06\/Low-risk-stress-fracture.png 1080w\" sizes=\"(max-width: 819px) 100vw, 819px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Once all five areas are ticked off, we guide you through a&nbsp;<strong>gradual return-to-run program<\/strong>, incorporating walk\/run intervals and progressive loading to build back confidence and capacity.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you\u2019ve had a recent stress fracture\u2014or suspect one\u2014get in touch. Our expert team can guide you through diagnosis, rehab, and your return to pain-free running.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Treatment for bone stress injury<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">An emerging treatment for bone strain and strss fractures is <a href=\"https:\/\/wandsworthphysiotherapy.co.uk\/service\/shockwave\/\">focused shockwave<\/a>. Sites of bone stress injuries treated with shockwave therapy:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Postero-medial tibia<\/li>\n\n\n\n<li>Metatarsal shafts and heads<\/li>\n\n\n\n<li>Metatarsal bases<\/li>\n\n\n\n<li>Cuboid<\/li>\n\n\n\n<li>Fibula<\/li>\n\n\n\n<li>Calcaneus<\/li>\n\n\n\n<li>Anterior tibial cortex<\/li>\n\n\n\n<li>Femoral shaft<\/li>\n\n\n\n<li>Lesser trochanter<\/li>\n\n\n\n<li>Inferior pubic ramus<\/li>\n\n\n\n<li>Navicular<\/li>\n\n\n\n<li>Sacrum<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Treatment may consist of five sessions of focused shockwave at 0.3 to 0.35 mJ\/ mm2 energy density flux. It&#8217;s important to consider avoiding the use of non-steroidal anti-inflammatories during the course of your focused shockwave to avoid offsetting the effects of the treatment. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you have a bony pain from running book a <a href=\"https:\/\/wandsworthphysiotherapy.co.uk\/specialist-clinic\/running-injury-clinic\/\">Run Fit Assessment<\/a> so our team can help you get back to what you love doing.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>At&nbsp;Wandsworth Physiotherapy, over the last 6\u201312 months, we&#8217;ve seen a noticeable increase in clients presenting with&nbsp;bone stress injury and stress fractures, particularly among runners and young, slim, active females\u2014though we\u2019re seeing this in males too. Stress fractures are common in runners and often occur due to a mix of training errors, inadequate nutrition, and insufficient [&hellip;]<\/p>\n","protected":false},"author":14,"featured_media":218507,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1,374,344],"tags":[],"class_list":["post-218506","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","category-physiotherapy","category-sports-injury"],"acf":[],"_links":{"self":[{"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/posts\/218506","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/users\/14"}],"replies":[{"embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/comments?post=218506"}],"version-history":[{"count":0,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/posts\/218506\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/media\/218507"}],"wp:attachment":[{"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/media?parent=218506"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/categories?post=218506"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/tags?post=218506"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}