Preventing bone stress injuries in runners with optimal workload

Review written by Tom Goom info

Key Points

  1. Bone stress injury prevention and management center around achieving a balance between bone loading and its capacity to manage this load.
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Bone stress injury (BSI) can be devastating for a runner. Stress fractures are often challenging to identify, taking on average around three months to be diagnosed (1). They can result in severe consequences, such as progression to a complete fracture, and often require a lengthy period away from sport.

The old adage ‘prevention is better than cure’ is certainly accurate with BSIs. There are several modifiable factors in the development of a BSI (such as training load and recovery) which could become targets in our efforts to prevent such injuries.

This narrative review provided an up-to-date overview of how we can optimize workload to help prevent these challenging injuries. Below we’ll review some of the key principles and recommendations from the authors, and their clinical implications.

Stress fractures take on average around three months to be diagnosed.
Running isn’t a particularly osteogenic activity; it lacks the high magnitude, rapid rate loading which is thought to confer the greatest benefits.


This review makes a bold statement - “All running injuries are training load injuries, and BSIs are no exception”. There may be a little debate around whether this is strictly true, but it makes a key point - bone stress

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