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Pubic Rami Bone Stress Injuries

Pubic rami bone stress injuries can be really tricky to catch but are another important BSI not to miss. Though considered moderate risk, they can take awhile to heal due to the attachment of so many muscles in the area. 

Find out when to suspect these & what to expect with rehab!

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Changes in Bone During BSI Recovery

After one bone stress injury, your risk for another significantly increases - which begs the question, are we doing a poor job with rehab? Is something else going on during recovery that increases risk for another BSI?

A study by Popp et al. in 2021 attempted to answer that final question by looking at volumetric bone mineral density (vBMD) over the 12 months following a diagnosis of tibial BSI.

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Training to Reduce Bone Stress Injuries

After one bone stress injury, your risk for another increases. The reasons for this vary from one runner to the next, making risk reduction very individualized and a bit of a challenge.

With that said, there are certain principles of bone loading and remodeling that can inform training to reduce injury risk - here are 3 training themes to decrease your risk for BSI.

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Hip Labrum Tear Myths

Finding out you have a hip labral tear can be a pretty unsettling experience. Consult with Dr. Google and you'll find a wide variety of opinions on the injury, from doomsday 'you'll never be the same' to toxically positive 'you're totally fine, lots of people have them!'

The most helpful advice probably lies somewhere in between - this can be a tough injury to recover from, but it is possible to manage and return to a pain-free, active life without surgery. 

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What Does a Bone Stress Injury Feel Like?

Typically we think of pain from bone stress injuries (BSIs) as pinpointed & easy to localize - but that's not usually how pain presents with with BSIs in the hip, thigh or pelvis, where symptoms are less straightforward.

So why does pain from a BSI differ and what might you feel if you have one?

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Interpreting DXA Scores

DXA (dual energy x-ray absorptiometry) scans are used to measure bone mineral density (BMD), a measure of bone health. Low BMD is associated with a higher risk of bone stress injury in distance runners, but isn't often measured in younger athletes.

 

So how do we interpret DXA scores in younger runners?

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When to Get Imaging for a Running Injury

No one wants to be the one to tell a runner they may have a bone stress injury (BSI), and even moreso, no runner ever wants to hear they might have a BSI.

 

Unfortunately, BSIs are pretty common among runners and they’re incredibly important not to miss. As written in an article by Warden, Davis & Fredericson in 2014: “...bone as the tissue of origin of a runner’s symptoms needs to be considered at all times during differential diagnosis to ensure prompt diagnosis and management.”

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You have a runner come in with an MRI that shows both a femoral neck stress reaction and an acetabular labral tear - where do you start?

It’s not uncommon to see coinciding intra-articular and bone pathologies on imaging. So what do we attribute this athlete’s pain to and how do we initiate treatment?

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As your stress fracture heals, you'll feel better and better. It's tough not to jump too far ahead during this stage - where you're allowed to walk without crutches, but not yet ready to run. 

Here are some recommendations and guidelines for mid to late stage rehab of femoral neck stress fractures. 

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It’s 100% possible to recover from a labral tear of the hip without surgery.

 

I've been there. When it’s flared up, it’s BAD - that deep, aching pain that keeps you from being comfortable in any position.

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Part 2 of 3 on Achilles tendon pain - the Rehab Essentials!

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Do you have trouble even making it to race day because of injuries or fatigue? Maybe your intensity is too high to be sustainable - find out how to get to the starting line healthy!

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Do you feel like every time you start running again, your ITB pain just comes back? Here’s how to stop that cycle!

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Has IT Band pain stopped you dead in your tracks during a run? Have you been told to stretch or foam roll, but it just keeps coming back?

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Running is Not a Good Bone-Building Activity

Running is a huge part of many of our lives & has a multitude of positive physical & psychological effects, but it’s just not a good way to build bone.

Optimal bone-building stimuli appears to be everything distance running is not: high-impact, short-duration loads with plenty of recovery in between. Here's how to optimize bone formation while still running!

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Fueling for Bone Health

We have a lot of research showing that low energy availability (not getting enough calories) is a significant risk factor for bone stress injuries.

Recently, however, researchers have looked deeper at the individual impact of carbohydrates, not just total calories, on bone breakdown and formation - and the results might surprise you.

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Gait & Bone Stress Injuries

Bone stress injuries are a heartbreaking injury for runners - taking time off to heal can be a huge challenge emotionally, socially and physically, so preventing them is the primary goal.

With prevention in mind, can we modify how someone runs or change their gait pattern to reduce risk for bone stress injury and avoid all the negative consequences that accompany this kind of running injury?

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All About Sacral Bone Stress Injuries

Sacral bone stress injuries in runners are often misdiagnosed as a problem with the SI joint dysfunction. They’re considered an uncommon cause of low back pain but they likely occur much more often than we think due to both a lack of awareness and the nonspecific nature of symptoms.

So when should you suspect sacral BSI?

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Bone Stress Injury Spectrum

All bone stress injuries (BSIs) are not created equal.

 

BSIs exist on a spectrum of severity, which is part of the reason their presentation can vary so widely from one individual to the next. Because of this, your recovery plan needs to be individualized, specific, and reflective of the grade of injury. 

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Marathon Recovery

Racing season is in full swing! You train for months, taper, carb load and run your heart out. And then it's time to recover - a time that's weirdly more challenging for some of us than the actual training & racing.

Why is recovery so important from a physiological standpoint, and what does it look like?

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Weight Gain & Bone Health

The relationship between weight gain, resumption of normal menstrual function and improvements in bone mineral density (BMD) is well-established, but we’re not talking about it enough. 

 

Low BMD is associated with increased risk for bone stress injuries, such as stress fractures. Low energy availability, disordered eating and clinical eating disorders are associated with low BMD. 

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If you've had one stress fracture, you probably know that you're at a significantly increased risk for another one. In fact, that's the single greatest risk factor for stress fracture.

So what can you do to potentially reduce your risk? Strength training. Heavy strength training.

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Stress fractures are truly a runner's worst nightmare - they're one of the only injuries that you absolutely won't be able to run through. 

Let's review what they are, how to diagnose them, and how to optimize healing in those early phases of rehab!

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Return to running can be tricky after a painful Achilles tendon episode - here are a few things to make that transition more manageable, as well as ways to continue training through an Achilles flare-up!

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Do you have Achilles tendon pain? Find out how to start rehabbing it in this 3-part series.

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How bad does it feel to be injured and sidelined from running?

Check out my thoughts on and lessons from running-related injuries.

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Part 2 on IT Band Pain in Runners: Why stretching & foam rolling aren’t working

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“Well, I don’t stretch as much as I should.”

Have you been told that your running injury happened because you didn’t stretch enough?

I disagree.

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