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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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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.

So 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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