Ep 378: Bone Stress Injuries: Causes, Symptoms & Early Warning Signs (Part 1)

*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id= "request-WEB:6a57fa5e-c460-45da-be9f-861e67a1cd4e-2" data-turn-id-container= "request-WEB:6a57fa5e-c460-45da-be9f-861e67a1cd4e-2" data-testid= "conversation-turn-4" data-turn="assistant"> In episode 378 of The Physical Performance Show, host Brad Beer is joined by Pogo physiotherapist Tim Studley for the first instalment of a three-part expert series exploring bone stress injuries. Drawing on decades of clinical experience and the latest research, Brad unpacks the mechanisms behind one of the most common and misunderstood injuries affecting endurance athletes.

This episode explains how bone stress injuries develop, why they occur, and why they're often missed until they become more serious. Brad and Tim discuss the relationship between training load, bone physiology, symptom progression, and risk factors, while providing practical insights for athletes, coaches, and clinicians seeking to identify problems before they become stress fractures.

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In this episode, you'll hear Why bone stress injuries exist on a continuum—from healthy bone through stress reactions to true stress fractures The biology of bone remodelling: osteoclasts, osteoblasts, microcracks, and why recovery is essential Why running intensity has a far greater impact on bone stress injury risk than training volume alone How a 10% increase in running pace can dramatically reduce the bone's fatigue threshold Why many athletes mistakenly blame the "last run" rather than the workload accumulated four weeks earlier The importance of deload weeks and allowing the skeleton time to repair accumulated microdamage Understanding the Fredericson grading system and what distinguishes stress reactions from stress fractures Why shin splints (medial tibial stress syndrome) are not the same as a bone stress injury How pain location and symptom behaviour provide more valuable diagnostic information than pain intensity Why serious bone stress injuries can sometimes hurt less than relatively minor periosteal injuries The progression of symptoms from post-run discomfort to persistent and night pain How clinicians assess training history, workload, Strava data, intensity distribution, terrain, and footwear The major biomechanical and biological risk factors that contribute to bone stress injuries Previous bone stress injuries as one of the strongest predictors of future injury The emerging discussion around performance footwear ("super shoes") and potential changes in bone loading Why muscle strength and tissue capacity remain important contributors to skeletal resilience Quotes / takeaways "A bone stress injury is simply stress of a bone."

"It's not usually the kilometres that catch people out—it's the intensity."

"Don't judge the severity of a bone injury by how painful it is."

"Symptoms often appear around four weeks after the training error—not the day after."

"If it's really obvious, it's probably important."

Show Sponsor PILLAR Performance creates evidence-based sports micronutrition products designed to support recovery, sleep, health, and performance for athletes and active people.

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