Keeping You in the Know: Preventing Bone Stress Injuries

With the weather improving and summer approaching, most runners are excited about hitting the road while enjoying the sun.

Unfortunately, those extra miles can cause discomfort in the form of a bone stress reaction or a stress fracture. These stress injuries frequently occur in the lead up to a major race or event. It is normal and healthy for our bones to withstand microdamage, however stress reactions can occur when the microdamage to the bone outweighs the body’s natural ability to repair the damage. 

In a recent article, as referenced below, workload management appears to be the most important factor in bone stress injuries. So……..What can we do to prevent these injuries?

1 – “Rest” is Okay

Periodization is an organized plan of training, usually breaking training cycles into blocks of time separated by “rest” periods……..and by “rest” we mean conditioning activities different from your standard training, not sitting on the couch. This allows us to help improve bone cell mechanosensitivity. This means we can prevent our bone cells from becoming complacent and help them continue to adapt proportionally to the continued loads of training.

2 – Have Some Variety

Play a variety of sports early in childhood. The years from birth through puberty provide a window of opportunity to accrue bone mass. Early sport specialization has been associated with an increased risk of overuse injury.


3 – Move in Multiple Directions

Bones adapt in accordance to the direction they are loaded in. Unidirectional sports may not give our bones enough variability to resist loading in different directions. Sports and activities requiring jumping and landing in different directions allow for building healthy bones.

In order to try and prevent bone stress injuries, throughout puberty you should incorporate a wide variety in workload with an emphasis on multidirectional movements and as adults you should track your workload and incorporating “rest” into each program.



Warden, Stuart J., et al. “Preventing Bone Stress Injuries in Runners with Optimal Workload.” Current Osteoporosis Reports, 2021, doi:10.1007/s11914-021-00666-y. 


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