Bone Stress Injuries: What They Are and How to Recover
Bone stress injuries (BSIs) are one of the most common overuse injuries seen in runners and athletes involved in jumping or impact-based sports. While often dismissed as “shin splints” or general soreness, BSIs are much more serious — and if ignored, they can turn into full fractures that take months to heal.
In this post, we’ll break down what BSIs are, why they happen, how to recognise them, and what you can do to recover and prevent them in the future.
What Are Bone Stress Injuries?
A BSI happens when bones are loaded more than they can handle. Think of it as your body’s “check engine light” for your bones. Normally, bone tissue is constantly breaking down and rebuilding in response to stress. But when the load (training, activity, impact) outpaces the repair process, microcracks build up.
Over time, this leads to:
Stress reaction → an early warning sign where the bone is irritated.
Stress fracture → a partial crack in the bone.
Complete fracture → if stress continues unchecked.
Why Do They Happen?
BSIs are almost always the result of too much stress, too soon, without enough recovery. But there are usually multiple contributing factors:
Training errors: sudden spikes in mileage, intensity, or frequency.
Muscle weakness: muscles act as shock absorbers — if they’re fatigued or weak, the bone takes more load.
Low energy availability: not fuelling enough for your activity (sometimes related to RED-S).
Hormonal or nutritional factors: low Vitamin D, low calcium, or disrupted hormones.
Biomechanics and footwear: changes in shoes, surfaces, or running technique.
Genetics and bone health history: some people are naturally at higher risk.
Early Warning Signs
Catching a BSI early makes recovery faster and easier. Look out for:
Dull, aching pain that gets worse with activity.
Tenderness over a specific bone (pressing on it hurts).
Pain at rest in more severe cases.
If you notice these signs, it’s important to stop pushing through and get checked by a health professional.
Recovery: Respect the Pain
The number one rule of recovery is: respect the pain. Continuing to load a bone that’s already struggling can set you back for months.
Instead, recovery should focus on:
Relative rest: stop the painful activity, but keep moving in other ways (swimming, cycling, elliptical).
Strength training: build up the muscles around the bone to protect it.
Gradual loading: short, controlled bursts of impact (“microdosing”) are better than long sessions. Bones adapt best to variety, not monotony.
Nutrition: ensure adequate energy, Vitamin D, and calcium to support bone repair.
A typical phased return might look like this:
Protection (0–4 weeks): pain-free weight-bearing, sometimes with crutches or a boot.
Early loading (4–8 weeks): start walking programs, light strength and balance work, cross-training.
Return to running (6–10 weeks): build up from walk-jog intervals, progress gradually.
Return to sport (10+ weeks): sport-specific drills, plyometric training, full return if pain-free.
Prevention Tips
Strong bones don’t just happen — they adapt when stressed appropriately and fuelled properly. Here’s how to keep them resilient:
Increase training gradually (10% rule is a good guide).
Keep muscles strong with regular resistance training.
Fuel your body with enough energy and nutrients.
Prioritise recovery: sleep, rest days, and stress management all matter.
Be cautious with changes: new shoes, new surfaces, or new training plans should be introduced slowly.
Consider gait retraining: small tweaks like increasing cadence can reduce bone loading.
Final Thoughts
Bone stress injuries can be frustrating, but they’re also preventable and very treatable when caught early. If you listen to your body, respect the pain signals, and give your bones the right mix of stress and recovery, you’ll not only heal — you’ll come back stronger.
If you’re experiencing persistent bone pain, don’t ignore it. Reach out to a healthcare professional who can help guide your recovery and get you safely back to the activities you love.
