If you’re a runner, dancer, or just someone who enjoys being active, you may have heard of something called a bone stress injuries (BSI) — or perhaps you’ve experienced one yourself. These types of injuries can sneak up on you and take you out of your training or routine for weeks (or longer), especially if they go unrecognised.
So, what exactly is a bone stress injury? And how can a physiotherapist help you recover — and even prevent it in the first place?
What is a Bone Stress Injury?
Bone Stress Injury (BSIs) occurs when a bone is repeatedly placed under load (like from running or jumping) and doesn’t have enough time to rest and repair. Instead of one big injury like a broken bone from a fall, BSIs build up gradually from microdamage — tiny cracks in the bone that develop over time due to overuse.
Think of your bones like a construction site — they’re constantly breaking down and rebuilding in response to stress. This natural process is called bone remodelling. When the stress is balanced with enough rest and recovery, your bones adapt and become stronger. But if you don’t allow enough time between activities (or increase your training too quickly), your bones may not keep up — and that’s when problems start.
Over time, this can lead to:
- Stress reactions (early warning signs of injury with bone swelling)
- Stress fractures (tiny cracks in the bone)
- And eventually, full fractures if left untreated
Why Do Bone Stress Injuries Happen?
BSIs usually come down to one thing: too much load, too soon, without enough recovery.
This can happen if you:
- Increase your training volume or intensity quickly
- Have a history of previous injuries
- Aren’t getting enough calories or nutrients (especially calcium and vitamin D)
- Have biomechanical issues (like poor running technique or weak muscles)
- Train on hard surfaces without the right footwear
What Does a Physiotherapist Do?
If you’ve been told you have a bone stress injury, don’t panic — physiotherapy is one of the best ways to manage it. Here’s how we help:
1. Diagnosis & Load Management
First, we assess your symptoms and training history, and help identify the likely cause of your pain. We’ll guide you on how much rest is needed, when to reduce weight-bearing activity, and when it’s safe to return to sport. Managing load is the most important part of letting the bone heal.
2. Movement & Strength Analysis
We’ll look at how your body moves — especially your technique, alignment, and muscle control. Weak hips, glutes, or calves can contribute to poor shock absorption, leading to stress on the bones. Targeted strength training is key.
3. Progressive Exercise Program
Once healing is underway, we design a gradual return-to-exercise plan. This might include:
- Balance and proprioception training
- Strengthening exercises for the lower limbs and core
- Low-impact cardio options (like swimming or cycling)
Eventually, we’ll guide you back into sport-specific training, helping you build tolerance to load in a controlled way.
4. Education & Prevention
Physios also help you understand your body better — how to listen to it, how to avoid overtraining, and how to adjust your training load sensibly. We may work alongside your doctor, coach, or dietitian to make sure all bases are covered.
How do physiotherapists help with bone stress injury?
1. Diagnosis & Load Management
First, we assess your symptoms and training history, and help identify the likely cause of your pain. We’ll guide you on how much rest is needed, when to reduce weight-bearing activity, and when it’s safe to return to sport. Managing load is the most important part of letting the bone heal.
2. Movement & Strength Analysis
We’ll look at how your body moves — especially your technique, alignment, and muscle control. Weak hips, glutes, or calves can contribute to poor shock absorption, leading to stress on the bones. Targeted strength training is key.
3. Progressive Exercise Program
Once healing is underway, we design a gradual return-to-exercise plan. This might include:
- Balance and proprioception training
- Strengthening exercises for the lower limbs and core
- Low-impact cardio options (like swimming or cycling)
Eventually, we’ll guide you back into sport-specific training, helping you build tolerance to load in a controlled way.
4. Education & Prevention
Physios also help you understand your body better — how to listen to it, how to avoid overtraining, and how to adjust your training load sensibly. We may work alongside your doctor, coach, or dietitian to make sure all bases are covered.
Recovery Takes Time (and That’s Okay)
Bone remodelling — the healing process for these injuries — takes time, usually between 6–12 weeks depending on the severity. That means patience is key. But with the right rehab and support, most people make a full recovery and come back stronger than before.
Bottom line: If you’re experiencing bone pain that gets worse with activity and better with rest, don’t ignore it. It may be your body’s way of saying it needs a break. Physiotherapists are here to help you recover safely, reduce pain, and get you back to doing what you love — stronger and smarter.
References
- Brukner, P., & Khan, K. (2017). Clinical Sports Medicine (5th ed.).
- Warden, S. J., Davis, I. S., & Fredericson, M. (2014). Management and prevention of bone stress injuries in long-distance runners. Journal of Orthopaedic & Sports Physical Therapy.
- Jonesco, M. (2014). Bone stress injuries: Diagnosis and treatment. Current Sports Medicine Reports.
- Tandom, S. (2020). Bone Healing and Remodeling.
