
Bone Stress Injury / Stress Fracture
A comprehensive multi-factorial rehabilitation programme is key to a successful return to sport following a bone stress injury. Both adult and adolescent long-distance runners can suffer bone injuries, with tibia (shin) and metatarsal (foot) stress fractures commonly diagnosed. A period of unloading is essential in order for the bone to heal. Additionally, a successful return to sport should address the following areas : training loads, running mechanics, biomechanics, strength, hormonal factors and energy availability. Start your journey back to sport today.
What is a Bone Stress Injury?
A bone stress injury (BSI) occurs in response to chronic repetitive stress, leading to an imbalance between bone formation and bone resorption (Nattiv et al, 2013). The strength of the bone is then compromised, making it more susceptible to injury.
BSI's are related to training load errors, and they occur along a continuum that begins with a stress reaction. If not managed appropriately, this stress reaction can progress to a stress fracture, and then a complete bone fracture (Warden, Davis & Fredericson, 2014).

T2-Weighted MRI of a Fredericson Grade 3 bone stress injury of the tibia. The arrow demonstrate marrow edema (Nussbaum et al, 2022)
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The Statistics
Females
Females are at a greater risk of sustaining a bone stress injury compared to males
Healing
The severity of your fracture & whether it's low or high risk, will determine your time off running
Rehab
Key areas to address include energy availability, strength, running mechanics, training loads & hormonal factors
Location
> 1/2 of bone stress injuries in long distance runners occur in the tibial (shin) & metatarsal (foot) diaphyses
Diagnosed with a bone stress injury?
Start your rehab today!
If you've been diagnosed with a bone stress fracture, you will require a return to sport plan. Yes, a period of unloading is required in order for the bone to remodel, but there are exercises that you can commence to prepare you for your return to running.
My rehabilitation programme also addresses the following key areas specific to bone stress injuries : training loads, running mechanics, neuromuscular control & strength, hormonal factors and energy availability.
I specialise in treating lower limb injuries. Contact me today to learn how I can help you get back to your sport!
Stress Fracture Rehabilitation
Rehabilitation from a bone stress injury involves 5 distinct phases. The work completed in each phase helps to prepare you for the next phase. You cannot skip phases!
Although we need to respect bone healing timeframes, rehabilitation is primarily criteria-driven, not time-driven. This means that you will work towards meeting specific targets in each phase. If you don't put in the work in one phase, you will not be ready or able to move to the next. This process is proven to work and it ensures that we leave no stone unturned & that nothing gets missed during your rehabilitation.
I understand that being injured can be tough. There will be challenging periods throughout rehab, but I am here to guide you the entire way. It is important that you reframe your rehab as being an opportunity to come out the other side, physically & mentally stronger than your were pre-injury. Thankfully, you will be able to cross-train in the early stages of rehab, along with completing exercises targeted at muscles away from the injured bone site.
Ultimately, the goal of rehab is not only to be back running or playing sport in a few weeks or months time, but to still be playing sport with healthy bones in 5 and 10 years time. Re-injury rates following stress fractures are high. With this in mind, I have refined my rehab process over the past 15 years, to ensure that you receive the latest evidence-based treatment & high quality exercise prescription.
The 5 phases of bone stress injury rehabilitation are outlined below.

Phase 1 - Load Management
Involves a period of reduced loading

Phase 4 - Return To Running
Commence a return to run programme

Phase 2 - Maintain Fitness
Cross-training (e.g. swim, bike, ski erg)

Phase 5 - Return To Sport
Return to your team or individual sport

Phase 3 - Muscle Function
Testing and Exercise Programming
Success Stories
Trusted By
Why Our Patients Choose Us
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15 Years of Private Practice Experience
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Individualised Exercise Programming
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Exercise Videos Available Via a Mobile App
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A Criteria-Driven Rehab Process
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Regular Testing Every 4-6 Weeks
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Access To 24/7 Support From Your Physio
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Supervised Gym Sessions
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Supervised On-Field / On-Court Rehab Sessions
Learn More : How To Rehab My Stress Fracture
Our Vision
Buan Physio is dedicated to providing exceptional injury rehabilitation and sports performance services. Whether you are recovering from an injury or seeking to enhance your performance, we are here to provide the support and expertise you need to succeed.
Opening Hours
Mon-Fri : 7am - 7pm
Sat & Sun : Closed
Contact us
51 Mount Merrion Avenue
Blackrock, Dublin, Ireland
(1st floor, above The Butler's Pantry)
© 2021 by Athlete Development Physiotherapy Teoranta