Overuse & Bone Stress Injuries

Understanding Bone Stress Injuries

Bone stress injuries develop when repetitive loading exceeds the bone's ability to remodel and repair. They are common on the Sunshine Coast - particularly in runners, triathletes, and endurance athletes training on the trails and roads around Noosa, Caloundra, and the hinterland. They exist on a spectrum, from early bone stress reactions visible on MRI but not X-ray through to complete stress fractures, and early diagnosis matters because management differs significantly depending on severity and location.

Common Stress Fracture Locations

• Tibial stress fractures - The most common site, particularly in runners. Usually classified as low-risk and manageable with load modification.
• Metatarsal stress fractures - Common in runners and military recruits. Most respond well to relative rest and gradual return to loading.
• Navicular stress fractures - A high-risk stress fracture requiring specialist management. Often missed or delayed in diagnosis.
• Femoral neck stress fractures - A serious injury requiring urgent assessment. Risk of progression to complete fracture if not managed appropriately.
• Sacral stress fractures - Can cause deep buttock or low back pain in runners.
• Pelvic stress fractures - Including pubic ramus fractures in distance runners.

Shin Splints (Medial Tibial Stress Syndrome)

Shin splints sit at the early end of the bone stress spectrum. Pain along the inner border of the tibia during running that improves with rest. Management focuses on load modification, biomechanical assessment, and graduated return to running.

Why Do Bone Stress Injuries Happen?

Bone stress injuries are rarely caused by a single factor. A thorough assessment should consider:

• Training load errors - Too much, too fast, or too soon. Rapid increases in running volume or intensity are the most common trigger.
• Bone health - Low bone density, vitamin D deficiency, or metabolic bone conditions.
• Energy availability & RED-s - Inadequate nutrition relative to exercise demands. Relative Energy Deficiency in Sport (RED-s) is a significant risk factor, particularly in female athletes and endurance athletes.
• Hormonal factors - Menstrual irregularity, low oestrogen, or other endocrine conditions.
• Biomechanics - Foot type, running mechanics, and footwear.

Recurrent Stress Fractures

Multiple bone stress injuries should raise concern for an underlying issue - particularly RED-s, low bone mineral density, or hormonal imbalance. I provide comprehensive investigation including blood work, bone density assessment, and nutritional screening.