Bone Stress Injuries in Runners with Next Gen Physio

If you haven't already - head over to Next Gen Physio's website to read part 1.

Now you know everything you can do to work around bone Stress injuries.

How can we get back running?

It is incredibly important that your return to running (RTR) is guided by evidence-based concepts that are easily implemented.

Easy metrics to use that can be performed by almost anyone is throughout this blog. However, remembering that every bone and muscoskeltal system is different and may not always respond as expected. Knowing this, always be guided by your health professional.

General principles:

Assess Pain tolerance and readiness to run

Plan graded return

Monitor response to training and modify where needed


Pain tolerance and readiness to run

Before understanding what running should look like. Subjective and objective tests can give us an indication of someone’s readiness to run.

Can you do the following with minimal pain (ideally pain free but a pain score of 2 or less out of 10 may be acceptable)?


- Perform usual activities of daily living - Walk 30 minutes

- Single leg stand (10 secs)

- Single leg squat (10 reps)

- Jog on spot (1 minute)

- Jump squats (10 to 15 reps)

- Bounding (10 to 15 reps each leg)

- Hop in place (10 to 15 reps or aim for 30 seconds)


The return to running phase is an important one and commonly a time when runners encounter flare ups or secondary injuries which need to be managed. Monitoring both training load and response to it is important. Firstly, being guided by pain. Bones are different to tendons, joints, and muscles where some pain is considered normal.

Discomfort at the area of pathology is something to be aware of. We don’t expect any pain at all during our return to run. Odd and inconsistent pain that may last a few steps is not considered harmful. It’s pain that consistently happens when you begin to run or starts after an extended period of running. If this is the case, a week of relative rest or cross training into exercises that don’t elicit pain is recommended. Following this, beginning your return to run again.

Plan graded return

Starting your RTR is important to get right. Generally, starting with 20 minutes in total of exercise broken down into running and walking is beneficial. This may look like 30 seconds of running with 4.5 minutes of walking x 4 for a total of 20 minutes. This can be progressed by 30 seconds at each interval. For example, once tolerated for 3 runs without any pain, progressing to 1 minute of running and 4 minutes of walking x 4. Building all the way to 20 minutes in total. There is no golden rule that you need to progress by 30 seconds. If you are feeling confident, progressing by 1 minute can be done. Once 20 minutes of running is achieved, progressing a rate no higher than 30% per week can be achieved in less severe