This month’s newsletter focuses on bone stress injuries and why early action matters. We’ve seen a spike in patients coming in with bone stress reactions and stress fractures recently, especially as more people are getting back into training routines or pushing performance goals. So, this month, we’re diving deep into the world of bone stress injuries: what they are, how to catch them early, and why proper diagnosis and management are critical. 

What Are Bone Stress Injuries?

Bone stress injuries happen when bones are overloaded by repetitive force without enough time to adapt or recover. Think of it as a spectrum, starting with bone stress reactions (inflammation and early micro-damage) and, if left unchecked, progressing to stress fractures (small cracks in the bone). 

Why Early Diagnosis Is Key

Getting seen early can be the difference between a short-term setback and a season-ending injury. At the early stress reaction stage, your body has a good chance of healing with relatively simple load management and guided rehab. But if you push through pain or ignore early warning signs, the injury can worsen, leading to a longer time away from activity, and in some cases, needing months of offloading or even surgery.

If we suspect a bone stress injury, getting the right scan is essential. 

• MRI is the gold standard for early detection, it picks up stress reactions before they become full-blown fractures. 

• CT scans may be helpful if we’re later in the process and need to see fracture lines, but often miss early changes. 

• X-rays are not helpful in diagnosing stress fractures unless its months down the line.

Bone stress injuries are graded from the imaging to guide rehab and return-to-activity timelines.

Most Common Sites We See 

While bone stress injuries can occur almost anywhere, some areas are particularly prone to trouble: 

• Shins (Tibia) – especially in runners and field athletes 

• Feet (Metatarsals, Navicular) – often from increased walking, running, or jumping 

• Hip/Pelvis (Femoral neck, Pubic bone) – common in distance runners and dancers 

• Lower back (Pars interarticularis) – particularly in young athletes doing extension sports like cricket, tennis, gymnastics. Kids should not experience back pain with sport!

Our Approach

At our clinic, we work with you to: 

• Identify symptoms early (e.g. activity-related pain that eases with rest) 

• Get the right scans promptly if needed 

• Develop a progressive rehab and return-to-activity plan that protects healing while maintaining fitness and strength 

• Explore contributing factors like nutrition, training load, footwear and biomechanics to name a few.

In Summary If You're Feeling That "Bone Deep" Ache… 

...don’t wait. Book in for a physio assessment, especially if pain is worsening with activity and easing at rest, or if you’ve recently ramped up your training.