Bone stress injuries (BSIs) are one of the most frustrating and misunderstood injuries in running. They often start subtly, get ignored, and then sideline athletes in Colorado Springs for months. For clinicians, they represent a classic mismatch between load and capacity. For runners, they are usually the result of doing too much, too soon, without giving the body time to adapt.
What Are Bone Stress Injuries?
Bone stress injuries exist on a spectrum ranging from mild bone stress reactions to full stress fractures. They occur when repetitive mechanical loading exceeds the bone’s ability to remodel and recover.
Bone is a dynamic tissue that constantly adapts to load. With increased activity, bone initially undergoes resorption (temporary weakening) before rebuilding stronger. However, when loading continues without adequate recovery, microdamage accumulates faster than repair, eventually leading to structural failure.
In runners, BSIs account for a significant proportion of overuse injuries, with estimates suggesting they may make up as much as 10 to 30 percent of running-related injuries in Colorado Springs.
How Bone Stress Injuries Develop In Runners
Running near Colorado Springs exposes the skeleton to thousands of repetitive loading cycles per session. When training variables increase too quickly, the bone cannot adapt fast enough. Key contributors include:
Factors That Increase Load
- Rapid increases in mileage, intensity, or frequency
- Sudden changes in terrain or footwear
- Inadequate recovery between sessions
- Muscle fatigue reducing shock absorption
Factors That Reduce Bone Capacity
- Low energy availability or inadequate nutrition
- Low bone mineral density
- Vitamin D or calcium deficiency
- Hormonal dysfunction (e.g., Relative Energy Deficiency in Sport)
- History of prior stress fracture
Training errors are the most consistent contributor. Increasing volume, speed, or duration without progressive adaptation significantly increases injury risk.
Importantly, cardiovascular fitness improves faster than bone adaptation. This creates a dangerous window where runners feel capable of doing more, but their skeletal system is not yet prepared.
Where Bone Stress Injuries Are Most Common
BSIs in runners near Colorado Springs most frequently occur in the lower extremity, unsurprisingly. In particular, they most commonly affect:
- Tibia (the most common site)
- Metatarsals (the long bones in your foot)
- Fibula
More rarely, they can affect the pelvis and femoral neck.
Consequences Of Ignoring Bone Stress Injuries
Ignoring a bone stress injury rarely works out.
What begins as a mild stress reaction can progress to a full fracture if loading continues. This can result in:
- Prolonged time away from running
- Increased risk of complete fracture
- Need for surgical intervention (in high-risk cases)
- Chronic pain or recurrent injury
Recurrence rates are also significant, with prior BSI being a strong predictor of future injury.
In my experience, runners aren’t great at deciding when it’s time to rest or actually following through when they do. Running in Colorado Springs is often a somewhat painful activity, so we get used to ignoring pain. But if that pain happens to be your bone breaking down, you will run into trouble.
How Physical Therapists Treat Bone Stress Injuries
Traditional management often emphasized rest alone. Hopefully by now, you know that RICE is an incomplete solution to an injury. While unloading is necessary early on, current evidence and clinical practice support a more active, aggressive approach.
1. Preventative Load Management
The most valuable service a physical therapist in Colorado Springs provides is teaching a runner how to avoid an injury in the first place. We often need to be the voice of reason, cautioning patients to actually stick to a walk-run program and minimize the miles while building up to longer distances.
We may also use advanced techniques like plyometrics and heavy weight lifting to increase bone stress and loading in a controlled manner, which better prepares a runner for the stresses of distance running.
2. Rehabilitative Load Management
If a runner near Colorado Springs is coming to us after already suffering a BSI, managing a runners load is still our first intervention.
This will often include:
- A reduction in miles or temporary cessation of running
- Cross-training to maintain fitness and encourage healing
- Gradual reintroduction of weight bearing activities
We don’t typically jump straight to cutting out your favorite activity if we can avoid it, but a BSI is something you can’t ignore. Focusing on other aspects of fitness is likely your best strategy for getting back to your normal running volume as fast as possible.
3. Addressing The Root Cause
Once we have a conversation regarding training volume and goals, we will then dig into the possible biomechanical, lifestyle, or training related causes of your injury in Colorado Springs.
- Training errors: too much work, advanced too quick
- Biomechanical inefficiencies: overstriding or other gait deviations resulting in preferential loading
- Strength deficits: inadequate shock absorption through muscles
- Nutritional issues: a caloric deficit can reduce recovery and cause brittle bones, leading to fractures.
Without addressing these, recurrence is common.
4. Initiation of Bone Stimulating Interventions
Once you are experiencing less pain and the root cause of your BSI has been identified, we initiate specific interventions meant to rebuild your bones. Bones respond to heavy or rapid loads through your skeleton, like heavy weight lifting and plyometrics near Colorado Springs.
Heavy weight lifting is a great place to start because it allows for stress to the skeleton without a rapid spike in loading like plyometrics.
However, plyometrics are the gold standard for bone healing because of that rapid onset of stress through the bones. This simulates running most closelyl, which is essentially just bounding from one leg to the other thousands of times.
A simple plyometric progression might look like this:
- Double-leg pogo jumps
- Single-leg hops
- Bounding and multidirectional drills
- Running-specific plyometrics
Typically we start with double leg tasks and progress to single leg ones. At the same time, we start with tasks performed in place and progress to adding directions. Once those basic parameters have been mastered, we start adding height like you would with box jumps to improve intensity.
Clinical Takeaways
- Bone stress injuries are a load vs. capacity problem, not just a “bone issue”
- Rapid training changes are the most common cause
- The tibia and foot are the most frequently affected sites
- Ignoring symptoms increases risk of fracture and prolonged recovery
- Rehab should include progressive bone loading and plyometrics
- Rest alone is insufficient for long-term recovery
- Addressing systemic causes of stress injuries is critical (ie nutrition)
When Should You Stop Running And Get Evaluated?
If you are struggling with pain while running in Colorado Springs and are wondering if you should get checked out, refer to the following list. If you are experiencing at least 3 out of 4, you may want to pursue further evaluation with our physical therapists at Backcountry Physical Therapy.
- Pain that worsens during a run
- Pain that lingers after activity
- Localized bony tenderness
- Pain with hopping
We proudly serve active individuals in Colorado Springs, Manitou Springs, Briargate, Falcon, Rockrimmon, and surrounding areas.
📞 Call us today or 📧 book your evaluation to get started with Physical Therapy near Colorado Springs: (719) 285-9670
