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No runner wants to be put in a walking boot or be told they need crutches. Yet, there are a few running injuries severe enough to warrant these precautions, and stress fractures, or what healthcare providers call bone stress injuries (BSIs) are one of them.
Receiving a BSI diagnosis can feel devastating, especially if it happens during the beginning or middle of a season, when training for a big race, or after returning to running post-hiatus.
Bone stress injuries occur when the bone’s capacity to repair is exceeded by the stress placed upon it. This can result from various factors, including insufficient recovery between runs, elevated stress (whether mental, emotional, or physical), poor running mechanics, strength deficits, or simply ramping up training too quickly. A common and often overlooked factor is energy imbalance, specifically low energy availability (LEA), where the body isn't receiving enough fuel to support both daily function and athletic demands.
LEA can contribute to a condition known as Relative Energy Deficiency in Sport (RED-S). RED-S affects more than just bones—it impacts performance, immunity, cardiovascular health, and overall well-being. In runners, this condition increases the risk of bone stress injuries, as the body lacks the necessary energy to maintain bone health, repair tissues, and handle the stresses of training. Understanding and addressing your energy intake is critical to reducing the risk of BSIs and optimizing long-term performance.
BSIs often start with a dull ache that can progress to sharp pain during walking or running. You'll likely notice point tenderness at the site of injury, and activities like hopping or jumping may become difficult and painful. Common BSI locations in runners include the 5th metatarsal (foot), tibia (shin), and femur (hip/thigh). If you suspect you have a BSI, it’s crucial to stop running and see a healthcare provider for imaging before the injury worsens. Ruling it out early will help you recover and return to running faster.
Running is a lifelong sport, so it’s important to take care of yourself when you feel pain, not when you can't walk. This means fueling your body properly, building strength, and addressing your mental, physical, and emotional well-being.
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