Bone Stress Injuries vs. Tendon-Related Pathologies in Runners: What You Need to Know
As a runner, dealing with pain can be frustrating, especially when trying to differentiate between common injuries like bone stress injuries (BSIs) and tendon-related pathologies. Understanding the key differences between these conditions can help you take the right approach to recovery and prevent setbacks in training.
Bone Stress Injuries: When Your Skeleton Rebels
Bone stress injuries occur when the load on the bone exceeds its ability to recover, leading to structural damage. These injuries exist on a spectrum, from bone stress reactions (early-stage) to full-blown stress fractures. BSIs are often caused by training errors such as rapid increases in mileage, insufficient recovery, and poor fueling.
Signs & Symptoms of BSIs:
- Gradual onset of localized pain that worsens with impact activities (running, jumping)
- Pain that initially appears only during activity but progresses to discomfort at rest
- Tenderness to touch at a specific point on the bone
- Swelling may be present in more advanced cases
- Common sites: tibia, metatarsals, femur, pelvis
Risk Factors for BSIs:
- Sudden increases in training volume or intensity
- Low energy availability or inadequate nutrition (RED-S)
- Weakness in surrounding musculature leading to poor load distribution
Tendon-Related Pathologies: When Your Tendons Push Back
Tendon-related injuries, such as tendinopathy, occur due to excessive or repetitive loading that exceeds the tendon’s ability to adapt.
Signs & Symptoms of Tendon Injuries:
- Gradual onset of pain, often with stiffness in the morning or after periods of inactivity
- Pain that worsens with increased load but improves with warm-up
- Localized swelling or thickening of the tendon
- Tenderness along the tendon, but typically no pinpoint bony pain
- Common sites: Achilles tendon, patellar tendon, proximal hamstring tendon
Risk Factors for Tendinopathy:
- Excessive or sudden increase in training load or intensity
- Insufficient strength in surrounding muscles, leading to tendon overload
- Overtraining and poor recovery
Managing & Preventing These Injuries
For BSIs, the priority is offloading and proper recovery. This often means reducing or eliminating activity until the bone heals. If a high-risk fracture site, crutches are necessary. Addressing nutrition, strength deficits, and life stressors are key for long-term prevention.
For tendinopathies, progressive loading is essential. While complete rest can be detrimental, managing training volume and incorporating physical therapy and resistance exercises can promote tendon remodeling and resilience.
Final Thoughts
Both bone stress injuries and tendon-related pathologies can sideline runners, but understanding their differences allows for better management and a more effective return to training. If you’re unsure about your pain, a thorough assessment from a running-specialized physical therapist can help guide you toward the right rehab plan and long-term prevention strategies.
Are bone stress injuries (BSIs) or tendinopathies keeping you from running your best? Crew Physical Therapy is here to help you recover, rebuild, and get back to pain-free miles. Reach out today to start your journey back to strong, healthy running!
