In episode 380 of The Physical Performance Show, host Brad Beer and Pogo Physio physiotherapist Tim Studley conclude their three-part expert series on bone stress injuries by focusing on what happens after diagnosis. From imaging and prognosis to rehabilitation, return to running, and long-term prevention, this episode provides a practical roadmap for athletes, coaches, and clinicians managing these complex injuries.
Brad explains why identifying the underlying causes of a bone stress injury is just as important as healing the bone itself. The discussion covers deloading, progressive reloading, strength and conditioning, bone-building exercise, and the simple but powerful strategies that can dramatically reduce the risk of recurrence.
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In this episode, you'll hear
- Why MRI remains the gold standard for diagnosing bone stress injuries and guiding treatment
- When a clinical diagnosis may be sufficient—and why imaging usually provides better certainty and prognosis
- The three-step rehabilitation framework: identify risk factors, deload appropriately, then progressively reload
- Why treating the underlying cause is essential to preventing repeat bone stress injuries
- How rehabilitation differs depending on injury severity and high-risk versus low-risk bone sites
- Practical principles for returning to running, including restoring volume before introducing intensity
- Why the opposite limb also requires strength and bone loading during rehabilitation
- The role of strength training, plyometrics and osteogenic exercise in rebuilding bone capacity
- Why bone responds best to short, novel loading sessions rather than long continuous exercise
- The concept that "bone cells get bored easily" and how to optimise bone adaptation
- Why multidirectional movement remains important long after returning to sport
- The impact of childhood sport participation and bone geometry on lifelong injury risk
- Brad's personal journey with osteoporosis and what it taught him about endurance athlete health
- Three practical strategies every endurance athlete can implement to reduce bone stress injury risk
- Why recovery—not just training—is where adaptation actually occurs
Quotes / takeaways
"Treat the cause—not just the injury."
"Restore volume before you restore intensity."
"Bone cells get bored easily."
"It's not the training you adapt to—it's the recovery from the training."
"Eat more than you think you need."
Partners / links mentioned
Show Sponsor: PILLAR Performance — 15% off your first order using code PHYSICALPERFORMANCE at checkout.
North America: thefeed.com
Timeline
00:00 – Introduction, sponsor and final episode of the Bone Stress Injury mini-series
02:27 – Clinical testing for femoral neck bone stress injuries
03:26 – Clinical diagnosis versus MRI: when imaging is essential
05:14 – Why MRI improves prognosis and return-to-sport planning
07:03 – The three-step rehabilitation framework: risk factors, deload, reload
08:58 – Deloading strategies for high-risk bone stress injuries
09:50 – Progressive tissue loading and returning to running
10:46 – Why training volume should return before intensity
11:45 – Reloading the unaffected limb during rehabilitation
12:44 – Strength training, muscle function and long-term bone health
14:30 – Why bone cells "get bored" and how osteogenic exercise works
15:56 – Novel loading strategies, multidirectional movement and chaos hopping
17:23 – Childhood sport participation and building stronger bones
19:14 – Brad's personal experience with osteoporosis as an endurance athlete
21:40 – Three practical strategies to reduce bone stress injury risk
24:29 – Skeletal deload weeks and cross-training alternatives
25:27 – Recovery as the key driver of adaptation
26:26 – Final advice for athletes and clinicians
27:49 – Brad's top performance tip: "Eat more than you think you need"
28:18 – Listener challenge: fuel immediately before and after every training session this week
28:56 – Episode close and conclusion of the Bone Stress Injury mini-series
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🏃 Brad Beer – Instagram & X @Bradbeer and YouTube @PogophysioAu
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