Posted On: August 31st 2026, 01:15 am
Rest may settle the pain. It does not always explain why the bone struggled to adapt.
Bone is living tissue. Loading creates microdamage. With appropriate recovery, it repairs and adapts. A bone stress injury develops when repeated loading outpaces this process.
Training load is only one side of the equation. Bone capacity is also influenced by energy and carbohydrate availability, hormonal health, bone density, recovery and previous injury.
One often missed contributor is low energy availability. This occurs when too little energy remains after exercise to support health and normal function. It can be unintentional, occur at any body size and be present even at a stable weight. When sustained, it may contribute to Relative Energy Deficiency in Sport, or REDs, affecting bone health, recovery and performance.
Not every bone stress injury is caused by underfuelling, but nutrition deserves assessment alongside training load, strength and biomechanics.
A Sports Dietitian can:
• Map intake against training and rehabilitation to identify fuelling gaps
• Assess energy, carbohydrate, protein, calcium, vitamin D, iron and supplements
• Screen for REDs and menstrual or hormonal changes
• Address GI symptoms, low appetite and dietary restrictions
• Liaise about blood tests or DXA with the medical team when indicated
• Develop a plan for healing, reloading and return to sport
Carbohydrate periodisation means adjusting carbohydrate amount and timing to the work being completed. It does not mean automatically cutting carbohydrate when running volume drops. Rehabilitation, cross training and increasing impact still need fuel, while adequate energy and protein support bone repair and preserve muscle.
At Physiologic, physiotherapy guides load management, strength, biomechanics and graded return to impact. Sports dietetics addresses fuelling, bone supporting nutrition and REDs risk. Together, we address both load and capacity.
Managing a bone stress injury or had more than one? Ask Physiologic about adding a Sports Dietitian review to your rehab plan.