Optimal Load for Managing Low-Risk Tibial and Metatarsal Bone Stress Injuries in Runners: The Science Behind the Clinical Reasoning

Low-risk bone stress injuries (BSIs) of the tibia and metatarsal diaphysis account for >50% of BSIs in runners. They interrupt training and are managed using non-invasive approaches. The desire by all involved is for a speedy, but safe return to running. What is the optimal load to manage low-risk tibial and metatarsal BSIs and safely return to running? Optimal load can be guided by knowledge of the BSI healing process and is symptom driven. At all stages, the optimal load does not produce symptoms during, after, or the day following loading. A period of initial load reduction, via partial- or non-weightbearing, is typically needed to alleviate presenting symptoms. Analgesics or NSAIDs may be used short-term (