Bone remodelling: why balance matters

Bone is constantly being renewed through a process called remodelling, which involves:

• Bone resorption (removal of old or fatigued bone)
• Bone formation (replacement with new, stronger bone)

Importantly, these processes don’t occur at the same speed.

When training load increases:

• Bone resorption increases relatively quickly
• Bone formation takes longer to catch up

This creates a temporary period where the bone is more vulnerable to stress.

If repeated loading continues without adequate recovery, small areas of bone injury can begin to develop and accumulate over time.

What does a bone stress injury feel like?

Symptoms of a BSI typically develop gradually and may include:

• Pain during or after activity
• Pain that becomes more consistent over time
• Localised tenderness when pressing on the area
• Discomfort with impact activities such as running or jumping

In the early stages, symptoms may be subtle — which is why they are sometimes overlooked.
It is best to get these symptoms looked into with a professional to rule out the possibility of a BSI. Book an appointment here.

Common areas affected

Bone stress injuries most often occur in weight-bearing bones, including:

• Tibia (shin)
• Metatarsals (foot)
• Femur (thigh)
• Calcaneus (heel)

Some locations are considered higher risk and may require closer monitoring.

Why early management matters

The stage of a BSI has a significant impact on recovery time.

• Early-stage BSI: may settle with load modification and appropriate management
• Advanced BSI (stress fracture): often requires a longer period of reduced loading and rehabilitation

Continuing to train through pain increases the likelihood of progression along the continuum and can delay recovery.