🎙️ Episode 19:  Femoral Bone Stress Injuries in Runners: Diagnosis, Management & Return to Run | Nathan Carlson

 

Femoral bone stress injuries can be difficult to diagnose, challenging to manage and, particularly at the femoral neck, potentially serious if missed.

 

In this episode of The Rehab Runway, Luke Nelson is joined by physical therapist and running coach Nathan Carlson to discuss the diagnosis and management of femoral neck and femoral shaft bone stress injuries in runners.

 

Nathan takes us through the clinical presentation of these injuries, the examination findings that should increase suspicion, the role of MRI, and how imaging findings influence decisions around conservative versus surgical management.

 

The discussion then moves into rehabilitation, including unloading, return to weight-bearing, progressive strength training, plyometrics and return to running. Nathan also explains how he progresses runners from their first run-walk sessions back toward normal training, and where clinicians and athletes commonly make mistakes during that process.

 

A major focus of the episode is looking beyond the injury itself. We discuss when a runner with a bone stress injury may require additional investigation, including blood tests and DXA scanning, and why clinicians should consider low energy availability, bone health, medications, hormonal factors and other systemic contributors when trying to understand why the injury occurred.

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In this episode, we discuss

• Why femoral neck bone stress injuries are considered high risk

• How femoral neck and femoral shaft injuries typically present

• Key clinical findings that should raise suspicion

• When MRI is indicated

• Compression-sided versus tension-sided femoral neck injuries

• When surgical review should be considered

• How long runners may need to unload

• Progressing back to normal daily activity

• Strength training during rehabilitation

• When to introduce plyometrics

• Criteria for returning to running

• How to structure a run-walk progression

• Progressing from easy running back to full training

• Common mistakes during return to sport

• When to investigate beyond the musculoskeletal diagnosis

• Blood tests following a bone stress injury

• When to consider DXA scanning

• Screening for low energy availability

• The role of multidisciplinary care in recurrent or high-risk bone stress injuries

 

About Nathan Carlson

Nathan Carlson is a physical therapist, running coach and founder of Running Mate, a running-specific rehabilitation and performance practice based in Kansas City.

He has a particular interest in the assessment and management of running injuries and has developed extensive clinical education around bone stress injuries, including femoral neck and femoral shaft injuries.

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Instagram: @runningmatekc

Website: Nathan Carlson

Link to Nate's Bone Stress Course: Rebuild Bone Stress Injury course

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🎙️ About the Host

Hosted by Luke Nelson, Sports & Exercise Chiropractor, running coach, and strength coach.​​​​​​​

• 📱 Follow Luke on Instagram: @sportschiroluke

• 🌐 Learn more & explore upcoming courses: www.healthhp.com.au​​​​​​​​​