Bone stress injury healing in runners is assessed inconsistently across clinical, functional, and imaging outcomes, limiting comparability and evidence-based return-to-sport guidelines.
This protocol describes a 1-year multi-site prospective observational cohort study of runners with MRI-confirmed bone stress injuries (BSIs) of the tibia, metatarsals, femoral neck, or sacrum. The study aims to characterize candidate outcomes for BSI healing, including time to pain-free functional milestones, return-to-run protocol completion, medical clearance, and changes in MRI grade and clinical severity scores, along with their time course and variability.
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Bone stress injury healing in runners is assessed inconsistently across clinical, functional, and imaging outcomes, limiting comparability and evidence-based return-to-sport guidelines. The current body of evidence comprises 1 study. EvidenceHub rates the overall confidence at 32/100 (low).
The Claim
Bone stress injury healing in runners is assessed inconsistently across clinical, functional, and imaging outcomes, limiting comparability and evidence-based return-to-sport guidelines.
This conclusion is most relevant to: Male and female runners with a recent MRI-confirmed BSI of the tibia, metatarsals, femoral neck, or sacrum, enrolled within 3 weeks of diagnostic MRI across four sites in the USA and Canada..
What the Research Shows
The conclusion draws on 1 linked study. Highlights from the cited literature:
- ▸Bone stress injury recovery and return to sport in runners: a multi-site prospective observational cohort study protocol across the USA and Canada. (BMJ open, 2026) —
How It Works
The proposed biological pathway:
- ▸Enroll runners with recent MRI-confirmed BSI within 3 weeks of diagnosis
- ▸Follow participants longitudinally for 1 year through recovery, return to sport, and full sport participation
- ▸Collect candidate outcomes across clinical, functional, and imaging domains at multiple time points
- ▸Use descriptive statistics to characterize time course and variability; explore associations with subsequent BSIs using regression models
Who Might Benefit
Evidence fit by population:
- ▸Male and female runners with a recent MRI-confirmed BSI of the tibia, metatarsals, femoral neck, or sacrum, enrolled within 3 weeks of diagnostic MRI across four sites in the USA and Canada.
Recommended Dose
N/A
Limitations & Caveats
Important context when interpreting this evidence:
- ▸Observational design; no control group or intervention, so causality cannot be established
- ▸Findings may be limited by variability in clinical practices across sites and potential loss to follow-up over 1 year
Frequently Asked Questions
What is the primary aim of this study?▼
To identify and characterize candidate outcomes for assessing BSI healing in runners, including their time course and variability across functional, imaging, and clinical domains.
Who can participate in this study?▼
Male and female runners with a recent MRI-confirmed BSI of the tibia, metatarsals, femoral neck, or sacrum, enrolled within 3 weeks of diagnostic MRI.
What outcomes are being measured?▼
Time to pain-free functional milestones (hopping, jogging), completion of return-to-run protocol, medical clearance for unrestricted activity, changes in MRI grade and clinical severity scores, plus secondary measures like training patterns, wearable-derived sleep and activity metrics, biomechanics, and serum proteomics.
How long is the follow-up period?▼
Participants are followed longitudinally for 1 year through recovery, return to sport, and full sport participation.
References
- 1.Popp KL, Whitcomb E, Hahn ME, Stellingwerff T, Guldberg RE, Kraus E, Bouxsein ML, Ackerman KE. “Bone stress injury recovery and return to sport in runners: a multi-site prospective observational cohort study protocol across the USA and Canada..” BMJ open, 2026. PMID: 42637262 DOI: 10.1136/bmjopen-2026-121916