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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.

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.

Last updated: Aug 26, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score32/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Bone stress injury recovery and return to sport in runners: a multi-site prospective observational cohort study protocol across the USA and Canada.

observational

Popp KL, Whitcomb E, Hahn ME, Stellingwerff T, Guldberg RE, Kraus E, Bouxsein ML, Ackerman KE · BMJ open (2026)

Participants: N/A
Duration: 1 year
Intervention: No intervention; observational study protocol.
Outcome: Candidate outcomes for BSI healing: 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; secondary outcomes include training patterns, wearable-derived activity and sleep metrics, biomechanical assessments, and serum proteomic profiles.
Effect Size: N/A
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.

Result:

PubMed: 42637262DOI: 10.1136/bmjopen-2026-121916

Mechanism Graph

Enroll runners with recent MRI-confirmed BSI within 3 weeks of diagnosis
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Follow participants longitudinally for 1 year through recovery, return to sport, and full sport participation
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Collect candidate outcomes across clinical, functional, and imaging domains at multiple time points
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Use descriptive statistics to characterize time course and variability; explore associations with subsequent BSIs using regression models

Limitations

  • ⚠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.

Products

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References

  1. 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
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.