Bone Stress Injuries 

Foot pain that lingers, comes and goes, or never fully heals can signal something more serious especially in runners. Episode 19 of Interdisciplinary Case Miles centers on a high school track athlete dealing with a navicular bone stress injury that persisted for nearly a year. This type of injury is one of the most challenging in running due to limited blood supply, high biomechanical demand, and the need for strict management early on. This case highlights how bone stress injuries develop from a combination of training load, biomechanics, and nutrition especially low energy availability in adolescent athletes. It also addresses why navicular injuries require careful progression, non-weight bearing phases, and long-term follow-up to avoid delayed healing or recurrence. You’ll hear how foot mechanics, posterior tibial function, and arch control influence stress at the navicular, along with how strength, mobility, and confidence all play a role in returning to sport. The conversation also emphasizes the importance of fueling, growth demands, and the unique challenges faced by youth and first-generation athletes navigating high training loads. Whether you’re a runner dealing with stubborn foot pain, a parent supporting a young athlete, or training in high-impact environments like track, trail, or jumping sports, this episode provides clear direction on preventing and managing navicular stress injuries. 00:00 – Intro to Interdisciplinary Case Miles Overview of the podcast and today’s complex case. 01:05 – Case Overview: High School Athlete with Persistent Foot Pain Track athlete with a year-long navicular bone stress injury. 03:10 – What Is the Navicular Bone & Why It Matters Location, function, and role as the “keystone” of the arch. 06:00 – Why Navicular Stress Injuries Are High Risk Limited blood supply and challenges with healing. 09:20 – The Perfect Storm: Load, Biomechanics & Nutrition How multiple factors combine to create bone stress injuries. 12:40 – Low Energy Availability in Young Athletes How underfueling impacts bone health and recovery. 16:30 – Growth, Development & High Calorie Needs Why adolescent runners require more fuel than expected. 20:10 – Practical Fueling Strategies for Busy Athletes Snacking, meal timing, and closing energy gaps. 24:00 – Posterior Tibial Function & Foot Mechanics How pronation control affects stress at the navicular. 27:45 – Physical Therapy Approach to Navicular Injuries Strength, mobility, stability, and load management. 31:20 – Confidence & Fear in Return to Sport Mental barriers after long-term injury. 35:00 – When to Repeat Imaging & Monitor Healing Using MRI and clinical signs to guide progression. 38:40 – Surgical vs Conservative Treatment Options When athletes consider early intervention. 42:10 – Athlete Stage Matters: Youth vs Elite Decisions How treatment varies by age and competition level. 45:30 – Key Takeaways from Each Expert Education, fueling, and whole-athlete care. #runninginjury #stressfracture #footpain #navicular #runnersofinstagram #trackandfield #highschoolathlete #youthathletes #runningtips #injuryprevention #sportsmedicine #physicaltherapy #sportsrehab #runhealthy #runstrong #ultrarunning #trailrunning #marathontraining #tracknation #runnerlife #sportsnutrition #fuelingforperformance #lowenergyavailability #REDs #bonehealth #enduranceathlete #runpainfree #mobilitytraining #strengthtrainingforrunners #biomechanics #returntosport #confidencebuilding #mississippirunners #southernrunners #denverrunners #trackathletes #distanceathlete #jumper #sprinter #evidencebased

What happens when a highly conditioned collegiate swimmer transitions into marathon training too quickly? In this episode of Interdisciplinary Case Miles, a 23-year-old former swimmer increases weekly mileage from 15–20 miles to 40 miles, adds hills and speed work, and begins to worry about low ferritin when performance stalls. What initially appears to be an iron concern reveals a broader picture involving low energy availability, fueling gaps, training load errors, and bone stress injury risk, ultimately resulting in a diagnosis of femoral shaft stress fracture. Dr. Sara Raiser (running medicine physician), Kelsey Pontius (sports dietitian), and Dr. Kate Mihevc Edwards (physical therapist) discuss: Why ferritin is often a marker of a larger issue The relationship between nutrition, iron stores, and bone health Unique injury risks when transitioning from non-weight-bearing sports How cardiovascular fitness can exceed musculoskeletal readiness Rehabilitation principles, plyometric loading, and safe return-to-run progressions This episode is essential listening for runners, clinicians, coaches, and endurance athletes navigating performance concerns, injury prevention, and the demands of marathon training. 00:00 – Welcome to Interdisciplinary Case Miles Meet the hosts and the evidence-informed approach behind real runner cases. 02:10 – The Case Introduction A former collegiate swimmer increases mileage from 20 to 40 miles/week while marathon training. 04:45 – “Is It My Ferritin?” Why athletes fixate on iron and ferritin when performance plateaus. 07:30 – Ferritin vs Iron Explained What ferritin actually represents and why it changes slowly. 10:15 – Red Flags for Low Energy Availability Sleep, libido, GI symptoms, recovery, and early warning signs of REDs. 15:40 – Nutrition, Bone Density, and Stress Injury Risk How low ferritin, low energy intake, and bone health intersect. 18:30 – Thigh Pain Isn’t “Just a Quad Strain” Why distance runner thigh pain raises concern for femoral stress fractures. 22:15 – Diagnosing a Femoral Shaft Stress Fracture Why this injury matters and how it differs from higher-risk stress fractures. 26:40 – The Swimmer-to-Runner Problem Cardio fitness vs bone loading, gravity, and anti-gravity sports. 31:50 – The Three Pillars: Nutrition, Training Errors, Biomechanics A framework for evaluating bone stress injuries. 36:20 – Training Errors That Add Up Fast Mileage spikes, speed work, lack of rest, and life stress post-college. 41:10 – Starting PT Before You Run Again Strength, education, and early rehab during protected weight-bearing. 45:30 – Plyometrics, Bone Loading, and Return-to-Run Why jumping matters and how bones adapt to force. 50:40 – Bone Geometry, Density, and Multi-Directional Movement Why specialization matters—especially in adolescence. 55:30 – The “Engine vs Chassis” Problem When cardiovascular fitness outpaces muscles, tendons, and bones. 59:20 – Why Return-to-Run Feels So Hard Managing athlete frustration while protecting long-term health. 1:02:30 – Final Takeaways from Each Expert Big-picture thinking, history matters, and don’t self-coach in isolation. 1:06:00 – Wrap-Up & How to Submit a Case #running #runninginjuries #runninginjury #sportsmedicine #physicaltherapy #enduranceathletes #nutitioncoach #wellness #wellnesstips #injuryprevention #pt

Welcome to Interdisciplinary Case Miles, a podcast where real runner stories meet clinical expertise. In Episode 11, Dr. Kate Mihevc Edwards (PT), Dr. Sara Raiser (MD), and sports dietitian Kelsey Pontius break down a common but often misunderstood injury: shin splints (medial tibial stress syndrome) in adolescent runners. Using the case of a 15-year-old male cross-country runner with bilateral shin pain, the team explores why shin splints are so prevalent in this age group and how rapid growth, training load changes, biomechanics, footwear, surfaces, and nutrition all intersect. The discussion highlights the critical role of energy availability, especially during periods of rapid growth, and why skipping meals, inadequate fueling, and school-related barriers to eating can contribute to ongoing symptoms. The hosts also discuss how shin splints can look very different depending on the athlete’s age and training history ranging from sudden spikes in mileage to more complex, layered cases involving chronic pain, stress, and low energy availability. From a physical therapy perspective, the episode covers gait patterns during growth spurts, strength and mobility needs, and the importance of collaborating with coaches and parents to support young athletes. In this episode you’ll learn: What shin splints are and how they differ from other bone stress injuries Why adolescents are at higher risk during growth spurts The role of nutrition and energy availability in healing shin pain Common fueling challenges for high school athletes How training load, surfaces, shoes, and spikes affect shin stress Why interdisciplinary care leads to better outcomes for young runners As always, this episode reinforces a core message of Interdisciplinary Case Miles: shin splints aren’t just a “training issue” or a “nutrition issue” they’re often both. Supporting young runners requires understanding the whole picture and meeting athletes where they are. Subscribe for evidence-informed conversations on running health Like, rate, and share this episode with parents, coaches, and runners Have a case you’d like us to discuss? Email us at runcasemiles@gmail.com #InterdisciplinaryCaseMiles #ShinSplints #TeenRunners #YouthRunning #MedialTibialStressSyndrome #RunningInjuries #InjuryPrevention #SportsMedicine #PhysicalTherapy #SportsDietitian #RunnerHealth #HighSchoolRunning #CrossCountryRunning #FuelForGrowth #EnergyAvailability #HealthyRunning #running #athletehealth

Dr. Kate Mihevc Edwards (physical therapist), Dr. Sara Raiser (Running Medicine Physician), and sports dietitian Kelsey Pontius break down the case of a professional marathoner returning to training postpartum after a C-section. From pelvic health and biomechanics to nutrition, hormones, and the mental side of recovery, the team highlights what it really takes to get back to running. Whether you’re an athlete, coach, or medical provider, you’ll walk away with practical strategies and interdisciplinary insights to support performance and long-term health. 0:00 – Welcome & sponsor introduction 4:15 – Case intro: professional marathoner postpartum 9:00 – Physical therapy approach (Dr. Mihevc Edwards) 16:30 – Physician considerations: delivery, injury history, pelvic floor (Dr. Raiser) 25:20 – Nutrition & fueling postpartum (Kelsey Pontius) 34:15 – Coaching influence, mindset & interdisciplinary teamwork 41:40 – RED-S, underfueling & blood sugar regulation 50:10 – Long-term recovery, rest, and community support 58:00 – Key takeaways from each discipline Have a question or a case you'd like us to explore on the show? We’d love to hear from you. Reach out anytime at runcasemiles@gmail.com. A big thank you to our sponsor, Lever Movement — a treadmill-based body weight support system used by clinicians, coaches, and athletes around the world. Whether you're rehabbing from injury, managing training load, returning postpartum, or focusing on performance, Lever is a versatile tool that helps keep runners running. As a listener, use the code CaseMiles for 20% off any of their 3 units. Thanks for joining us on Interdisciplinary Case Miles — real runners, real problems, real solutions.

In this episode of Interdisciplinary Case Miles, hosts Dr. Sara Raiser(MD), Kelsey Pontius RD , and Dr. Kate Mihevc Edwards PT break down a complex real-world case of a male marathoner caught in a cycle of injury, underfueling, and recovery. When multiple stress fractures, low testosterone, and low ferritin collide with emotional stress and high training volume, the team dives deep into how Relative Energy Deficiency in Sport (RED-S) affects performance, hormones, and bone health. Kelsey unpacks the concept of within-day energy deficits and the athlete’s struggles with reactive hypoglycemia. Dr. Sara Reiser highlights why femoral neck stress fractures are among the most serious running injuries often requiring urgent imaging and complete rest. Dr. Kate Mihevc Edwards PT shares the detailed process of returning safely to running, from load management and biomechanics to rebuilding strength and confidence. This episode showcases the power of an interdisciplinary approach where nutrition, medicine, and physical therapy work together to help runners heal fully and sustainably. Episode Highlights 00:00 Welcome & introductions 01:10 Kelsey presents the case: male runner with recurring stress injuries 07:45 Understanding reactive hypoglycemia and RED-S 10:20 Dr. Raiser explains femoral neck stress fractures & key lab work 16:50 Dr. Edwards on rehab, biomechanics, and safe return-to-run 23:30 The importance of interdisciplinary collaboration 28:40 Top takeaways for clinicians & athletes Submit your cases: runcasemiles@gmail.com Follow, share, and review to support the Interdisciplinary Case Miles community.