Episode 12: Nathan Carlson, DPT - Optimizing rehabilitation and return to run for bone stress injuries in runners

Ready to Run

Nathan Carlson is a physical therapist, coach, and business owner based out of Kansas City. He specializes in the management of bone stress injuries, managing the high school and collegiate runner, and implementing resistance training with endurance athletes. Nathan teaches nationally and internationally on these topics. Nathan has two digital resources - A Guidebook to Running After a Stress Fracture and A Guidebook to Navigating High School Running.

In this episode, we focus on how to approach bone stress injuries once we have established our diagnosis. We open our discussion with the physiology of bone healing and what the current research says about how long it actually takes for a bone to heal and how that may differ based on the location of the injury. We also discuss the factors that influence treatment, how to test when an athlete is ready to return to running, and how to progress training load for a successful recovery.

Bone stress injuries are one of the most complex and frustrating injuries for runners. After our discussion with Nathan, we hope that you will have a better understanding of the training, nutrition, and metabolic factors that need to be considered with diagnosing and treating these injuries.

What we talked about:

3:05- The physiology of bone healing and the expectations to set for patients

17:40- Modalities for recovery

22:20- Focus for the return to run program

31:00- Being flexible with the protocol

Show notes:

Nathan's website

Nathan on Instagram

References:

• Gehman S, Ackerman KE, Caksa S, Rudolph SE, Hughes JM, Garrahan M, Tenforde AS, Bouxsein ML, Popp KL. Restrictive Eating and Prior Low-Energy Fractures Are Associated With History of Multiple Bone Stress Injuries. Int J Sport Nutr Exerc Metab. 2022 May 6;32(5):325-333.
• Popp KL, Ackerman KE, Rudolph SE, Johannesdottir F, Hughes JM, Tenforde AS, Bredella MA, Xu C, Unnikrishnan G, Reifman J, Bouxsein ML. Changes in Volumetric Bone Mineral Density Over 12 Months After a Tibial Bone Stress Injury Diagnosis: Implications for Return to Sports and Military Duty. Am J Sports Med. 2021 Jan;49(1):226-235.
• Rudolph SE, Caksa S, Gehman S, Garrahan M, Hughes JM, Tenforde AS, Ackerman KE, Bouxsein ML, Popp KL. Physical Activity, Menstrual History, and Bone Microarchitecture in Female Athletes with Multiple Bone Stress Injuries. Med Sci Sports Exerc. 2021 Oct 1;53(10):2182-2189.
• Warden SJ, Davis IS, Fredericson M. Management and prevention of bone stress injuries in long-distance runners. J Orthop Sports Phys Ther. 2014 Oct;44(10):749-65.
• Warden SJ, Edwards WB, Willy RW. Optimal Load for Managing Low-Risk Tibial and Metatarsal Bone Stress Injuries in Runners: The Science Behind the Clinical Reasoning. J Orthop Sports Phys Ther. 2021 Jul;51(7):322-330.