Running Related Injury in a Collegiate Runner - Multidomain Assessment to Guide Safe Return-to-Run
Faculty Mentor
Joel Sattgast
Presentation Type
Poster
Start Date
4-14-2026 9:00 AM
End Date
4-14-2026 11:00 AM
Location
PUB NCR
Primary Discipline of Presentation
Physical Therapy
Abstract
HISTORY: An 18-year-old male distance runner transitioning to collegiate competition presented with insidious left midfoot pain (2/10 VAS). Running history included 5 years of training and PRs of 14:55 (5k) and 4:14 (1500m). Over the prior 12 months he sustained multiple bone stress injuries (BSI), including a high-risk femoral neck stress fracture. Two previous return-to-run attempts resulted in reinjury. Review of training revealed high cumulative volume, inconsistent strength training, and under-fueling, consistent with moderate risk relative energy deficiency in sport (RED-s). PHYSICAL EXAMINATION: Vitals and neurologic screening were normal. Lower extremity ROM was normal bilaterally. Functional testing demonstrated asymmetrical squat (ipsilateral unloading); single-leg stance 18 seconds; diminished single leg calf-raise strength on involved side; and inability to complete lateral step-down without compensation on involved side. Squeeze test provocation was positive. Impact testing (to include pogo jumps and single-leg hopping) was deferred due to suspected BSI. DIFFERENTIAL DIAGNOSIS: left metatarsal BSI. TEST & RESULTS: Magnetic resonance imaging without contrast demonstrated increased marrow edema at the bases of the 2nd and 3rd metatarsals consistent with Grade 2 bone stress injury. DIAGNOSIS: Grade 2 bone stress injury of the 2nd and 3rd metatarsals. INTERVENTION/OUTCOMES: Running was discontinued for 6 weeks to achieve pain-free weight bearing. Nutritional consultation addressed identified RED-s risk. A progressive 6-week strength and plyometric loading program preceded a structured 12-week return-to-run protocol emphasizing graded exposure and pain-monitoring principles. Footwear recommendations were provided. Return to running occurred at 6 months without symptom recurrence. Improved dynamic single-leg control and strength symmetry demonstrated. CONCLUSION: This case highlights the importance of multidomain assessment – including training load, fueling status, mechanical capacity, and past running history – when managing recurrent BSI in competitive runners. Structured load progression and interdisciplinary collaboration within the injury-to-performance spectrum are essential to mitigate reinjury risk and support safe return-to-run.
Recommended Citation
Lester, Paxton; Carver, Hannah; and Schultz, Brooklynn, "Running Related Injury in a Collegiate Runner - Multidomain Assessment to Guide Safe Return-to-Run" (2026). 2026 Symposium. 4.
https://dc.ewu.edu/srcw_2026/ps_2026/p1_2026/4
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Running Related Injury in a Collegiate Runner - Multidomain Assessment to Guide Safe Return-to-Run
PUB NCR
HISTORY: An 18-year-old male distance runner transitioning to collegiate competition presented with insidious left midfoot pain (2/10 VAS). Running history included 5 years of training and PRs of 14:55 (5k) and 4:14 (1500m). Over the prior 12 months he sustained multiple bone stress injuries (BSI), including a high-risk femoral neck stress fracture. Two previous return-to-run attempts resulted in reinjury. Review of training revealed high cumulative volume, inconsistent strength training, and under-fueling, consistent with moderate risk relative energy deficiency in sport (RED-s). PHYSICAL EXAMINATION: Vitals and neurologic screening were normal. Lower extremity ROM was normal bilaterally. Functional testing demonstrated asymmetrical squat (ipsilateral unloading); single-leg stance 18 seconds; diminished single leg calf-raise strength on involved side; and inability to complete lateral step-down without compensation on involved side. Squeeze test provocation was positive. Impact testing (to include pogo jumps and single-leg hopping) was deferred due to suspected BSI. DIFFERENTIAL DIAGNOSIS: left metatarsal BSI. TEST & RESULTS: Magnetic resonance imaging without contrast demonstrated increased marrow edema at the bases of the 2nd and 3rd metatarsals consistent with Grade 2 bone stress injury. DIAGNOSIS: Grade 2 bone stress injury of the 2nd and 3rd metatarsals. INTERVENTION/OUTCOMES: Running was discontinued for 6 weeks to achieve pain-free weight bearing. Nutritional consultation addressed identified RED-s risk. A progressive 6-week strength and plyometric loading program preceded a structured 12-week return-to-run protocol emphasizing graded exposure and pain-monitoring principles. Footwear recommendations were provided. Return to running occurred at 6 months without symptom recurrence. Improved dynamic single-leg control and strength symmetry demonstrated. CONCLUSION: This case highlights the importance of multidomain assessment – including training load, fueling status, mechanical capacity, and past running history – when managing recurrent BSI in competitive runners. Structured load progression and interdisciplinary collaboration within the injury-to-performance spectrum are essential to mitigate reinjury risk and support safe return-to-run.
