It is with great enthusiasm that we present this targeted issue of the Aspetar Sports Medicine Journal, dedicated to Bone Stress Injuries (BSI). When challenged by our Chief Editor, Dr Nebojsa Popovic, to explore this topic in depth, we—Juan Manuel Alonso, Stephen Targett, and Evan Jeanguyot—embraced the opportunity to dissect BSI from every conceivable angle. The result is a comprehensive and multifaceted issue, enriched by contributions from leading experts in the field.
BSI, a term now preferred over “stress fractures,” better captures the continuum of bone overuse injuries—from early stress reactions to high-grade stress fractures. This terminology shift reflects a more nuanced understanding of the pathology and its clinical implications.
Despite its relatively low prevalence compared to muscle or ligament injuries athletes affected by BSI often face prolonged recovery periods, and the injury’s impact on performance and career trajectory can be significant. Surprisingly, PubMed search comparisons reveal that BSI-related publications rival or exceed those on ACL ruptures and tendinopathies. However, the literature is dominated by case reports and series, with a notable scarcity of randomized controlled trials, especially in prevention strategies.
BSI remains a “supporting actor” in sports medicine conferences, often overshadowed by more prevalent injuries. Yet, its clinical importance demands greater attention. Sports such as cricket, athletics and triathlon illustrate the injury’s burden, where early diagnosis and optimal treatment are crucial for timely return to play.
This issue exemplifies the “Aspetar Way,” which is our hospital’s hallmark multidisciplinary approach to managing BSI. Recognising that BSI arise from a diverse range of causes and risk factors, we believe that effective management demands the coordinated input of an interdisciplinary team. The manuscripts contributed by Aspetar staff in this issue provide insight into our protocols, covering key aspects such as radiology, return-to-running programmes, strategies for managing high-risk injuries, surgical indications, shock wave therapy, and the significance of relative energy deficiency. These contributions encapsulate the collaborative spirit of our BSI Multidisciplinary Group. Here, professionals from various departments work together, pooling their expertise to identify and mitigate all potential causes and risk factors. This collective approach enables us to deliver the highest standard of care and best-practice management for athletes affected by BSI.
In addition to the manuscripts contributed by Aspetar staff, this issue has benefited greatly from the involvement of renowned international experts in the field of BSI. Articles on bone health, classifications of BSI, Lumbar BSI and Rib BSI provide valuable information for clinicians, sports physicians and sports physiotherapists that deal regularly with BSI. By drawing on the expertise of leading figures in the field, this issue aims to equip healthcare professionals with the latest evidence-based strategies for managing BSI, ensuring optimal care for athletes and active individuals.
As we look ahead, the need for further research is clear. Advancing our understanding of BSI through robust clinical trials, innovative diagnostics, novel managements will be key to improving outcomes for athletes worldwide.
We invite you to explore this issue and hope it inspires deeper engagement with a condition that, while often overlooked, deserves a central place in sports medicine practise.
Enjoy the read.
Juan-Manuel Alonso, MD, PhD
Sports Medicine Physician,
Aspetar
Stephen Targett, MD
Head of Sports Medicine,
High Performance Sport, New Zealand
Evan Jeanguyot, PT
Sports and Exercise Physiotherapist,
Aspetar