Forward Physio Stress Fractures and Bone Stress Injuries with Steph Mundt
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Nov 30, 2025 Steph Mundt, a physical therapist and running coach who founded Volante PT & Performance, discusses bone stress injuries from her personal and clinical perspective. She covers causes like low energy availability and training spikes. Conversation includes screening strategies, imaging choices, offloading and rehab timelines, safe progressions back to running, and preventing recurrence.
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How Energy Deficit Leads To Bone Stress Injuries
- Low energy availability causes hormonal shifts that reduce bone formation and increase bone breakdown, allowing microdamage to accumulate.
- Bone stress injuries lie on a continuum from periosteal edema to full fracture, explaining variable symptoms.
Get DEXA For Trabecular Rich Or High Risk Sites
- For trabecular-rich or high-risk sites (eg femoral neck, sacrum), order a DEXA to check bone density because low BMD slows progression and lengthens return-to-sport.
- Use a Z-score < -1 to guide more cautious loading.
Treat High Risk Sites As BSI Before Imaging
- If you suspect a BSI, refer for imaging but treat high-risk sites as BSI immediately and make them non-weight bearing until confirmed.
- Use MRI for proximal/high-risk sites; X-ray sensitivity is low and often false negative.