Bone Stress Injuries, Carbon Shoes & Under-Fueling

In episode 390 of The Physical Performance Show, we’re syndicating a conversation from the All In Triathlon podcast, where Pogo Physio’s very own Brad Beer, sports and exercise physiotherapist, joins hosts Jelle Geens and Aaron Royal for a deep dive into bone stress injuries (BSIs). Brad brings 20 years of clinical experience in endurance sport, plus his own lived experience of recurring femoral shaft bone stress injuries.

Together they explore whether BSIs are really on the rise, how advanced footwear technology may shift load up the chain, why some athletes are more bone-injury prone than others, and why under-fueling is such a powerful driver. Brad also shares his practical “bone density Olympics” prescription for athletes and coaches. It’s a conversation that challenges how runners, triathletes and coaches think about bone health.

Huge thanks to Jelle, Aaron and the All In Triathlon team. Please head over and give their podcast a listen (link in the show notes below).

SHOW SPONSOR:
💯 Today’s episode is brought to you by Pogo Physio’s Telehealth consultations. If you’re an endurance athlete battling bone, tendon or joint-related concerns, our online telehealth consultations with Brad Beer or any of the Pogo Physio team are an ideal platform to help get you back to your physical best. Book online at https://pogophysio.com.au.

IN THIS EPISODE YOU’LL HEAR:

Whether we’re really seeing more bone stress injuries, or whether social media and Strava just make them more visible
Brad’s clinical experience: over 20 sacral bone stress injuries in a single year, the most he has ever treated
The difference between distal (below the knee) and proximal (above the knee) BSIs, and why the drivers differ
How advanced footwear technology (carbon-plated “super shoes”) may reduce demand at the foot and ankle and shift load proximally
Why the recovery benefits of super shoes can also tempt athletes to tolerate more intensity and volume
Brad’s practical advice on carbon shoes: avoid sudden wholesale changes rather than avoiding them altogether
Why changing the shoe-to-ground interaction shifts injury risk, from minimalist shoes and Achilles issues to high stack heights
Soft-tissue-prone vs bone-prone athletes: the roles of genetics, collagen quality, cellular turnover and athlete psychology
Why one previous bone stress injury raises the risk of another for the rest of an athlete’s career, and why that cycle is so hard to break
How the drive to feel good and train hard can derail return-to-run plans, even when the athlete has all the head knowledge
The “engine before the chassis” problem: triathletes keep their cardiovascular fitness while injured, but their skeletons aren’t ready for load
Why symptoms lag the biology, and why the run that tips you over may not be the run that caused the problem
Why you can go from no symptoms to a significant bone injury within a single run, and why pain levels don’t reliably reflect severity
How bone density and bone geometry are built during a window through puberty and early adulthood
The perils of early sports specialisation and the value of multi-directional sports for building wider, more resilient bones
Why bone density can still be improved later in life through heavy lifting and fueling, while bone geometry can’t be changed
How small daily energy deficits add up over a year, and why under-fueling is so hard to detect without data
How the body triages energy when under-fueled: reproductive function and bone health are deprioritised
The Australian triathlon data: how common BSIs were across an Olympic cycle, and the higher risk in female athletes
Whether you can be fit, strong and well-fueled and still develop a BSI, and why the time course matters
Secondary markers of under-fueling: iron studies, sex hormone profiles, menstrual cycle function and morning erections in males
Why Brad’s one message for every coach is to get athletes to eat more than they think they need
When not to run through pain: when you know deep down that something isn’t right
Brad’s three priorities for the “bone density Olympics”: eat more than you think you need, expose your skeleton to unfamiliar stimulus (plyometrics and multi-directional work), and schedule regular skeletal resets
Why Brad suggests every 12th week as a non-running week, and how cross-training, plyometrics, strength and fueling can continue

QUOTES / TAKEAWAYS:
“Just get athletes to eat more than they think they need.”
“The symptoms lag the biology.”
“You don’t get atypical performance from typical thinking and typical behaviours.”
“The body has to triage resources.”
“Every little bit of width that you add to a bone circumference, you markedly make that bone more resilient.”
“Athletes are great self-deceivers.”
“Every 12th week as a non-running week.”

TIME STAMPS:
00:00 – Episode introduction and sponsor
01:07 – Guest introduction: Brad Beer joins All In Triathlon
02:28 – Are we seeing more bone stress injuries?
04:39 – Brad’s lived experience and clinical caseload
06:36 – Distal vs proximal bone stress injuries
07:35 – Carbon shoes and advanced footwear technology
13:18 – Why some athletes are more bone-injury prone
16:39 – Why one BSI raises the risk of another
18:34 – Brad’s story: when psychology drives behaviour
20:27 – Returning to run: the engine vs the chassis
21:56 – Why symptoms lag the biology
23:15 – Pain, innervation and bone stress grades
25:12 – Bone density, geometry and multi-directional sport
27:08 – The window of opportunity and early specialisation
33:54 – Under-fueling: what happens to the bones?
39:27 – The Australian triathlon bone stress data
40:27 – Can a fit, strong, well-fueled athlete still get a BSI?
42:50 – The one thing every coach should understand
44:41 – Tracking fueling and secondary markers of under-fueling
48:01 – When should you not run through pain?
49:41 – The bone density Olympics: three priorities
52:10 – Skeletal reset: every 12th week
53:40 – Where to find Brad and wrap-up
54:34 – Episode close

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YOUR HOSTS:

🏊🚴🏃 All In Triathlon Podcast: https://open.spotify.com/show/7rqpbqsR8bQEyXWXewf89u

🏃‍♂️‍➡️ Brad Beer – Instagram & X @Bradbeer and YouTube on @PogophysioAu

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