In episode 379 of The Physical Performance Show, host Brad Beer and Pogo Physio physiotherapist Tim Studley continue their three-part expert series on bone stress injuries by shifting the focus from training errors to the biological factors that determine whether an athlete’s skeleton can tolerate training demands.
This episode explores the critical role of energy availability, bone health, recovery, and risk stratification in both preventing and diagnosing bone stress injuries. Brad shares practical screening strategies developed over two decades of clinical practice, explaining why identifying the underlying cause—not just treating the injury—is essential for long-term athletic performance and injury prevention.
PILLAR Performance is leading a new frontier in sports nutrition through micronutrition innovation. Their new Collagen Repair formula, developed in collaboration with Gelita Laboratories, is designed to support tendon and ligament health while promoting collagen synthesis to help athletes stay healthy and perform at their best.
For 15% off your first order, visit pillarperformance.shop (or thefeed.com for North American listeners) and use the discount code PHYSICALPERFORMANCE (one word, capitals) at checkout.
“Training loads the skeleton—but biology determines whether the skeleton can cope.”
“Eat more than you think you need.”
“The biggest driver of bone stress injuries is often invisible.”
“Above the knee, think fuelling. Below the knee, think biomechanics.”
“Treat the cause—not just the bone.”
Show Sponsor: PILLAR Performance — 15% off your first order using code PHYSICALPERFORMANCE at checkout.
North America: thefeed.com
00:00 – Introduction, sponsor and recap of the Bone Stress Injury mini-series
02:27 – Why biological risk factors deserve greater attention than ever before
03:51 – Early sport specialisation and athletic history as risk factors
04:50 – Medical conditions, medications and bone health
05:45 – Sleep, stress and the biological contributors to bone stress injuries
07:08 – Understanding low energy availability (RED-S)
08:32 – Practical screening questions for under-fuelling
09:02 – Female athlete indicators: menstrual health and amenorrhoea
10:29 – Male athlete indicators: libido and morning erectile function
11:51 – Blood tests, iron studies, vitamin D and hormone profiles
13:18 – Why even small daily energy deficits accumulate over time
14:16 – Working with sports dietitians and estimating energy requirements
15:40 – Brad’s number one recommendation: “Eat more than you think you need”
16:08 – Common sites of bone stress injuries throughout the body
18:00 – Using injury location to distinguish biomechanics from under-fuelling
18:48 – High-risk versus low-risk bone stress injury locations
21:12 – The most commonly missed bone stress injuries in runners
22:37 – Clinical examination: observation, palpation and localisation of symptoms
24:19 – Differentiating shin splints from bone stress injuries through palpation
25:14 – Functional loading tests and when hop testing is appropriate
26:31 – Hop testing, femoral neck injuries and clinical safety considerations
27:24 – Differential diagnosis and key assessment principles
28:25 – Episode wrap-up and preview of Part 3
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Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online.
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Telehealth rehabilitation can be effective for people needing help to get back to their physical best who are geographically not able to attend appointments in person at POGO Physio (Mermaid Waters, Gold Coast).
Our team of physiotherapists routinely conduct telehealth consultations for patients who live:
There are several elements of an in person consultation that cannot be actioned when receiving a telehealth consultation. However in most instances this does not represent a barrier to an effective consultation being delivered.
Manual therapy (hands-on) treatment can also not be conducted remotely. If a patient will benefit or requires manual therapy it can be sought in the patient’s local area with guidance (if required) from a local provider.
Exercises are demonstrated and prescribed via our exercise prescription software and app TrackActive. Trackactive has viewable videos and photos, as well as detailed commentary on how to complete the exercises with accuracy at home or the gym. See below for an example series of exercises:
COLLAGEN REPAIR
Now, you've all heard me talk about Pillar Performance. They have truly led a new frontier in the sports nutrition industry through their micronutrition innovation — and as someone who has spent their career working with endurance athletes managing injury, this one really caught my attention.
You may have also recently seen Pillar launch some new product lines under the banner of Performance Health. Like all Pillar products, this expansion is designed to maximize those crucial hours outside of training and racing, helping you return to the start line in peak condition.
One of their newest releases is Collagen Repair. This has been specifically developed to address some of the most common tendon and ligament overuse injuries among endurance athletes — conditions like hamstring tendinopathy, Achilles tendinitis, shin splints, and patellofemoral pain. As a physio, these are honestly the injuries I see walk through the door most often.
This product was brought to market in collaboration with Gelita Laboratories from Germany, and features a clinically trialled collagen peptide called Tendoforte, designed to strengthen and promote collagen synthesis.
Did you know that after the age of 30, you lose 1% of your body's collagen every year? That's significant — especially if you're pounding out kilometres week after week.
All you need is one scoop — it's flavorless and pairs perfectly with your morning coffee.
So check it out. Visit PillarPerformance.shop, or for North American listeners, head to TheFeed.com and use the code PHYSICALPERFORMANCE for 15% off your first purchase.
TRIPLE MAGNESIUM
On The Physical Performance Show, we talk a lot about training load, but sleep and recovery are where the real adaptation happens — and that's something I've become genuinely obsessed with optimising.
Pillar's Triple Magnesium has become a non-negotiable part of my evening routine. Informed by leading Heart Rate Variability researcher Dr Dan Plews, I take it 30 minutes before bed every night to help my body spend as much time as possible in REM and deep sleep.
Pillar uses a high dose of Glycinate Magnesium, which activates the parasympathetic nervous system — essentially telling your body it's time to switch off, recover, and rebuild. My WHOOP data each morning tells the story: higher HRV, longer deep sleep cycles, and I genuinely wake up feeling more restored.
For anyone listening who is serious about performance — whether you're training for your first marathon or your tenth Ironman — sleep quality is the multiplier on everything else you do. This is the product that's moved the needle most for me personally.
Head to PillarPerformance.shop and use code PHYSICALPERFORMANCE for 15% off your first purchase.
