Episode 381
This episode is essential listening for runners, coaches, and clinicians alike, unpacking how to tell the difference between medial tibial stress syndrome (MTSS/shin splints) and a true tibial bone stress injury — two conditions that can feel identical but require completely different management. Brad and Tim walk through the physiology of bone loading, the palpation tests that separate a “safe to keep running” diagnosis from one requiring an MRI, and the loading tests used to stress-test the tibia safely in clinic.
In episode 381 of The Physical Performance Show, host Brad Beer — sports and exercise physiotherapist — sits down with Pogo physiotherapist Tim Studley for the first instalment of a two-part mini-series on shin pain and tibial bone stress injuries, following on from their earlier three-part bone stress injury series.
Show Sponsor:
Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain.
Head to pillarperformance.shop (or thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase.
Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at https://pogophysio.com.au.
Listen in as we delve into the following:
Quotes
“You can go from hero to zero really quickly with bone.”
“Higher levels of pain don’t necessarily mean a worse injury.”
“Muscle loads bone.”
Timeline
00:00 – Introduction & sponsor: Pillar Performance
02:15 – Introduction to Tim and Brad’s conversation
02:27 – Prevalence of tibial bone stress injuries
03:56 – Why bone stress injuries occur: workload and biomechanics
05:22 – Symptom patterns: bone stress injury vs. other shin pain
07:42 – Heterogeneity of bone innervation and pain variability
10:10 – Why pain severity doesn’t predict injury severity
11:07 – MTSS vs. bone stress injury: two schools of thought
12:06 – Brad’s clinical experience and personal injury history
13:59 – Cardinal signs and symptom progression in MTSS
15:23 – The three-legged stool: history, physical exam, imaging
16:19 – The 10cm palpation rule explained
19:43 – Applying the rule in practice
20:42 – Anterior shin pain: a higher-risk presentation
21:39 – Loading tests: from calf raises to forward hopping
24:07 – Individualising the loading-test progression
26:03 – Does the 10cm rule apply anteriorly?
26:55 – History as the biggest predictor of reinjury
27:53 – MRI, prognosis, and grading via the Fredericksons scale
29:15 – Reading hesitancy and movement quality in loading tests
31:10 – Why bone stress injuries aren’t purely about vertical impact
33:03 – Calf girth and bone stress risk correlation
34:56 – Case study: a triathlete’s navicular injury and recovery
35:58 – Episode close & sponsor mentions
THE TEAM:
Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow
Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online at pogophysio.com.au.
Your Hosts:
🏃 Brad Beer – Instagram & X @Bradbeer and YouTube @PogophysioAu
🏃♂️➡️ Timothy Studley – Instagram @timothy_physio
The Physical Performance Show can be found at:
Facebook: facebook.com/thephysicalperformanceshowpodcast
X: @tppshow1
Instagram: @physicalperformanceshow
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.
