we can forget to ask some or all the concerns & questions we wish to have answered, which causes frustration & uncertainty when we leave.

Take your time beforehand, list all the concerns, questions & other things that you wish to get answers for, then take them with you.

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Cortical (e.g., tibial shaft, fibula) = more tolerant → quicker return

⚠️High-risk sites often carry >40% complication rates if progressed aggressively.

6/6

💡 Same injury type, different bone = completely different rehab plan.

Why the Difference?

🔬 Trabecular vs Cortical bone

Trabecular (e.g., femoral neck) = more vulnerable to overload → slower healing

5/6

From Hoenig et al., 2023 (systematic review & meta-analysis):

📆 Mean return-to-sport timelines varied hugely
• Femoral neck: ~107 days
• Tarsal navicular: ~127 days
• Medial malleolus: ~106 days
• Tibial shaft: ~44 days
• Fibula: ~56 days

4/6

📍 Lower-risk BSI locations (Posteromedial tibial shaft, Fibula, 1st–4th mets, Pubic bone)
➡️ Usually heal faster
➡️ Safer, earlier progression when symptoms allow

3/6

High Risk vs Low Risk Sites

📍 High-risk BSI locations (Femoral neck, Navicular, Anterior tibia, Medial malleolus, 5th metatarsal)
➡️ Slower healing
➡️ Higher complication rates
➡️ Greater risk if rushed back too soon

2/6

noting that using a 1% incline on the treadmill is only necessary to simulate overground running at speeds faster than 7:00 mins per mile (approximately 4:21/K).

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These are earlier signals than injury.

4️⃣ Consistency beats bravado.

Skipping recovery doesn’t make you tough — it increases your injury risk.

5️⃣ Think long-term athletic durability.

Recovery is a performance enhancer, not a sign of weakness.

13/13

Thanks for reading 👍

2️⃣ If your volume is high (or you’re older, busy, stressed, or in a heavy block), you need more recovery, not less.

Life load = training load.

3️⃣ Watch for consistent soreness, sleep disturbance, rising resting HR, or performance drop.

12/13

Aim for two days each week where intensity and load are meaningfully reduced.

THIS CAN AND MUST CHANGE AS YOUR TRAINING AND RACING CHANGE!!

11/13

🏁 Practical Takeaways for Real Athletes

As a physio working with endurance athletes every day, here’s the real-world interpretation:

1️⃣ You need recovery days — but they don’t all have to be full days off.

10/13

5. Overuse injury was based on questionnaires, not clinical diagnosis — so definitions might vary between athletes.

In other words: the direction of the message is strong, but the exact numbers aren’t gospel.

9/13

3. Group = Finnish high-level athletes aged 15–35 — findings may not generalise to recreational athletes, older athletes, or people with different training structures.

4. Training volume measured broadly — not broken down into intensity distribution, surface, monotony, or spikes in load.

8/13

1. Retrospective + self-reported — athletes recalled symptoms and weekly rest days after the fact, which introduces memory bias.

2. “Rest day” wasn’t standardised — we don’t know if that meant total rest or light activity.

7/13

The spirit of the finding = you need structured, deliberate recovery — not perfection.

🔍 Study Limitations You Should Know (Because Context Matters)

Even though the headline finding is useful, here are the caveats:

6/13

For many endurance athletes, a “rest day” may be:
✔ Active recovery (easy Zone 1 spin, swim, or walk)
✔ Technique-only sessions
✔ Mobility, conditioning, or strength at low load
✔ Sleep + nutrition-focused day
✔ A day off running but light cross-training

5/13

BUT…

“2 rest days” doesn’t mean two full couch-bound days every week. It means two days where the global load drops enough for your body to recover.

4/13

The study suggests:

Athletes who never create space for recovery accumulate load faster than their tissues can repair.

Overuse injury risk rises when training is continuous and high-volume with no meaningful down-regulation.

3/13

Pretty striking… but here’s the nuance you rarely see in social posts 👇

🧠 What This Really Means (Not Just “Take 2 Days Off”)

Before you panic about having exactly two rest days — let’s break it down intelligently.

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