The Distance Dr: In Practice

Bone stress injuries are common in endurance athletes, and one of the most frustrating parts is that they often feel like they “came out of nowhere.” In Part 1 of this two-part series, I’m joined by sports dietitian Lauren Nash (Up Dietitian) to unpack what a bone stress injury actually is, why the terminology is confusing (even among experts), and why two athletes can run the “same program” yet have totally different outcomes.
We cover the load side (quiet training changes, session density, too few true low-load days, and why it can feel
Link to the Delphi Consensus Study: https://pubmed.ncbi.nlm.nih.gov/39638438/
sudden), and the physiology side (low energy availability, REDs, menstrual dysfunction, and why you can be under-fuelling without losing weight). We also dig into overlooked contributors like diet culture, calcium intake, and gut conditions that can reduce nutrient absorption.
In Part 2, we go practical: management, return-to-run, and how to reduce recurrence risk.

In this episode, I break down a study in competitive cyclists that tested whether adding 8 weeks of maximal strength training can improve cycling performance-relevant outcomes. The intervention was deliberately simple: half-squats, 4 sets of 4RM, three times per week, alongside normal endurance training. We cover the effects on cycling economy and work efficiency at 70% of VO₂max, and time to exhaustion at maximal aerobic power, as well as changes in maximal strength and rate of force development. I also discuss the mechanisms proposed by the authors, key limitations, and how to translate the protocol into a time-efficient strength session for real-world cyclists.

Study link: https://pubmed.ncbi.nlm.nih.gov/19855311/

This episode breaks down a study investigating whether 8 weeks of maximal strength training (half-squats, 4×4RM, 3 sessions/week) can improve performance-relevant outcomes in well-trained distance runners. We cover the effects on running economy at 70% VO₂max and time to exhaustion at maximal aerobic speed, alongside changes in maximal strength and rate of force development, and the fact that VO₂max and body weight did not change. I also unpack the mechanisms proposed by the authors, and what those results mean in practice for endurance runners.
Link to the paper: https://pubmed.ncbi.nlm.nih.gov/18460997/

In this episode of the Distance Dr podcast, Nick and I sit down and properly dissect a recent large cohort paper examining training load changes and injury risk in endurance athletes.
We walk through the study design, what the researchers actually measured, and why the results challenge some long-held assumptions about weekly mileage progression and the so-called “10% rule.” In particular, we dig into the role of single-session spikes, especially long runs, and why these may matter more than gradual changes in weekly volume alone.
We also spend time on what this paper can tell us, what it can’t, and the important limitations that need to be understood before anyone rushes to change how they train. From there, we translate the findings into practical, real-world coaching decisions, including how to think about long run progression, tapering, and load management without oversimplifying complex physiology.
Study link: https://bjsm.bmj.com/content/59/17/1203

This podcast episode explores the intersection of female athletes' training and their menstrual cycles, emphasizing the importance of understanding individual physiological differences. Host Kate Baldwin and Associate Professor Claire Badenhorst discuss the Menstrual Health Manager, a tool designed to help athletes and coaches communicate effectively about menstrual health. They highlight the variability of menstrual cycles, the impact of hormonal contraception, and the need for athletes to collect personal health data to inform their training and health decisions.
Link to Claire's Publication:
https://pubmed.ncbi.nlm.nih.gov/38904920/