Adolescent bone-risk screen
Bone Stress
Risk Signals
For coaches, parents, and adolescent runners
Young runners often show bone trouble through pain, missed fueling, or repeated training spikes before a stress fracture is fully obvious.
Evidence-basedCoach-safeReferral requiredNot diagnosticCitations on sheet
Bone durability depends on enough fuel, progressive loading, and earlier attention to pain.
Low Risk (Green)
Normal soreness with no focal pain, no repeated injury history, and steady fueling.
Action: keep the athlete on regular meals, impact progression, and early pain reporting.
Moderate Concern (Yellow)
Localized pain, missed meals, or growth-plus-training stress starting to stack together.
Action: reduce load, document the site, and refer this week before the pain becomes a season-long problem.
High Risk (Red)
Pain with walking, hopping, or everyday activity, especially with prior injury or underfueling history.
Action: stop impact work and move to same-day sports medicine guidance.
Risk Clusters
Pain Pattern
- Point tenderness in one spot instead of general soreness.
- Pain that worsens as the week goes on or shows up sooner each run.
- Pain that lingers after practice or changes normal walking.
Fueling + Growth
- Skipped meals, weak lunches, or a long school-day gap before practice.
- Rapid growth, new mileage, or a bigger training block without more food.
- History of missed periods or low energy availability when relevant.
Risk History
- Prior stress fracture or repeated bone pain.
- Low calcium, vitamin D concerns, or poor recovery habits.
- Visible fatigue, weight loss, or repeated illness alongside training drift.
Immediate Referral TriggersRefer to athletic trainer or physician today if you notice:
Localized bone pain lasting more than a few sessions
Pain with hopping, walking, or stairs
Previous stress fracture plus a new focal pain site
Bone pain paired with obvious underfueling or menstrual disruption
What Not To Say
- Do not call focal pain normal if it keeps repeating.
- Do not tell the athlete to push through bone pain to prove commitment.
- Do not frame the problem as only calcium if the athlete is clearly underfueled.
Coach Action Steps
- 1Treat point tenderness as a referral question, not a grit test.
- 2Ask about meals, lunch quality, recovery food, and recent training changes.
- 3Loop in the family quickly when the athlete is still growing and the pain is focal.
- 4Keep the language on durability and healing, not weight or toughness.