There is now an international consensus on bone stress injuries
And its headline number is that a 41-member panel could agree on only 41 of 58 statements, so a confident single answer about grading, screening or return timing is over-claiming
Key Findings
A modified Delphi in three parts: (1) pathophysiology, diagnosis, classification systems and terminology; (2) screening, prevention and risk factors; (3) return to sport and management.
Panel of 41 members from six continents, including both experts (scientists and clinicians) and representatives (athletes and coaches), convened by a multidisciplinary steering committee. 33, 28 and 28 members completed rounds 1, 2 and 3.
Consensus was reached on 41 of 58 statements — meaning roughly three in ten of the questions the panel considered important enough to vote on did not reach agreement.
The authors state the findings outline a multifactorial approach to identifying and managing bone stress injuries and to promoting bone health, including recommendations for diagnostic workup and treatment for clinicians.
The process explicitly identifies knowledge gaps and sets a framework for future research — the authors' own reading is that the field is not settled.
Practical Application
An international modified-Delphi panel of 41 members (clinicians, scientists, athletes and coaches from six continents) reached consensus on 41 of 58 statements on bone stress injuries, outlining a multifactorial approach and recommending diagnostic workup and treatment for clinicians. Treat a suspected bone stress injury as a medical diagnosis and refer.Not from this paper; the base's own practice: bone pain that is localised, load-related and worsening is a stop-and-refer signal, not a training-load problem to be solved in a plan.
Say that an international consensus exists and that this base does not hold its clinical criteria. Naming the source and its limit is better than improvising grading, imaging or timing advice; the athlete's clinician has the statements.
Read "41 of 58" as licence to be uncertain. Where a clinician's plan differs from something read online, follow the clinician — the panel itself could not agree on nearly a third of the questions.
Do not use this entry to decide when running restarts. Use REF-3498 for the return-to-running criteria and progression, and the treating clinician for the case.
Limitations
This entry is written from the published abstract. The full text is paywalled, is not in PubMed Central and was not readable at the time of writing, so none of the 41 consensus statements is reproduced here — no terminology, no grading system, no high-risk site list, no screening protocol, no return-to-sport criteria and no timelines. Do not let a coach or an assistant infer any of those from this entry.
A Delphi consensus measures agreement among a panel, not evidence. Where the underlying evidence is level IV — as REF-3498 found it to be for return-to-running — consensus does not upgrade it.
Panel attrition across rounds (33 → 28 → 28) means the later statements were voted on by a smaller group than the first.
17 of 58 statements did NOT reach consensus, and this entry does not know which ones.
Medical topic. Diagnosis, imaging and clearance to return belong to a treating clinician; nothing here substitutes for that.
How this entry was checked and changed
Why this level
(design) — but see Limitations: this entry is written from the published abstract, so it carries the consensus's existence and scope, not its statements
Content correction 2026-09-27
Lead now states the consensus itself (41 members, 41 of 58 statements); "localised, load-related, worsening bone pain = stop and refer" labelled as the base's own practice.
Cross-reference REF-623 corrected: a healthy-runner distance-change cohort, not a symptom-graded return study.