Strong Bones for the Long Run: A Guide for Female Trail Runners
Trail Notes | Female Athlete Health
strong bones for the long run
Bone Health Beyond
the Kilometres.
Trail running is weight-bearing exercise. We climb, descend and move across uneven ground. All of that can support strong bones.
But running is only one part of the bone-health picture. Bone responds to the type of force it receives, not simply the number of kilometres completed. Repeating the same movement can maintain strength in some areas without providing everything the hips and spine need.
This becomes increasingly important through midlife, when hormonal changes, under-fuelling, interrupted sleep and years of accumulated training can influence how well bone is maintained and repaired.
Running supports bone health. Strong bones, however, need more than running alone.
They also need progressive strength work, varied loading, enough energy, good recovery and individual medical support when risk factors appear.
Trail Note · 01
What running gives your bones
Running is a weight-bearing activity. Each foot strike places force through the lower body, giving bone a reason to maintain its structure. Trail running can add useful variation through climbing, descending and changes in direction.
The benefit is not identical at every part of the skeleton. Research in female runners suggests that running may support the hip more strongly than the lumbar spine. The response also changes with age, menstrual health, nutrition and training history.
That does not make running ineffective. It means we should stop asking one activity to do every job.
Keep running. Then add the forms of loading your regular running does not provide.
Trail Note · 02
Strength builds what the trail may miss
Progressive resistance training creates strong muscular forces around the hips and spine. Exercises such as squats, deadlifts, step-ups, lunges, rows, presses and loaded carries can complement the repeated lower-body loading of running.
The word progressive matters. Bone and muscle need an appropriate challenge that gradually develops as your capacity improves. A program should be technically sound, sufficiently challenging and suited to your training history.
For many runners, two strength sessions each week provide a realistic foundation. The exact exercises, load and placement should fit around the individual rather than follow one fixed formula.
Her Trails coaching cue
The gym should complement the trail. Build strength through the hips, legs, back and upper body rather than simply recreating another endurance session indoors.
Trail Note · 03
Variety gives bone a different reason to adapt
Bone responds particularly well to forces that are stronger, faster or different from what it experiences every day. Depending on your injury history and current bone health, this may include jumping, hopping, skipping or multidirectional movements.
More is not automatically better. Small, well-planned doses of quality loading may provide a more useful stimulus than adding extra kilometres. Anyone with osteoporosis, current pain or a history of bone stress injury should seek professional guidance before adding high-impact work.
Trail Note · 04
You cannot out-train under-fuelling
Bone is constantly being broken down and rebuilt. That process requires energy, protein and essential nutrients. When training demand repeatedly exceeds the energy available, the body may reduce its investment in functions such as bone formation and reproductive health.
This is one reason low energy availability and Relative Energy Deficiency in Sport, or RED-S, are associated with impaired bone health and bone stress injuries.
Fuel needs vary between athletes and across training weeks. The goal is not to eat perfectly. It is to avoid repeatedly asking the body to train, recover and rebuild without enough energy to do the work.
Support the rebuilding process
Eat enough across the whole day, not only around the hardest session.
Include carbohydrate for training, protein across meals and calcium-rich foods regularly.
Avoid beginning every morning session depleted simply because training fasted has become a habit.
Discuss supplements with a qualified clinician or sports dietitian rather than treating a suspected deficiency yourself.
Trail Note · 05
Signals that deserve attention
Bone problems do not always announce themselves clearly. Look for patterns across your training, menstrual health, nutrition, recovery and injury history.
Persistent focal pain
Pain that is localised, worsens while running or begins to affect walking, sleep or daily movement needs assessment. Hip, groin, pelvic and sacral pain should be taken particularly seriously.
Menstrual changes
Unexpectedly irregular or absent periods can be one sign of low energy availability. Hormonal contraception and perimenopause can make this harder to interpret, so consider the whole picture.
Repeated injuries
A history of bone stress injuries, especially more than one, deserves a broader review of fuelling, training load, menstrual health and possible medical risk factors.
Recovery that stays poor
Ongoing fatigue, declining performance, disrupted sleep, frequent illness and significant weight change may suggest that training demand and recovery support are out of balance.
Trail Note · 06
The hormonal picture through midlife
Hormones are one part of bone health, but they are not something a training plan can assess on its own. Changes in oestrogen around menopause can accelerate bone loss. Menstrual or ovulatory disturbances may also matter earlier, particularly when they occur alongside low energy availability.
A regular bleed does not always confirm that ovulation is occurring, but this does not mean every woman needs routine progesterone testing. Hormone results can vary across the cycle and should be ordered and interpreted in the context of symptoms, cycle history and individual risk.
If your periods change unexpectedly, menopause occurs early, you have repeated bone stress injuries or you are concerned about your bone health, speak with a GP or clinician experienced in female athlete and midlife health.
Training can provide useful clues. It cannot diagnose low bone density, hormonal changes or a bone stress injury.
That part belongs with an appropriately qualified health professional.
Trail Note · 07
Do you need a bone-density scan?
Age 35 alone is not usually a reason to have a bone-density scan. Testing is based on your wider risk profile and should be discussed with your doctor.
A clinical review may be appropriate if you have experienced repeated bone stress injuries, a fracture following minor trauma, prolonged menstrual disruption, early menopause, an eating disorder, known low energy availability or a condition or medication that affects bone.
Blood tests for iron, vitamin D or other nutrients should also be guided by symptoms and individual risk. There is no single ferritin number that determines bone health for every runner.
Your bone-health foundation
Keep running: it is valuable weight-bearing movement and supports your wider physical and mental health.
Strength train: include progressive resistance work that challenges the hips, legs, spine and upper body.
Add appropriate variety: use multidirectional or impact loading when it is suitable for your body and injury history.
Fuel the work: meet your overall energy needs and include adequate carbohydrate, protein and calcium-rich foods.
Protect recovery: make sleep, rest and sensible training progression part of the plan.
Respond early: investigate persistent focal pain, menstrual changes and repeated bone injuries rather than trying to train through them.
Clinical perspective
For women wanting to explore the clinical side of hormonal and bone health, Dr Kirstey Holland provides further women's health education. External resources should complement, rather than replace, individual medical assessment.
The long view
Train for the body you want to keep exploring in
At Her Trails, we coach women who want to run trails for decades. That means looking beyond the next race block and supporting the body that will carry you through every season that follows.
Running remains part of that future. So do strength, varied movement, enough food, quality recovery and appropriate health care.
Bone health does not suddenly begin at 35. It is built across a lifetime, and the choices you make now can help protect the adventures still ahead.
strong bones, long trails
Written by the Her Trails coaching team
Trail Notes are evidence-informed coaching journals written for women who train, race and run on trails.
Key references and resources
Healthy Bones Australia: Exercise and Bone Health
Healthy Bones Australia: Bone Density Testing
Australian Institute of Sport: Female Athlete Health Education
Fanning DM et al. Female runners and bone mineral density. PMID 17977158.
Goto K et al. Bone mineral density in premenopausal and perimenopausal athletes. PMID 8939772.
Tenforde AS et al. Factors associated with high-risk bone stress injuries. PMID 38779133.
Keep going with us
General education only, not medical advice. Seek assessment from a qualified health professional for persistent pain, menstrual changes, suspected RED-S or concerns about bone health.
