Stress Fracture Rehabilitation for the Runner
By Dr. Otto Lam, PT, DPT
At Good Reps Physical Therapy, we work with many different types of athletes. We see runners of every sort; casual, short distance, long distance and even ultra marathoners. Every so often, we have runners with stress fractures looking to return to running. A stress fracture is when tiny cracks form in the bone (usually in the lower leg or foot) due to repetitive trauma, most commonly seen in participants with sports that require a lot of running. This is an injury that requires immediate medical attention because the affected leg must be offloaded to prevent further damage and allow the bone to heal (usually it takes at least 6 weeks for initial healing to occur depending on severity). Stress fractures usually occur in runners due to a training load error, whether there was a sudden increase in mileage or intensity. Below are signs and symptoms to look out for a stress fracture:
Pinpoint tenderness in the local region
Pain with hopping on one leg
Further examination by a medical professional is a must if you suspect that you have a stress fracture. An MRI can help to detect and confirm a stress fracture early on so that the appropriate steps can be taken to facilitate healing and subsequent rehab.
If the goal is to return to running, a comprehensive rehab program led by a licensed Physical Therapist is crucial for a safe return. The greatest predictor for a future stress fracture is a previous stress fracture that has not healed properly.
Rehab for Stress Fractures
Once you’ve been diagnosed with a stress fracture, rehab can help to safely return you to running. Recovery and rehab time varies depending on the severity of the stress fracture and individual differences. The following is a general guideline for stress fracture return to sport rehab:
Offloading Phase
During the first couple weeks after your stress fracture, you will be instructed to reduce the amount of weight you put on the affected side throughout day to day activities by using crutches or a boot. This will allow initial bone healing to occur without disruption. Rehab will focus on minimizing mobility and strength loss. This generally will encompass weeks 1-4.
Loading Phase
During the loading phase, Wolff’s Law is the overarching theme which dictates that bones will adapt based on the stresses placed on them. When adequate healing has occurred, you will be instructed to place more weight on the affected side and wean off of the crutches/boot. At this point, rehab will focus on building strength and capacity of the lower extremities and core. A walking program is usually recommended as well. This usually takes 2-4 weeks.
Plyometrics/Return to Running
In this phase, plyometrics will be introduced to gradually expose the bone to greater impact. This can take many forms, but generally starts with landing drills. The ability to land and tolerate impact forces is similar to making sure the brakes of a car work before accelerating. When certain criteria have been met as determined by your physical therapist, a walk/run program will be initiated to facilitate a return to continuous running. This takes us to a total of at least 8-12 weeks to return to continuous running from initial onset of injury, keeping in mind that timeline for recovery can vary from person to person.