Tibial Stress Fracture - Non-operative
treatment
Type 1: Pain only after activity
- 25% workload reduction
- Ice massage or ice wrap after activity
- Symptom-free stretching and strengthening program (gastrocnemius, anterior and posterior tibialis, peroneals)
- Check for pronation problems
Type 2: Pain during activity, not restricting performance
- 50% workload reduction
- Ice massage or ice wrap after activity
- Stretching and strengthening as above
- NSAID’s (loading dose, give 10-14 days)
Type 3: Pain during activity, restricting performance
- Relative rest
- Alternate activities (non-impact, symptom-free activities, cycling, swimming, Nordic Track)
- Stretching and strengthening as above
- Ice massage or ice wrap
- NSAID’s
Type 4: Pain, chronic, unremitting
- Exhaustion of all conservative modalities
- Immobilization (cast boot)
- Bone stimulator
- Surgery
Return to Activity
- When patient can tolerate alternate activites and rehabilitation for 4-8 weeks
- First, alternate running with non-weight bearing exercise for 2-3 weeks
- Gradually increase mileage and intensity. Rule of too’s
- Don’t run too much, too soon or too fast and make sure your shoes are not too old