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Stress Fractures in Female Runners

Return to Running and Competition

Medical Followup

After 6 to 8 weeks the physician will order another X-ray to see if the stress fracture has healed. The doctor will look for positive indications that bone remodeling and calcification of the bone has occurred. The physician determines if the patient is healed and must grant permission for the athlete to begin a "return to running schedule." This schedule will last anywhere from 4 to 8 weeks. Most protocols involve a mixture of running and walking followed by a day of non-weight-bearing exercise or no exercise at all.

Return to Running Schedule

A seven-week schedule for returning from injury should be adapted to the individual patient.

Patient's Responses to Running

The return to running schedule is adapted to allow some stress to be applied to the bone while remodeling continues to occur. This causes an organization of collagen fibers which increases the strength of the newly-formed bone. During this time, some pain may be experienced at the beginning of the patient's weight-bearing exercise. The pain should not be constant or continue after exercise has ceased. The pain may be shooting but should not resemble the initial stress fracture pain. If constant pain is experienced or pain in the same intensity or frequency that was experienced prior to stress fracture diagnosis, weight-bearing exercise should be stopped. In this case, the patient should be referred back to their physician.

Red Flags to Running Progression

If the patient reports a dull ache and soreness in the healing area, she still should continue with her running / walking schedule. A red flag and definite indication for not running or performing a repetitive weight-bearing activity is pain prior to exercise. For instance, if a patient feels mild soreness or pain walking around or at rest then running should be omitted or postponed. When soreness or pain termed "appropriate" is experienced, the patient should wait until no pain is felt while walking around during the day and then exercise for the same duration and intensity as their last pain-free and symptom-free exercise session.

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Last Update: Nov 29 2012