Treatment of Stress Fracture: Structured Rehabilitation Toward Pain-Free Return to Activity
Stress fracture management aims to allow the injured bone to heal while progressively restoring function — ultimately enabling a return to daily activities and sport without pain at the injury site.
Treatment approach
The protocol involves activity modification and, for lower extremity injuries, protected weight-bearing or immobilisation as initial measures. Structured physical therapy — incorporating specific movement and loading modalities — forms the rehabilitation backbone. Nutritional status, including vitamin D, and relevant lifestyle factors are also addressed as part of the approach. The complete sequence, criteria for progression, and full specifics are in the protocol.
Treatment goals
- Pain-free during daily and sports activities
- Pain-free on palpation of the bone stress injury site
- Negative bone loading tests (e.g., single-leg hopping test)
- No pain with running at the injury site
References
DOI: 10.1136/bjsports-2024-108616
Treatment approaches include activity modification, protected weight-bearing, immobilisation, physical therapy, nutritional counselling and, in some cases, surgical fixation.
A rehabilitation protocol should be used with structured physical therapy following any bone stress injury.
Multi-directional and/or osteogenic activities should be added to the rehabilitation process.
The panel concluded that athletes with a bone stress injury should be provided nutrition counselling and supplemental vitamin D if serum levels are insufficient.
The panel acknowledged that lifestyle factors including sleep and psychological stress may be important to address, consistent with prior work suggesting these mechanisms being associated with rapid bone loss.
Being pain-free during daily or sports activities; being pain-free during palpation of injury site (if palpation possible); negative bone loading tests (e.g., single-leg hopping test); pain with running at the injury site is not permissible when rehabilitating bone stress injuries.
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