Abstract
BACKGROUND: Low-risk bone stress injuries (BSIs) of the tibia and metatarsal diaphyses account for more than half of BSIs in runners. They interrupt training and are managed using noninvasive approaches that are designed to achieve a speedy but safe return to running. CLINICAL QUESTION: What is the optimal load to manage low-risk tibial and metatarsal BSIs and safely return to running? KEY RESULTS: Optimal load can be guided by knowledge of the BSI healing process and is symptom driven. At all stages, the optimal load does not produce symptoms during, after, or the day following loading. CLINICAL APPLICATION: A period of initial load reduction, via partial or non-weight bearing, is typically needed to alleviate presenting symptoms. Analgesics or nonsteroidal anti-inflammatory drugs may be used in the short term (sooner than 7 days), but only for resting pain and night pain. Healing supplements (eg, low-intensity pulsed ultrasound and/or recombinant parathyroid hormone therapy) may be attempted to influence tissue healing. Athletes can maintain cardiopulmonary fitness via cross-training, while simultaneously addressing musculoskeletal fitness. A return-to-run program can be initiated once an athlete is pain free during daily activities for 5 consecutive days. Progress is directed by symptom provocation and initially focuses on increasing running volume before speed. Optimal loading should be continued following return to running and may include jump training and/or gait retraining to reduce subsequent BSI risk. The optimal loading approach to managing low-risk tibial and metatarsal BSIs is clinically successful, but requires further scientific validation.
| Original language | English |
|---|---|
| Pages (from-to) | 322-330 |
| Number of pages | 9 |
| Journal | Journal of Orthopaedic and Sports Physical Therapy |
| Volume | 51 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2021 |
Funding
1Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN. 2Indiana Center for Musculoskeletal Health, School of Medicine, Indiana University, Indianapolis, IN. 3La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia. 4Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada. 5McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada. 6School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT. This clinical commentary was partly made possible by support from the National Basketball Association and GE Healthcare Orthopedics and Sports Medicine Collaboration (BSI-030, D776) and the US National Institutes of Health (P30 AR072581). Dr Warden serves as an associate editor for JOSPT, but was blinded to the peer-review process. The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Dr Stuart J. Warden, Department of Physical Therapy, School of Health and Human Sciences, Indiana University, 1140 West Michigan Street, CF-124, Indianapolis, IN 46202. E-mail: [email protected] U Copyright 2021 JOSPT ®, Inc
| Funder number |
|---|
| D776, BSI-030 |
| P30 AR072581 |
Keywords
- Exercise
- Relative energy deficiency in sport
- Running
- Stress fracture
- Stress reaction