Encountering a stress fracture can be one of the most daunting challenges for any runner.
Luckily, rehab for a stress fracture can often be more straightforward than other problematic injuries such as Plantar Fasciitis, ITB Syndrome, or Runner’s Knee. Nevertheless, a stress fracture still requires serious attention and treatment.
Numerous factors can lead to the occurrence of a stress fracture, often arising when the demands of your training surpass your body’s tolerance level.
As runners engage in repetitive, high-impact activities, the bones can accumulate micro-damage from repetitive loading and inadequate rest. Ignoring this condition can escalate to a complete break.
Our goal is to equip you with effective strategies for treating this challenging injury and guide you toward a successful recovery while answering the question, how long does a stress fracture take to heal?
More specifically, we will cover the following:
- How Long Does A Stress Fracture Take To Heal?
- Foot Stress Fracture Treatment Guide
- Return To Running
Let’s get into it!
How Long Does A Stress Fracture Take To Heal?
A stress fracture is a small crack or hairline fracture that can happen when there’s repeated excessive force on a part of the body.
A single event like a fall does not usually cause it; overuse stands as the primary etiological factor in stress fractures in runners.
Now, the healing time for a stress fracture can vary from person to person. It depends on factors like where the fracture is located, how severe it is, your body’s healing capacity, how well you stick to the treatment plan, and your lifestyle.
So, how long does a stress fracture take to heal?
On average, most stress fractures in the foot or lower leg may take about 8 to 10 weeks to fully heal. But keep in mind that some fractures might need even more time to mend, ranging from 8 to 12 weeks or possibly longer.
Foot Stress Fracture Treatment Guide
Over 80% of stress fractures are found in the lower extremities. Here we will look at an example of what sort of rehab format I would go through with clients at my clinic.
Rehab will always be different for different people. As such, you should seek the guidance of a medical professional to ensure you are getting the right treatment.
How Long Does A Stress Fracture Take To Heal: Phase I – Acute Phase
Timeframe: Weeks: 1-4
Immobilization: The foot may need to be immobilized using a walking boot, cast, or crutches to prevent weight-bearing on the affected foot and promote healing. Use a cast boot or pneumatic leg splint for 2-4 weeks.
Phase Goals:
- Relieve stress from the injured area.
- Effectively manage pain and discomfort.
- Prevent deconditioning and maintain overall fitness.
- Educate on modifying activities to support healing.
- Enhance flexibility and range of motion.
- Restore dynamic muscle control, balance, and proprioception for improved stability and coordination.
Suggested Treatments:
- Pain management: Incorporate appropriate pain medications or therapies to manage pain and inflammation, such as cryotherapy, low intensity, pulsed ultrasound, soft tissue mobilization, and electrical stimulation.
- Manual therapy by a Sports Massage Therapist or Physiotherapist: Soft tissue mobilization of lower extremity kinetic chain alongside joint mobilization.
Exercise Examples:
Gentle range of motion movements: Calf complex, ankle, and tibialis posterior.
Stretching: hip flexors/quadriceps, hamstrings, gastrocnemius, and soleus.
Non-weight-bearing lower body strengthening, focusing on glutes: clams, side lying leg raise, straight leg raise, fire hydrants. Ankle inversion and eversion alongside intrinsic foot strengthening exercises.
Criteria to advance to the next phase:
- No pain when palpating the area of bone that is indicated in stress fracture.
- Pain-free daily activities.
- Dorsiflexion (lifting toes towards the ceiling) within 5ห or less of the uninjured leg.
How Long Does A Stress Fracture Take To Heal: Phase II – Subacute Phase
Timeframe: Weeks: 4-6
Phase Goals:
- Begin the process of returning to running.
- Proceed with weight-bearing activities.
Suggested Treatments:
- Gradual weight-bearing: Once the fracture begins to heal, gradually introduce weight-bearing exercises.
If you were previously training before, start at <50% prior training volume/intensity. At this stage, it is crucial to listen to the signals of the body; if an exercise hurts, stop. See if you can modify the activity to make it easier and try again.
- Manual Therapy: Continue as needed for joint and soft tissue limitations throughout the lower extremities.
Exercise Examples:
Foot/ankle strengthening: Start to include proprioceptive activities, emphasizing single limb stability, such as single leg calf raises, and foot intrinsic strengthening exercises in a weight-bearing position, such as towel scrunches.
Lower extremity mobility exercises: Calf complex stretching, ankle inversion/eversion, dorsiflexion, and plantarflexion.
Proceed with lower limb strengthening exercises in weight-bearing position: squats, single leg squats, lunges with forward trunk lean, step ups, step downs, and lateral band walks.
Crosstraining: Maintain cardiovascular fitness by utilizing cross-training activities such as swimming, stationary bike, etc.
Hydrotherapy: If you have these facilities at your disposal, try low-impact exercises in a pool or underwater treadmill. It is an effective way to improve strength and mobility without full weight bearing.
Simultaneously try to increase step rate, step width, and/or forward trunk lean to encourage shock absorption.
Criteria to advance to the next phase:
- Perform 15 single-leg hops without experiencing pain or discomfort.
- Complete a 30-minute walk with minimal/no increase in pain.
- Perform 6 repetitions of a 6-second squat at 60% body weight with good control.
- Successfully perform more than 25 single-leg heel raises on each leg.
How Long Does A Stress Fracture Take To Heal: Phase III – Advanced Strengthening
Timeframe: Weeks 6-10
Phase Goals:
- Successfully resume running activities.
- Safely engage in recreational and sporting activities.
- Restore normal strength in the lower extremity kinetic chain.
- Regain normal muscle length in the lower extremity kinetic chain.
Specific Instructions:
- Continue progressively loading the muscles along the blueprint of the previous exercise program; a good guideline is to increase activity by no more than 10-15% per week.
- Consider Return to Running: We’ll look at that in more detail below.
Exercise Examples:
Foot/ankle strengthening: Continue balance and foot intrinsic strengthening in a single-limb weight-bearing position.
Lower extremity mobility: Continue addressing lower extremity kinetic chain mobility deficits.
Hip strengthening: Continue single-limb proximal stability exercises.
Plyometric exercises (emphasis on soft landing): Begin to incorporate plyometric exercises, with an emphasis on soft landing.
Double limb exercises: Box jumps, drop jumps, forward jumps, tuck jumps.
Single limb exercises: Lunge hop, single box hop, drop with single-leg land, single forward hop.
Return To Running
Below we will detail an example of what a return-to-running plan may look like.
It should be started once you are able to walk 30 min consecutively without pain/injury.
That said, pain isn’t necessarily to be avoided at all costs. If pain should return with running, you may continue as long as:
- The pain is not sharp or extreme: It’s essential to differentiate between normal discomfort and sharp, extreme pain. If the pain you experience during your run is mild, it might be your body adjusting to the exercise. However, if you ever feel sharp or extreme pain, it’s crucial to stop immediately.
- The pain lessens or remains unchanged as the running session continues: This could be a sign of your body adapting to the activity. In such cases, it’s generally safe to continue, but remember to pay close attention to your body’s signals.
- The presence of pain does not alter your running gait: If the pain you experience during your run does not cause you to alter your usual running form or lead to limping, it suggests that the discomfort might be manageable.
Although some pain is expected, it is sensible to listen to your body and give it the rest it needs before pushing forward again.
Here are four scenarios in which slight alteration may be needed:
1. Soreness during warm-up that continues throughout the session: Take two days off. It’s a signal that your body needs more time to recover. In this case, I recommend taking it easy and returning to the demands of the previous week.
2. Soreness during warm-up that goes away: If you feel soreness during your warm-up that disappears as you continue running, that’s generally a good sign. It means your body is adjusting to the exercise. In this situation, it’s best to stick to the current step of your training plan. Your body is adapting well, so there’s no need to make any changes at this point.
3. Soreness during warm-up that goes away but redevelops during the session: Take a break for two days to allow your body to fully recover. After that, reduce the intensity a bit and drop back to the schedule of the previous week. It’s essential to prioritize your body’s recovery and avoid pushing yourself too hard.
4. Soreness the day after running (not delayed-onset muscle soreness.) If you experience soreness the day after running, that’s not the typical muscle soreness; it could be a sign of overloading your body. In this case, take one day off from running and resist the urge to advance to the next step of your training plan.
Walk/Run Combination:
This blueprint is designed to help you build your running endurance gradually and safely. Alternate between walking and running intervals as indicated in the plan.
Follow the walk/run combination provided below:
Week 1:
- Day 1: 6 Repeats: Walk for 4.5 min + run for 30 seconds.
- Day 3: 6 Repeats: Walk for 4 min + run for 1 min.
- Day 5: 6 Repeats: Walk for 3.5 min + run for 1.5 min.
Week 2:
- Day 1: 6 Repeats: Walk for 3 min + run for 2 min.
- Day 3: 6 Repeats: Walk for 2.5 min + run for 2.5 min.
- Day 5: 6 Repeats: Walk for 2 min + run for 3 min.
Week 3:
- Day 1: 6 Repeats: Walk for 1.5 min + run for 3.5 min.
- Day 3: 6 Repeats: Walk for 1 min + run for 4 min.
- Day 5: 6 Repeats: Walk for 30 seconds + run for 4.5 min.
Week 4:
- Day 1: Run for 30 minutes.
- Day 3: Run for 30 minutes.
- Day 5: Run for 30 minutes.
Post-Run Stretching: After each running session, don’t forget to perform your stretching exercises again. This post-run stretching helps promote better recovery and mobility.
Congratulations on completing Week 4 of your recovery! Now, it’s time to start your gradual transition back to continuous running.
As you progress and return to your pre-injury running level, it’s essential to do so cautiously. To minimize the risk of injury recurrence, I recommend increasing your training duration or intensity by no more than 10% per week.
This gradual approach will allow your body to adapt to the increased demands without putting too much strain on it.
Remember, consistency and patience are key during this phase. By following this gradual progression, you’ll be on track to safely and successfully resume your regular running routine.
Stress Fractures – Final Thoughts
If you have a stress fracture, proper diagnosis and treatment are crucial for effective recovery. Therefore, you should always seek out the help of a medical professional.
Active participation in a rehabilitation plan will influence the question, “How long does a stress fracture take to heal?” so get involved!
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