Treatment and Rehabilitation Approaches for Stress Fractures in Long-Distance Runners: A Literature Review

Abstract

Stress fractures (SFs) result from repetitive mechanical stress on bones, leading to an imbalance in osseous tissue adaptation and resulting in cortical fractures. The majority of SFs occur in the lower limb due to excessive mechanical loads. Long-distance runners are highly susceptible to SFs, especially when there is a significant increase in the load or intensity of their activity. Various intrinsic and extrinsic factors contribute to the development of SFs. Common SF locations in long-distance runners include the tibial shaft, femur, metatarsal, and pelvic region. Diagnosis may be delayed due to mild symptoms and unremarkable imaging tests. However, the chronicity and recurrence of misdiagnosed SFs may lead to debilitating complete fractures that are even more challenging to treat. In this review, we present data revealed from published case reports and case series studies obtained through PubMed and Embase databases focusing on the management of SFs in long-distance runners and correlate treatment outcomes with rehabilitation and return to high-level athletic performance.

Consecutive Bilateral Iliac Stress Fracture in an Adult Male Runner

“…To ensure successful management, physical therapy primarily involves core stability and hip girdle strengthening exercises, monitoring the return to sports activities, and incorporating non-impact aerobic exercises, followed by a gradual progression to running [9]. This may be because runners usually return to sports within a period of four weeks [17]. However, surgery may be necessary in cases of non-union or delayed union [18].…”