From the Guidelines
A tibial stress fracture should be treated with a combination of rest, activity modification, and possibly a walking boot or brace rather than a traditional splint. Initially, stop the aggravating activity (typically running or jumping) for 4-8 weeks depending on severity, as recommended by recent studies 1. Use a pneumatic walking boot or CAM walker for more severe cases to reduce weight-bearing stress on the tibia. For mild cases, supportive shoes with cushioning insoles may be sufficient.
Key Considerations
- Take NSAIDs like ibuprofen (400-600mg three times daily with food) for pain management, but limit use to 1-2 weeks to avoid delayed bone healing.
- Gradually return to activity using an individualized approach, considering the athlete's risk profile, pre-injury training status, and severity of the injury, rather than a one-size-fits-all "10% rule" 1.
- Cross-training with low-impact activities like swimming or cycling can maintain fitness during recovery.
- Monitor for pain and adjust the progression of running load accordingly, as pain is a key indicator of overload and potential reinjury 1.
- Consider the athlete's risk profile and manage the risk by balancing the athlete's interests and reinjury prevention, with a focus on individualized graduated return to running programs 1.
Return to Running
- Running distance should be progressed before speed following a tibial BSI, with a focus on individualized progression based on risk and grade of the injury, as well as the level of the athlete 1.
- Females may benefit from a slower progression of running due to higher tibial bone stresses and higher-grade BSIs 1.
- The rate of progression should be tailored to the individual athlete, taking into account their specific needs and risk factors, rather than relying on a generic principle like the "10% rule" 1.
From the Research
Tibial Stress Fracture Splint
- A tibial stress fracture splint is not explicitly mentioned in the provided studies, however, treatment options for tibial stress fractures are discussed 2, 3, 4, 5.
- Treatment of stress fractures consists of activity modification, including the use of nonweight-bearing crutches if needed for pain relief, and pneumatic bracing can be used to facilitate healing 2.
- Nonoperative treatment is the standard for tibial stress fractures, but surgical intervention may be necessary in some cases 3.
- Initial treatment protocols without the use of imaging were found to be effective in more than two-thirds of the cases for medial tibial stress fractures 4.
- The use of a splint or brace is not specifically mentioned as a treatment option, but pneumatic bracing is mentioned as a way to facilitate healing 2.
Diagnosis and Treatment Guidelines
- Diagnosis of tibial stress fractures should be based on the presence of pain, tenderness, and a positive fulcrum and/or hop test 4.
- Suspicion of medial tibial stress fracture was based on the presence of pain, tenderness <1/3 the length of the tibia and a positive fulcrum and/or hop test 4.
- A bone scan was performed only when recruits failed to respond to the rest regimen or required immediate diagnosis 4.
- Treatment of tibial stress fractures consists of activity modification, including the use of nonweight-bearing crutches if needed for pain relief, and pneumatic bracing can be used to facilitate healing 2.