Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field

Marissa Jamieson, MD; Allison Schroeder, MD; Jason Campbell, BS; Courtney Seigel, MS, ATC; Sonsecharae Everson, ATC, MS; Timothy L. Miller, MD


Curr Orthop Pract. 2017;28(4):393-397. 

In This Article

Materials and Methods

After institutional review board approval was obtained, a retrospective chart review was performed for all track and field athletes competing for a Division I university from 2011 to 2014. During this time frame all athletes were treated under the supervision of the senior author. The medical charts for all athletes were completed by the senior author or by the team's athletic trainer. All female track and field athletes who sustained a tibial stress fracture during this time frame were identified for inclusion in the study. Exclusion criteria included traumatic acute fractures, medial tibial stress syndrome, and any diagnosis without imaging studies.

Demographic variables, medical history, training variables, injury history, and nutritional or dietary information were obtained from the chart. Using the K-M classification system,[7] all stress fractures were graded by the senior author and confirmed by another sports medicine trained orthopaedic surgeon. All athletes in our study had MRI studies, which were used to determine grade.

All athletes were treated under the supervision of the senior author based on a previously described algorithm by Miller and Kaeding.[8] This includes nutritional supplementation with calcium and vitamin D to optimize healing potential, stopping the causative activity with relative or complete rest, use of immobilization with a fracture boot as needed, and gradual return to running after a minimum of 4 wk or when symptoms resolved. High-risk fractures, specifically anterior tibial cortex fractures, were treated with complete rest or strict nonweightbearing.

Descriptive statistics, including mean, standard deviation, frequency, and percentage were used to describe numerical data. Clinical assessment and demographic variables were assessed and compared with historical standards. Statistical analysis was completed with the Epi Info 7 software program for statistical computing. Linear regression analysis was used to determine the relationship between the K-M grading system and time to return to running as well as BMI and time to return to running. Statistical differences were considered to be significant when the P value was less than or equal to 0.05.