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


Twenty-three female track and field athletes who had sustained a stress fracture were identified. Tibial injuries accounted for 75% of the stress injuries in this group with other locations, including the metatarsal, tarsal bones, pubic rami, and femur. Twenty-four tibial stress fractures were identified in 18 athletes. Six athletes sustained bilateral injuries.

The mean age at the time of injury was 19.78 yr (SD 1.2). Eight athletes were in their first year of competition when they sustained the injury, eight were in their second year, and two were in their third year. Fifty percent of the athletes who suffered a tibial stress fracture reported menstrual irregularities or amenorrhea. Eight athletes were African-American, and ten were Caucasian. Two athletes had a history of previous stress fractures and three had recurrent tibial stress fractures. Five athletes were primarily 400 meter runners, two were jumpers, one was a pole vaulter, seven were distance runners (1500 meters and greater), two were sprinters (100/200 meters), and one was a multi-event athlete. Two patients required operative intervention. One had bilateral anterior tibial cortex nonunions classified as grade V, and the other had a proximal tibial and midfibular fracture classified as a grade II. The anterior cortex grade V injuries required intramedullary nailing.

To avoid skewing of data, one athlete was excluded from our statistical analysis because of her prolonged length of recovery and two were excluded because complete information regarding time to recovery was lacking. This left 20 tibial stress fractures in 15 athletes to be included in our analysis. Thirteen injuries were classified as grade II, five as grade III, and two as grade V. The average time to return to running for all athletes included in our analysis was 13.7 wk (SD 5.02). As shown in Table 2, athletes with a K-M grade of V had an average time to return of running of 17 wk compared with 12.4 and 13.7 in grade III (range 10–18 wk) and II (range 5–27 wk), respectively. However, when extreme outliers were removed, average time to return for grade II injuries was 11.7 wk. This difference did not reach significance in our linear regression model (P=0.534) but did show a positive relationship between K-M grade and time to recovery (coefficient=0.785) as shown in Figure 4.

Figure 4.

Time to return to running versus Kaeding-Miller grade.

The average BMI among the athletes in this study was 21.634 kg/m2 (SD 1.68), which is classified as a normal weight according to the National Institutes of Health grading system. Three athletes had a BMI considered underweight (<18.5 kg/m2), one athlete had an overweight BMI (>25 kg/m2), and the remaining had normal BMIs. There was no statistically significant relationship between BMI and time to return to sport (P=0.767); however, our analysis gave a negative coefficient or slope value of −0.191, showing an inverse relationship between BMI and time to clinical healing (Figure 5).

Figure 5.

Time to return to running versus body mass index.