Basic rehabilitation for uncomplicated, incomplete, tension-side femoral neck stress fracture*

Patient remains on bed rest for 1 to 2 weeks. This is followed by non-weight bearing restrictions for the injured extremity (using crutches for ambulation) for an additional 4 to 8 weeks, until patient is completely pain free during a trial of ambulation.

Patient begins range of motion exercises.

Weekly plain radiographs are obtained for first 4 to 6 weeks, followed by bi-monthly radiographs until 12 weeks out from treatment to monitor for fracture progression or non-union.

Phase 2 is performed for four weeks after completion of Phase 1. 

Weeks 1 through 2: The patient is allowed to transition from toe-touch to partial weight-bearing with crutches to ambulating without crutches for daily activities.

Weeks 3 through 4: The patient may begin walking for exercise starting with one-quarter mile (0.4 km) daily, and increasing to up to 2 miles (3.2 km) daily by the end of Phase 2. The patient may cross-train on a stationary bicycle, elliptical machine, pool running, or swimming, but total exercise duration may not exceed 45 minutes per day, and is not permitted if the patient develops any pain.

Patient continues performing range of motion exercises, and begins proprioception/balance exercises and strengthening exercises with light resistance. 

Phase 3 begins after successful completion of Phase 2. During this phase, the patient may run, AT MOST, every other day. This is to minimize the risk of fracture recurrence. If pain develops at any point during a given week, the patient should revert to the distance or time limit from the prior week and spend an additional 1 to 2 weeks at this previous level, assuming they remain pain-free. The basic training scheme for Phase 3 is as follows:

Week 1: Patient begins trial of running starting with one-fourth mile (0.4 km) on day 1 and advancing to 1 to 2 miles (1.6 to 3.2 km) daily by end of week.

Week 2: Patient may run 1.5 to 2 miles (2.4 to 3.2 km) per session.

Week 3: Patient may run for up to 30 minutes per session (weekly total duration of 80 minutes/3 sessions). 

Week 4: Patient may run for up to 40 minutes per session (weekly total duration of 100 minutes/3 sessions).

Week 5: Patient may run for up to 50 minutes per session (weekly total duration of 120 minutes/3 sessions).

Week 6: Patient may run for up to 60 minutes per session (weekly total duration of 140 minutes/3 sessions).

If Phase 3 proceeds to completion without return of symptoms, the patient may gradually resume full training. We suggest that total mileage not increase by more than 5 to 10 miles (8 to 15 km) each week, and total running time not increase by more than 1 hour per week.