Version June 2024
| Phase 1: Rest phase |
| Weeks 1 through 2: Strict non-weight-bearing on affected lower extremity; patient to use crutches to ambulate. |
| Weeks 3 through 4: Advance weight-bearing as tolerated, ensuring patient remains pain-free (if patient develops any pain with weight-bearing, extend the Rest Phase an additional 2 weeks [until pain-free with ambulation for 1 week]). Begin basic range-of-motion exercises. |
| Weekly plain radiographs should be obtained to monitor for fracture progression or non-union during the first 4 to 6 weeks, followed by bi-monthly radiographs, until the patient is 12 weeks out from presentation. |
| Phase 2: Cross-training |
| Weeks 5 through 6: Patient may gradually advance low-impact exercise, such as swimming, stationary cycling, and aqua-jogging. Begin proprioception exercises (eg, single-leg balance), light strength training, and continue range-of-motion exercises. Any exercise that causes pain should be stopped. |
| Weeks 7 through 8: Patient may gradually advance moderate-impact exercise, such as walking, elliptical machine, and stair-climber. Any exercise that causes pain should be stopped. |
| Phase 3: Return to running |
| Weeks 9: Patient begins running every other day. Start with quarter mile (0.4 km), and advance to 1 to 2 miles (1.6 to 3.2 km) per session by end of week. Begin lower extremity weight training. Limit total exercise (including cross-training and strength training) on affected lower extremity to 45 minutes per day. Patient must remain pain-free (or an additional 1 to 2 weeks is taken at the previous (pain-free) stage. |
| Week 10: Continue running every other day. Begin with 15 to 20-minute running session, and gradually advance to 30-minute running session. Limit total exercise (including cross-training and strength training) on affected lower extremity to 60 minutes per day. Patient must remain pain-free or training regimen reverts to previous week. |
| Week 11: Continue running every other day. Begin with 30-minute running session. For athletes/patients who are targeting high-mileage running, gradually advance to 40-minute running session. Limit total exercise (including cross-training and strength training) on affected lower extremity to 75 minutes per day. Running must be pain-free or training regimen reverts to previous week. |
| Week 12: Continue running every other day. Begin with 40-minute running session; gradually advance to 50 minute session. Limit total exercise (including cross-training and strength training) on affected lower extremity to 80 minutes per day. Running must be pain free or training regimen reverts to previous week. |
| Week 13: Continue running every other day. Begin week with 50-minute running session; may advance to one 60-minute session. Running must be pain free or training regimen reverts to previous week. |
| Week 14: Patient runs 5 days this week, but limits sessions to 60 minutes or less. Total weekly running time should not exceed 180 minutes. |
| If the return to running phase (Phase 3) proceeds to completion without return of symptoms, the patient may gradually resume full training. Total weekly mileage should not increase by more than 5 to 10 miles (8 to 15 km), and total weekly running time should not increase more than 1 hour. |
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