Version June 2024
| Phase 1: Rest |
| Weeks 1 through 3: Patient should be non- or partial-weight bearing on the affected lower extremity (ie, use crutches). This phase may be bypassed in cases of femoral stress reaction (no radiographic fracture line) if the patient is completely pain-free with ambulation (ie, only develops pain with running). |
| Phase 2: Cross-training |
| Weeks 4 through 6: Resume full weight-bearing. May start swimming (and can transition to stationary bike) and general weight training, but no strength training of the affected extremity is permitted. |
| Phase 3: Return to running |
| Week 7: Patient begins jogging every other day. Patient jogs for 2 minutes and then walks for 1 minute, with a total duration not to exceed 21 minutes. Limited cross training with weights is permitted, and may include partial squats and lunges with moderate weight (approximately 40 to 60 lbs/20 to 30 kg for adults; no more than 30% of body weight). Knee flexion limited to 45 degrees with squats. Cross training using a stationary bicycle is permitted, but maximum time for aerobic exercise on any given day is 45 minutes. |
| Week 8: Jogging 5 to 10 minutes followed by walking for 1 to 2 minutes, with a total duration not to exceed 30 minutes. This is performed every other day. Weight work and cross training are the same as week 7. |
| Week 9: Jogging 10 to 15 minutes followed by walking for 4 to 5 minutes. This may be repeated once if the patient remains pain free (ie, maximum total jogging time of 30 minutes). This is performed up to four days during the week. Weight work and cross training are the same as week 7. |
| Phase 4: Advance running¶ |
| Week 10: Jogging up to 30 minutes continuously, up to five days per week. Aerobic cross training allowed, but no more than 1 hour total of aerobic training daily. Weight work as above but may add 5 to 10 lbs/2 to 5 kg (approximately 5 to 10% of initial load) to the loads used. May add step up exercises to squats and lunges. Knee flexion for squats continues to be limited to 45 degrees. |
| Week 11: Jogging up to 45 minutes continuously, up to five days per week. Cross training and weight work unchanged. |
| Week 12: Jogging up to 45 minutes six days per week. Cross training and weight work unchanged. |
| Week 13: If a patient completes the resumption phase through week 12 without complications, they may resume regular training on week 13. However, total mileage should not increase by more than 5 to 10 miles (8 to 15 km) over the mileage of week 12; total running time should not increase by more than 30 minutes to one hour. |
| The hop test and fulcrum test are done at the end of each phase. If the patient is symptomatic, the patient should repeat that phase of rehabilitation. |
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