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SPORTS MEDICINE STRESS FRACTURES
TABLE 3: LOCATION OF HIGH RISK STRESS FRACTURES
n Femoral neck – supero-lateral n Patella n Anterior tibial diaphysis n Medial malleolus n Talus n Tarsal navicular n 5th metatarsal n Sesamoids
with activities of daily living then a short period of non or partial weight- bearing with elbow crutches (up to 10 days) may be required, this may also be useful to educate players on the importance of relative rest and help with compliance.
Bracing As pressure is high in academy football with most young players only having two seasons to win full professional contracts, players, coaches and medical staff are constantly looking for new ways to accelerate healing and reduce the time spent on the sideline. Several authors have documented a reduction in time to return with the use of a long pneumatic leg brace (Aircast) (15, 16). There is evidence to suggest that a pneumatic leg brace accelerates return to activity and it is reasonable to assume that there may be a beneficial effect on the healing of other lower limb stress fractures (11).
Muscle strengthening Due to the vital role muscles play in shock absorption Kannus and Bennell (3) recommend that a specific strengthening programme should be part of the treatment plan, beginning immediately after diagnosis. Strength work also helps to counteract the
ONLY HAVING TWO SEASONS TO WIN FULL PROFESSIONAL CONTRACTS, PLAYERS, COACHES AND MEDICAL STAFF ARE CONSTANTLY LOOKING FOR NEW WAYS TO ACCELERATE HEALING AND REDUCE THE TIME SPENT ON THE SIDELINE
TABLE 4: LOWER LIMB MUSCLE STRENGTHENING PROGRAMME
3 sets of 15 repetitions for all exercises
n Squats n Lunges n Calf raises n Single leg squat n Step ups n Step downs n Split squats n Romanian spilt squat n Windmills n Standing Ts
effects of detraining and should be undertaken for a 6-12 week period concentrating on the endurance of muscles surrounding the joints above and below the fracture site. For academy football players it is also useful at this stage to include weight training technique sessions without load to improve moves such as the dead lift, back squat and clean, to allow maximal power development to resume once the fracture is healed and the player is returning to sport. However, it is important not to provoke symptoms and exercise must be performed free of pain at the fracture
TABLE 5: WEEKLY DEEP WATER RUNNING PROGRAMME
Day 1
2 3
4 5
6 7 Training regime
Interval training: 4x5 minutes with 1 min rest in between; heart rate = 175–180 BPM
Low intensity run: 30–45 minutes; heart rate 130–150 BPM
Interval training: Hard intervals – 6x3 minute with 1 min rest; heart rate 175–180 BPM
Low intensity run: as per day 2
Interval training: Short 5–15 x 2 minute or 5 x 1 minute, with 30 second rest; heart rate 175–180 BPM
Long, steady state run: 40–90 minutes; heart rate 145–165 BPM
Rest day
site (13). Table 4 is an example of a lower limb strengthening programme.
Maintenance of fitness The maintenance of fitness in prolonged periods of forced rest is of particular concern and studies have shown that a period of six weeks rest from training can produce a decline in maximal oxygen uptake of 14 to 16% (17). Therefore the athlete with a stress fracture needs to maintain strength and cardiovascular fitness during phase
TABLE 6: AN ACTIVITY PROGRAMME AFTER AN UNCOMPLICATED LOWER LIMB STRESS FRACTURE FOLLOWING A PERIOD OF REST AND ACTIVITIES OF DAILY LIVING (ALL NUMBERS REFER TO MINUTES)
Day 1
Week 1 Week 2
Week 3
Week 4 Week 5
Walk 15 Walk 20 Jog 5
Walk 20 Walk 5 Jog 40
Day 2
Walk 20 Walk 15 Jog 10 Walk 15 Jog 45
NUMBER OF MINUTES Day3
Walk 25 Walk 15 Jog 15 Walk 15 Jog 35
Stride 10 Day 4
Walk 30 Walk 10 Jog 20 Walk 10 Jog 30
Stride 15 Day 5
Walk 35 Walk 10 Jog 25 Walk 10 Jog 30
Stride 20
Add functional activities and gradually increase all week Resume full training
25 Day 6
Walk 40 Walk 5 Jog 30 Walk 5 Jog 35
Sprint 10 Day 7
Walk 45 Walk 5 Jog 35 Walk 5 Jog 30 Sprint 15
AS PRESSURE IS HIGH IN ACADEMY FOOTBALL WITH MOST YOUNG PLAYERS