| Phase 1: Cross training (typical duration: 2 weeks) |
- Wear long air splint continuously while standing and during cross training, but not needed for sleep
- Apply ice to fracture site 2 to 3 times daily for 10 to 20 minutes; may repeat if swelling increases and after training sessions
- Take supplemental calcium 1500 mg and vitamin D 800 IU daily throughout rehabilitation
- Ride stationary cycle for 45 minutes daily
- Perform heel raises and squats with weight every other day; use 25 to 30% of body weight for 3 sets of 15 repetitions for each exercise
- Advance to Phase 2 when patient can jog 50 steps without pain in a long air splint
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| Phase 2: Initiation of weight-bearing exercise (typical duration: 16 days) |
- Perform all weight-bearing activity in long air splint
- Every other day, run 400 m and then walk 400 m for 8 laps (lap = 400 m) on a soft track; perform 2 sessions
- Next, every other day, run 500 m and then walk 300 m for 8 laps; perform 2 sessions.
- Continue this progression, performing 2 sessions at each level, as follows: run 600 m/walk 200 m; run 700 m/walk 100 m; total of 8 laps for each session, 1 session every other day
- Ride stationary cycle for 45 minutes on alternate (non-running) days
- Apply ice to fracture site after activity and as needed for mild swelling for 10 to 20 minutes at a time
- Perform weighted strength exercises as described in Phase 1 on non-running days
- Advance to Phase 3 when patient can complete 8 laps of 700 m run/100 m walk without limp or pain
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| Phase 3: Initiation of protected training (typical duration: 2 weeks) |
- Perform all weight-bearing activity in long air splint
- Ride stationary cycle for 45 minutes on alternate (non-running) days
- Run 2 miles (3.2 km) every other day for 3 sessions, then progress to next step
- Run 2.5 miles (4 km) every other day for 4 sessions
- Continue strength exercises as described in Phase 1 on non-running days
- Apply ice after activity as above
- Advance to Phase 4 if running for Phase 3 is completed without limp or pain, fracture site is non-tender, and patient is able to hop 10 times and jog without limp without wearing air splint
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| Phase 4: Weaning from long air splint (typical duration: 2 to 3 weeks) |
- Continue running 2.5 miles (4 km) every other day
- Run without a splint on first day and with splint on second day; thereafter, alternate splint use every other day
- Continue strength exercises as described in Phase 1
- Advance to Phase 5 when pain free on all run days without splint
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| Phase 5: Progressive training (typical duration: 4 weeks) |
- Increase run duration by 5 minutes after 2 workouts at each level; do not wear air splint
- 5 runs per week during weeks 9 and 10
- 6 runs per week during weeks 11 and 12
- When tolerating 40 continuous minutes of running without significant pain, resume normal training
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| Protocol guidelines |
- If patient has problems at any stage of rehabilitation, move back to previous phase for an additional week and then try to advance
- Perform all training for the first 12 weeks on a soft, level surface (the softer the better)
- Evaluate patient in the office every 2 weeks for evidence of healing and signs of injury until they reach Phase 5
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