Expected Time to Return to Athletic Participation Following Stress Fracture in Division I Collegiate Athletes

OBJECTIVES: The objective of this study was to evaluate and determine the expected time to return to athletic participation in Division I collegiate Track and Field athletes. METHODS: All stress fractures diagnosed in athletes on a single Division I collegiate men’s and women’s track and field/ cross-country team were recorded over a 4-year period. Site and severity of the injury were recorded and graded based on the Kaeding-Miller Classification System for stress fractures. Time to return to full unrestricted athletic participation was recorded for each athlete and correlated with the site and severity grade of the injury. Time to return to athletic participation was also analyzed for gender differences. RESULTS: Fifty-seven stress fractures were diagnosed in 38 athletes over a 4-year period. Thirty-seven of these injuries occurred in women; twenty in men. Mean time to return to participation in women was 13.9 weeks and 11.2 weeks in men. There were 10 athletes who sustained recurrent or multiple stress fractures. Thirty-three stress fractures occurred in the tibia, and 10 occurred in the 2(nd) through 4(th) metatarsals. Three occurred in the 5(th) metatarsal, 6 in the tarsal bones (2 navicular), and 5 in the pelvis. Mean times to return to athletic activity based on site of injury and with extreme outliers removed were as follows: tibia- 13.3 weeks, 2(nd) through 4(th) metatarsals- 11.7 weeks, 5(th) metatarsal- 11.7 weeks, tarsals- 12.1 weeks, and pelvis- 13.0 weeks. There were 31 grade 2 stress fractures, 11 grade 3 stress fractures, and two grade 5 stress fractures that occurred bilaterally in the same patient. Mean times to return to athletic participation again with extreme outliers excluded were as follows: Grade 2- 12.3 weeks, Grade 3- 14.1 weeks, and Grade 5- 17 weeks. There were no Grade 4 (displaced) stress fractures diagnosed in this cohort of patients. CONCLUSION: Stress injuries to bone occur frequently in track and field athletes. Based on data collected from review of all recorded stress fractures diagnosed in members of a single Division I collegiate men’s and women’s track and field team over a period of four seasons, the expected time to return to full unrestricted athletic participation following diagnosis of a stress fracture is 12 to 13 weeks for all injury sites. Greater severity of injury correlated with increased time to return to participation with small numbers in the Grade 5 (nonunion) category making determining expected time to return to activity difficult.