Classification and return-to-play considerations for stress fractures

Jason J. Diehl, Thomas M. Best, Christopher C. Kaeding

Research output: Contribution to journalReview articlepeer-review

52 Scopus citations


Stress fractures are common injuries, particularly in endurance athletes. Stress fracture management should take into consideration the injury site (low versus high risk), the grade (extent of microdamage accumulation), and the individual's competitive situation. Low-risk stress fractures usually respond well to nonoperative management, and treatment is largely guided by the patient's symptoms. High-risk stress fractures should be treated more aggressively with absolute rest or surgical fixation, with the goal of fracture healing and minimizing risk of complete fracture or refracture. The overall goal of treatment is to allow activity and avoid deconditioning when appropriate, while minimizing the risk of significant complication to the athlete. Overtreatment of low-risk stress fractures can result in unnecessary deconditioning and loss of playing time. Undertreatment of a high-risk stress fracture may place the athlete at risk of a significant complication, putting the athlete's career at risk. Understanding the classification and grade of stress fractures and their implications on return-to-play decisions is key to optimal care of the athlete.

Original languageEnglish (US)
Pages (from-to)17-28
Number of pages12
JournalClinics in Sports Medicine
Issue number1
StatePublished - Jan 2006
Externally publishedYes

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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