- Initial Phase (Rest and Protection):
- Activity Modification: Complete cessation of weight-bearing activities that aggravate pain is paramount. This may involve using crutches or other assistive devices.
- Pain Management: Ice, anti-inflammatory medications (if prescribed by a doctor), and gentle, pain-free range-of-motion exercises can help reduce discomfort and maintain mobility.
- Non-Weight Bearing Exercises: Upper limb conditioning and hydrotherapy (aquatic therapy) can maintain fitness without stressing the fracture site.
- Progressive Loading Phase:
Once pain subsides and initial healing occurs, gradual progressive loading is introduced.
- Gradual Weight-Bearing: Slowly increasing weight-bearing from non-weight-bearing to toe-touch, to partial, and eventually to full weight-bearing as pain allows.
Strengthening Exercises:
- Core Strengthening: Exercises like planks, side planks, and Pallof holds to improve trunk stability.
- Gluteal Strengthening: Exercises focusing on the gluteal muscles, such as clamshells, side-lying straight leg raises, hip abduction with resistance bands, and glute bridges.
- Hip and Lower Extremity Strengthening: Progression to squats, single-leg squats, lunges, step-ups, and step-downs, with a focus on proper form and muscle balance.
- Foot and Ankle Strengthening: Addressing any weakness in the ankle invertors, evertors, and foot intrinsics.
- Mobility and Flexibility: Stretching for hip flexors, quadriceps, hamstrings, and calf muscles (gastrocnemius and soleus) to address any muscle imbalances or tightness.
- Cardiovascular Fitness: Low-impact activities like swimming, cycling, and elliptical training to maintain fitness without excessive load on the femur.
3. Advanced Rehabilitation and Return to Activity:
This phase focuses on preparing the individual for their specific activity or sport.
- Biomechanical Correction: Gait and running retraining to identify and correct poor mechanics that may have contributed to the injury. This may involve video analysis.
- Plyometrics: Introduction of jumping and landing exercises (e.g., box jumps, drop jumps, single-leg hops) to enhance bone strength and prepare for high-impact activities, emphasizing soft landings and hip strategy. These should be introduced gradually and with careful monitoring for pain.
- Agility Drills: Sport-specific drills that involve changes in direction and quick movements.
- Manual Therapy:
While direct manipulation of the fracture site is avoided, manual therapy can be highly beneficial for addressing associated soft tissue restrictions and joint stiffness. This may include:
- Soft Tissue Mobilization: Gentle massage or myofascial release techniques to address muscle tightness, spasms, or trigger points in surrounding muscles (e.g., quadriceps, hamstrings, glutes, hip flexors) that may be contributing to altered biomechanics or pain.
- Joint Mobilizations: Gentle mobilizations to the hip joint (if restricted and pain-free), lumbar spine, or knee to restore normal joint mechanics and reduce compensatory stresses.
- Nerve Glides: If there’s any nerve irritation or impingement, gentle nerve gliding exercises might be used.
- Kinesiology Taping:
Kinesiology tape is an elastic therapeutic tape that can be used as an adjunct to other treatments. While it doesn’t directly support the bone fracture, it can:
- Pain Modulation: By stimulating mechanoreceptors, it may help block pain signals and provide a neurosensory input that reduces perceived pain.
- Muscle Facilitation or Inhibition: Depending on the application, it can facilitate weaker muscles or help to relax overactive muscles around the hip and thigh, potentially improving muscle balance and reducing stress on the bone.
- Edema Reduction: Some applications (e.g., fan method) are designed to lift the skin microscopically, creating space to promote lymphatic drainage and reduce swelling, though evidence for significant edema reduction specifically with femoral stress fractures is mixed.
- Proprioception: It can enhance proprioception (awareness of body position), potentially improving movement patterns and reducing the risk of re-injury.
- Dry Needling
Dry needling involves inserting thin needles into myofascial trigger points (taut bands of muscle) to release tension and improve muscle function. For femoral stress fractures, it can be used in the surrounding musculature (e.g., glutes, quadriceps, hamstrings, adductors) to:
- Reduce Muscle Pain and Tension: Releasing trigger points can alleviate localized pain and muscle tightness that may be contributing to altered biomechanics and increased stress on the femur.
- Improve Blood Flow: Dry needling can promote vasodilation and increase blood flow to the treated muscles, which can aid in tissue healing and reduce ischemia.
- Improve Muscle Balance and Function: By addressing dysfunctional muscles, dry needling can help restore proper muscle activation patterns, reducing abnormal forces transmitted to the bone.
- Decrease Pain Sensitization: It can help reduce central and peripheral pain sensitization.
