J Orthop Sports Phys Ther. 2021 Jul;51(7):322-330. doi: 10.2519/jospt.2021.9982. Epub 2021 May 7.
Low-risk bone stress injuries (BSIs) of the tibia and metatarsal diaphyses account for more than half of BSIs in runners. They interrupt training and are managed using noninvasive approaches that are designed to achieve a speedy but safe return to running.
What is the optimal load to manage low-risk tibial and metatarsal BSIs and safely return to running?
Optimal load can be guided by knowledge of the BSI healing process and is symptom driven. At all stages, the optimal load does not produce symptoms during, after, or the day following loading.
A period of initial load reduction, via partial or non-weight bearing, is typically needed to alleviate presenting symptoms. Analgesics or nonsteroidal anti-inflammatory drugs may be used in the short term (sooner than 7 days), but only for resting pain and night pain. Healing supplements (eg, low-intensity pulsed ultrasound and/or recombinant parathyroid hormone therapy) may be attempted to influence tissue healing. Athletes can maintain cardiopulmonary fitness via cross-training, while simultaneously addressing musculoskeletal fitness. A return-to-run program can be initiated once an athlete is pain free during daily activities for 5 consecutive days. Progress is directed by symptom provocation and initially focuses on increasing running volume before speed. Optimal loading should be continued following return to running and may include jump training and/or gait retraining to reduce subsequent BSI risk. The optimal loading approach to managing low-risk tibial and metatarsal BSIs is clinically successful, but requires further scientific validation. .
胫骨和跖骨干的低风险骨应力性损伤（BSI）占跑步者 BSI 的一半以上。它们会中断训练，并采用旨在快速但安全地恢复跑步的非侵入性方法进行治疗。
管理低风险胫骨和跖骨干 BSI 并安全恢复跑步的最佳负荷是多少？
最佳负荷可以通过了解 BSI 愈合过程并根据症状来指导。在所有阶段，最佳负荷在加载期间、加载后或加载后的第二天都不会产生症状。
通常需要通过部分或非负重来减轻当前的症状，从而实现初始负荷减少。短期（7 天内）可能会使用止痛药或非甾体抗炎药，但只能用于休息时疼痛和夜间疼痛。可以尝试使用愈合补充剂（例如低强度脉冲超声和/或重组甲状旁腺激素治疗）来影响组织愈合。运动员可以通过交叉训练来保持心肺健康，同时解决肌肉骨骼健康问题。一旦运动员在连续 5 天的日常活动中无疼痛，就可以开始恢复跑步计划。进展情况由症状诱发决定，最初侧重于在提高速度之前增加跑步量。一旦恢复跑步，就应继续进行最佳负荷，这可能包括跳跃训练和/或步态再训练，以降低后续 BSI 的风险。管理低风险胫骨和跖骨干 BSI 的最佳负荷方法在临床上是成功的，但需要进一步的科学验证。
