Non-Operative — Medial Tibial Stress Fracture — Pediatric

Massachusetts General Hospital · MGH Brigham Pediatric Sports Medicine

Weight-Bearing

WBAT with boot/splint per MD; no impact activities through Phase III

Key Restrictions

Boot/splint as directed by MD (Phase I); no impact activities until Phase IV; imaging confirmation (X-ray) required before advancing WB; 15% max increase in running distance per week; discharge criteria: 95% LSI strength HHD and hop testing >=95%

Timeline & Phases

Phase I (0-8 wks): WBAT with boot, NWB hip strengthening, ankle AROM, core strengthening, UBE; criteria: imaging confirmation of healing, no palpation pain; Phase II (9-12 wks): progressive WB, bilateral heel raises to step-ups, AlterG walking program, balance; Phase III (13-18 wks): progressive loading (squats, deadlifts, lunges), beginner plyometrics, AlterG running; Phase IV (4-6 mo): return-to-run interval program (start at 50% intensity, max 10-15% increase/wk), sport-specific plyometrics/agility

Notes

Pediatric protocol for medial tibial stress injury; imaging required before WB progression; AlterG used in Phase III for reduced WB running; discharge criteria: 95% LSI strength and hop testing >=95%; Micheli Functional Scale not used (postural back pain protocol instead). [Archived copy — original Massachusetts General Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2025-02-16.]

Surgeon / Author

MGH Brigham Pediatric Sports Medicine