20 / 116
A
sano
LYJ
et
al
.
516
R
ev
A
ssoc
M
ed
B
ras
2014; 60(6):512-517
and risk of significant complication (
D
).
60
It is useful to
divide stress injuries into high and low grades. This sim-
plification provides an approximate assessment of the
healing time, with high reliability (
C
)
35
(
D
).
8,9
Healing time is defined as the time required to return
to full activity without any symptoms. This time was sig-
nificantly greater in scintigraphy with high grade stress
injuries compared with low grade ones. This grading of
stress injury provided by scintigraphy was a significant
indicator for the time until full recovery (
B
).
29
Low risk stress fractures generally heal when the ath-
lete is limited to activities without pain, over a period of
4 to 8 weeks. This healing period is an ideal time to as-
sess the modifiable risk factors that could decrease the
change of injuries recurring. A gradual increase in activity
(daily life activities) should begin after the athlete is free
from pain and the site is not injured (
D
).
61
In a study by
Arendt and Griffith (
D
),
62
returning to full activity from
initial stress injuries (3.3 to 5.5 weeks) was significantly
quicker than for more serious injuries (11.4 to 14.3 weeks).
For stress fractures in the navicular bone, the time for
returning to sports activities and condition for returning
to competitions is around 4 months (
B
).
38
Khan et al. (
B
)
37
reported on the time to returning to full activity among
55 patients with stress fractures of the navicular bone trea-
ted conservatively. The treatment of 6 weeks without bea-
ring weight enabled 86% of the patients to return to full
activity in an average period of 5.6 months after injury.
Considerations related to returning to training for
athletes with high risk stress fractures are more difficult
than in low risk fractures. In general, returning should
only be recommended after suitable treatment and when
the injury has completely healed, given that high risk frac-
tures have the most frequent complications, such as de-
layed consolidation and refracture (
D
).
8,60
Recommendation
Returning to practicing sports should be conducted gra-
dually after consolidation of the fracture, which depends
on the grade and location of the fracture, with greater
rest time required for high risk fractures.
Other guidelines at
www.projetodiretrizes.org.brR
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