Evidence-based Sports Medicine

Evidence-based Sports MedicineTable 26.3 Weekly water running training regimen. (Adapted fromFrangolias DD et al 72 .)DayTraining regimen1 Interval training, simulated mile repeats: 4 × 5 min to 6 × 5 minwith 1 min rest; HR = 175–180 bpm2 Low intensity run: 30–45 min; HR = 130–150 bpm3 Interval training, hard intervals: 6 × 3 min with 1 min rest;HR = 175–180 bpm4 Low intensity run, as for day 25 Interval training, short: 5–15 × 2 min or 5–15 × 1 min, with30 sec rest; HR = 175–130 bpm6 Long steady state run: 40–90 min; HR = 145–165 bpm7 Rest day (or low intensity run performed)a six day training and one day rest schedule was initiated on week 4(Table 26.3). Treadmill VO 2max and ventilatory threshold showedsmall decreases but progressive improvement when measured at 23and 30 weeks post-injury compared to pre-injury levels. Ten kilometerrace performance at 31 weeks post-injury was six seconds faste thanhis pre-injury time.Alternate activities have been shown to maintain VO 2max andmuscular strength, but specific metabolic and neuromuscularadaptations that affect skill are not easily duplicated. For this reason,isolated skill related activities are resumed as early as possible inPhase 1. It is possible in most cases for the athlete to maintain specificsports skills. In ball sports these can involve activities either seated orstanding still. This active rest approach also greatly assists the athletepsychologically.Modification of risk factorsAs with any overuse injury, it is not sufficient to merely treat thestress fracture itself. Stress fractures represent the result of incrementaloverload. Subtle adjustments to the modifiable factors that contributeto the total load are an essential component of the management ofan athlete with a stress fracture. A thorough history and clinicalexamination will assist in identifying the factors that may havecontributed to the injury and those that can be modified to reducethe risk of injury recurring (Table 26.4). The fact that stress fractureshave a high rate of recurrence is an indication that this part of themanagement programme is often neglected. 1,73 However, it should bepointed out that there have been few clinical trials to evaluate theeffectiveness of risk factor modification in reducing stress fracture498