Rehabilitation After Tibia and Fibula Fracture

Initial Recovery Phase

A patient should be pain-free with ambulation and activities of daily living for at least 10-14 days before introducing running-related loads 3
Pain-free walking exercises should be progressed to 30-45 minutes of continuous walking 3, 4
Resolution of bony tenderness is crucial before advancing to more demanding exercises, especially for high-risk tibial fractures 4
Lower extremity functional movements should be assessed before introducing running-related loads 3

A graduated walk-run progression with short-duration running periods initially (30-60 seconds) interspersed with walking is recommended, focusing on pain-free movement and progressive loading 1, 2
Short 30-60 second running increments should be interspersed with 60-second walking periods 2
Exercises should be performed on alternate days to allow bone cells to regain mechanosensitivity (98% returns after 24 hours of rest) 2, 5
The exercise pace should begin at a slower pace than pre-injury running speed 1
Pain during and after exercise should be monitored, and if pain occurs, rest until symptoms resolve, then resume at a lower level 5, 6

Initially, a treadmill or more compliant surface should be used for running exercises 4, 7
Hard surfaces and uneven terrain should be avoided during early recovery 4
Progression to level surfaces should occur before introducing hills 4
Terrain should only be varied once back to normal training 4

Distance should be progressed before increasing speed, building to 50% of pre-injury distance level before introducing speed work 4, 5
Running distance should be increased gradually, with the "10% rule" as a guideline, although this lacks strong empirical validation 6
Pain during and after exercise should be monitored as the primary guide for progression 2, 5

Strengthening exercises for local muscles, including calf and tibialis anterior, should be incorporated 4
Proximal strength training for core and pelvic muscles should be added 4
Progression to plyometric strengthening and running drills should occur once the patient can sprint or squat 1.5 times their body weight 4
Muscle flexibility, particularly in the calf and hamstring, should be addressed 4

Female patients may benefit from a slower progression due to higher tibial bone stresses across running speeds compared to males 7
High-risk tibial fractures require slower overall progression and delayed integration of speedwork 7
Rehabilitation should be modified according to injury severity, with slower progression for higher-grade bone stress injuries 7
The single leg hop (SLH) test can be used to assess readiness for return to running, as it's strongly correlated with functional progression 3