Return to Running after a Tibial Stress Fracture

Return to Running after a Tibial Stress Fracture

Return to Running after a Stress Fracture:

The initial stage when treating a Tibial stress fracture is a cessation of weight bearing activity, followed by a gradual return to running after a tibial stress fracture has healed. It is important to return to running on a gradual basis, the pace to which you return to running depends on a number of variables; age, initial injury, past injuries etc.

We have taken a look at a piece of research published in 2015 that looked a 15 different research articles to assess what is the best evidence-based guideline and treatment plan to treat a tibial stress fractures and suggested protocol to return to running after a tibial stress fracture.

The published article can be found here, we have put together some of the main points of the article and made some short videos of the type of exercises they mention as part of the overall treatment plan and have shown to be most effective.

Overuse injuries and Stress Fractures in Runners:

In general, most overuse injuries occur in the lower extremities in runners and this is due to repetitive tissue stress. Edwards et al2 estimate that 26% of recreational and 65% of competitive runners will sustain some form of overuse injury in any given year. In addition to this a higher incidence of injury has occurred in runners with previous lower extremity injuries.

Of these injuries stress fractures account for 15% to 20% of overuse injuries in runners. A stress fracture is a mechanical failure of the bone, in which repetitive loading of the bone, with inadequate recovery and rest, resulting in the bone being unable to repair itself between exercise sessions.

There are additional factors that can contribute to the development of stress fractures:

  • increase in training intensity and weekly high mileage (60K per week)
  • running on hard surfaces
  • inappropriate footwear
  • poor bio-mechanics

The tibia is reported to be the most common site of stress fracture occurrence, accounting for 35% to 56% of all stress fracture injuries. Tibial stress fractures in runners are most commonly located in the lower half of the shaft of the tibia.

Research suggests that improper training programmes are a key extrinsic factor in the occurrence of stress fractures. A study by Matheson et al8 states approximately 30% of athletes who had stress fractures incurred the injury within 12 weeks of a change in training regimen e.g. training for a marathon.

Similarly, poor running mechanics are common intrinsic factors contributing to stress fracture. Females are more likely to develop stress fractures, this may be due to lower bone density as compared to males.

Treatment of Tibial Stress Fracture:

Once you have been diagnosed with a Tibial stress fracture it is important to cease all weight bearing activity, you may be required to have an MRI to diagnose the extent of the injury. If the injury is significant you may need to spend a number of weeks on a soft boot (6-8 weeks) to immobilise the foot and ankle to reduce further stress on the tibia.

The proposed treatment plan is not a “One size fits all” and we recommend you attend your doctor or therapist in advance of starting any treatment plan. The following treatment plan starts from the time the stress fracture is diagnosed and these exercises can be started straight away.

Phase I: Rest 3 – 10 days (depending on extent of injury)

During this phase the athlete is NWB until they are pain free at rest and cleared to weight bear by a doctor. The focus of phase I is on education, pain management, assessing muscular imbalances, strengthening and stretching.

  • Non-weight bearing exercises only, until walking is pain free
  • Control pain and swelling through Rest, Ice and Elevation of leg
  • Progress to Phase II when walking ½ mile is pain free

Phase I: Exercises

  • Clams and Shoulder Bridges to strengthen hips
  • Bird Dog quadruped to maintain core strength
  • Stretch Hamstring and Calf

Exercise Video: [embedyt][/embedyt]

Phase II: Cross-training 4 – 7 weeks (Cleared for Weight Bearing Activity)

The focus of this phase is to progress strengthening exercises and introduce cross-training as tolerated.

  • Begin to introduce high impact activity
  • Remain pain-free through-out plan
  • Complete 10 minutes of pain free light jog­ging before final phase of the protocol.

Phase II: Exercises

  • Stretch Hamstring and Calf in standing
  • Heel raises
  • Plank & Side Plank
  • Side stepping with band
  • Shoulder bridge progressions
  • Lunges

Exercise Video:[embedyt][/embedyt]

In addition to above exercises athlete should be working up to 30 minutes of pain free low Impact cardio: such as Swimming, Water Walking, Walking , Cross trainer or Cycling. The athlete should also be maintaining upper body strength in conjunction with lower body strength exercises. Cardio and strength exercise should be alternated every other day.

Athlete should not start jogging until at least week 3 of this phase, if any pain then athlete must regress back a week in their training. Research suggests that one full cycle of bone healing will take 16 to 24 days (about 3 weeks), and that extra care should be taken during the last 6 to 10 days of this cycle to avoid over­stressing the new deposition

Phase III: Return to Running: 4 weeks

There was no specific evidence-based return to running protocol found, however research does suggest that when an athlete is returning to running after a stress fracture they must make adjustments to running speed and stride length.  Increasing athletes running cadence allows for the reduction of stride length and impact forces, without effecting speed. With this in mind an athlete can be working up their speed over a 4 week cycle.

The first couple of weeks of this phase are about increasing high impact activity and introducing different running surfaces while building in sport specific exercise.

Phase III: Exercises

  • Forward Hops
  • Bounding
  • Step Hops
  • High Knees
  • Marching drills

Exercise Video: [embedyt][/embedyt]

The 10% Rule is a well recognised way of increasing training load among runners, however there was no evidence-based research found for using the 10% rule.

Similarly, at we like to use a Walk/Run progression with our athletes, this also is not validated or tested but we do find it is a good way to regulate an athletes return to their normal running levels.

Walk/Run program:

Day 1: 2min Walk & 2min Jog = 4 mins x 6 sets = 24 mins

Day 2: Rest: Access if any pain from day 1, no pain and progress to day 3

Day 3: 1:45min Walk & 2:15min Jog = 4 mins x 6 sets = 24 min

Day 4: Rest: Access if any pain from day 3, no pain and progress to day 5

Day 5: 1:30min Walk & 2:30 Jog = 4 mins x 6 sets = 24 min

Day 6: Rest: Access if any pain from day 3, no pain and progress to day 7

Day 7: 1:15min Walk & 2:45 Jog = 4 mins x 6 sets = 24 min

Continue above program of reducing Walk slot by 15 secs and add to Run slot until you are running nonstop 24 mins, pain free. If you have pain after a walk/run day, regress to previous level and remain at that level until pain free. Use this protocol and monitor your pain as an indicator to progress.

When an athlete gets to 24 minutes running pain free they should continue to increase their run time gradually for a further 2 – 4 weeks as they get back to their normal level of trainin

Please contact us if you are recovering from a Stress fracture and need additional information.

Prenatal Pilates & Postnatal Mummy and Baby Pilates Classes Lucan

Prenatal Pilates & Postnatal Mummy and Baby Pilates Classes Lucan

We are delighted to confirm we will be starting our first 6 week block of Prenatal Pilates and Mummy & Baby Classes Lucan. If you or a friend are expecting in the New Year or if you have had a baby recently, now is the time to sign up, 6 week blocks will role every 6 weeks.

Mummy and Baby Pilates Classes Lucan
Mummy and Baby Pilates Classes Lucan
  • 6 Week Block - Starting Monday 9th January
  • Postnatal Mummy and Baby Class: Monday's 10:45am - 11:45am
  • Prenatal Class: Monday's 8pm
  • 6 Week Block €80


Our postnatal Mummy and Baby Classes (Monday's 10:45am - 11:45am) will be a great way for new mums to bond with their babies, in a warm safe environment. This time will also give mum a chance to recover from the child birth and start to get back into exercise in a controlled manner. Classes are open to mums after their 6 or 10 week check up.

Our Prenatal Pilates (8pm Monday) classes will be one of the safest and most effective methods of exercise and relaxation for women who are pregnant. If you are new to Pilates you can start pregnancy classes any time from about your 2nd or 3rd trimester. It is not too late if you are 34 weeks, any Pilates is better than no Pilates.....

Pre Natal Pilates Lucan
Pre Natal Pilates Lucan

Some of the benefits?
- Pilates encourages deep breathing and relaxation
- Pilates encourages mind body focus – a useful skill for giving birth
- Pelvic floor strength is essential for the prevention of stress incontinence
- Core control will help to support, stabilise the back and pelvis.
- Pilates helps to reduce the risk of problematic pre & postnatal conditions

Places are limited so book online:

or contact us 086 8318931

Part Time Therapist with Pilates Instructor Experience

Part Time Therapist with Pilates Instructor Experience Physical Therapy is recruiting a Therapist and Pilates Instructor for our West Dublin clinic.

Job Opportunity.

Part Time Therapist with Pilates Instructor Experience has an opportunity for a qualified therapist (Chartered Physiotherapists/ Physical Therapist) to work as part of the team. The therapist will also be a qualified Pilates Instructor, the position will be a mix of treatments and implementing a number of classes weekly.

The successful candidate with demonstrate the following skills

  • Passion for helping people achieve their goals
  • Passion for Pilates and working with people
  • Be a team player
  • Be willing to continuously learn and evolve with the industry
  • Be client focused
  • Be willing to work industry hours including early mornings, evenings and weekends

The position will be part time initially with an opportunity to work full time.

Please send in a copy of your CV along with a cover letter to

Closing date for application is the 16th December 2016

Part Time Pilates Instructor – Pilates Teacher

Part Time Pilates Instructor – Pilates Teacher

Location: Physical Therapy Clinic, Lucan Village, West Dublin (This position would suit somebody living locally or close to the M50).

Times – Days: Morning and Evening Mat Pilates Classes minimum 5 classes a week

The objective is to develop Reformer Classes / Pre - Post Natal Classes

 Start: January 2017

 Skills Required:

  • Ability to teach safe and varied Fitness/Pilates classes
    (up to Mixed or Intermediate level)
  • Ability to teach toning/conditioning class
  • Knowledgeable of the various Pilates principles and movements
  • Good communication skills
  • Reliable and able to work on own initiative

Qualifications required:

  • Fitness Instructor Qualification NCEF, NTC or equivalent
  • Pilates Qualification e.g. Pilates Institute, Body Balance, STOTT Pilates, NTC
  • Up-to-date First Aid Qualification

Other Requirements:

  • Indemnity Insurance

Experience would be an advantage but not essential.


  • Working as part of a small team within a pleasant work environment.

Please apply by email with cover letter and CV:

Understanding Your Pain

At Physical Therapy the vast majority of our clients come to us in pain, either acute or chronic pain. Understanding your pain is a key area we focus on when helping clients to manage injury and pain.

The Fear Avoidance model above was introduced by Lethem et al. in 1983, explains how people can develop chronic pain from musculoskeletal injuries. What starts out as a minor injury e.g. Back pain, can develop into more chronic pain through fear and avoidance of activity. This fear and avoidance thought process can feed into pain, until a person becomes paranoid to move and the pain becomes all consuming everyday.

Obviously at the early stage of an injury it is important not to over stress an injured site while rehabbing the area and preparing the area for a return to work or sport.

The Fear Avoidance model talks about how a person, when injured starts to have anxiety about the cause of the injury, missing work or training, fear of re-injury or they go to a doctor or specialist who tells them their injury is very serious.

This fear and avoidance thought process can develop into a vicious cycle of doing less activity, visiting different doctors and therapist looking for different solutions to the pain. So in the example of a client with back pain, they might stop their weight training classes, stop picking up the kids or carrying shopping, for fear they might re injury their back. We always hear people say "I have a weak back" or an "I have an old back injury so I cant exercise much", it is important to remember damaged tissues in the body heal within 6 - 8 weeks.

During the course of the injury the brain has been programmed to look for these pain signals from the back, in this case the nerves in the back can be hypersensitive and even thinking about a set of dumbbells can trigger these pain signals. These signals are not actually pain, they are warning signals sent to the brain. The brain then decides if it should transmit these signals into pain or not... so yes technically the pain is in your head.  In the case of chronic pain, the brain is programmed to transmit these signals into pain.

The process of understanding your pain and managing it, starts by trying to reduce these warning signals to the brain and change how the brain interprets these signals, at we see movement as the best way to do this.

At we educate clients on the importance of finding a baseline for your pain and movement, then starting at this base line and building on the simple movement that causes little or no pain. Then we build from this point by slowly introducing new ways to move e.g. starting movements on the ground, progressing onto the knees and then into standing.

As the body learns to move differently and warning signals lessen, the brain stops looking for these warning signals, so you may eventually get to a stage were movement is now pain free or modify your movement so as it is pain free.

This process can take some work and time, and we feel it is important to educate clients to understand their pain, do their research (not on Dr Google) and learn to control their thoughts around their pain.

If you would like to learn more about understanding your pain, please contact us for an appointment.


Injury Prevention Lucan

Injury Prevention Lucan

There are a couple of areas that need to be addressed when you are training for an endurance event and want to ensure Injury Prevention across a number of disciplines e.g. Triathlons / Adventure Races / Marathons.

The topics below should give a good overview to help assist in the reduction of developing injuries while training.

  • Warm up & Cool Down
  • Foam Rolling
  • Core Strengthening
  • Training Tip
  • Recovery Strategies
  • Common Training Mistakes & Injuries
  • Injury Management

Warm Up

  • Allow 10 – 15 minutes warm up
  • Include elements of the discipline you are training for e.g. Jogging, Strides, Jumping Jacks, Dynamic drills
  • A good warm up prepares the body for the training session
  • Move muscles & joints through full range of motion
  • Get the blood pumping throughout the body, build your warm up slowly
  • A good warm up help prevents any acute injuries

Cool Down

  • Walk/jog for 5-10 minutes – keep moving at a slower pace
  • Perform static stretches hold for 15 seconds x 2-3 reps
  • Static Stretching increases muscle length
  • Foam Rolling after your session helps reduce trigger points and increase muscle tightness
  • A good warm down helps recovery and prepares muscles & joints for increased training volumes

‘Foam Rolling’

  • While it can be sore form rolling is a great to self-massage/release tight muscles and keep the supple after training.
  • Roll along the entire length of the muscle 10 times
  • Stop on trigger points and pulse over them 10 times
  • Spend 1-2 minutes on each muscle
  • Foam roller can be used on legs / back as shown on video below.

 Core Strengthening

  • Your "core" refers to the muscle of your Pelvic floor / Back / Abs and Hips
  • Core muscles work to support the spine and pelvis helping to maintain good posture during daily and training activity.
  • A strong core leads to more efficient performance and reduces the energy required when training making you more efficent
  • Perform core work on rest days or build in a Pilates class on easy training days.
  • Below are some links to short videos to target Hips & Glutes, Low back and Shoulders.
  • Your focus should be on quality more than quantity

Training Tips

  • Wear suitable training gear and weather appropriate
  • Don’t just focus on cardio, work on technique and technical skills of disciplines.
  • Build in rest days - weekly and easy weeks - monthly, these allow the body recover then increase volume monthly.
  • Vary your training daily between disciplines.
  • Build in core / strength / resistance training into your schedule.
  • Rest when tired.

Recovery Strategies

  • Always perform a cool down
  • ‘Foam Roll’ regularly
  • Have regular massages to aid recovery & loosen tight muscles, i.e. 4-6 weeks

Common Training Injuries & Mistakes

  • Acute sprains, Fall and Trips
  • Overuse Training can lead to overuse injuries
  • To many intense sessions per week, i.e. 1 or 2 max per week
  • Not enough rest or recovery
  • Ignoring pain, training through pain
  • Not doing strength and resistance work
  • Not stretching or doing a cool down

Managing Injuries

Acute Injuries - P.R.I.C.E Protocol

P:      Protection is meant to prevent further injury, avoid weight-bearing, partially immobilising the injured area.

R:      Rest is important to allow for healing, as well as “relative rest” that allows for healing, such as gentle, pain-free, range-of-motion and basic movements of the joints and muscles around an injury.

I:      Ice refers to the use of cold treatments to treat acute injuries. 2 mins on the injured site / 2 mins off the injured site, repeat for 20 minutes, break for 20 mins and repeat.

C:      Compression is the use of a compression wrap, such as an elastic bandage, to apply an external force to the injured tissue. This compression minimizes swelling and provides mild support.

E:      Elevation of the injured site is recommended, it is best to have the injured site above the heart e.g. for ankle injury lie down and place ankle on a pillow so it is higher than the heart.

Do not train through pain when:

  • it is sore enough to prevent you training and you have to stop mid session
  • if the pain last more than a week
  • if you can not train the following day

If you are suffering from on going from exercise call us for an appointment and assessment: 086 8318931


Our 1st Birthday Giveaway!!

How Time Flies!

This time last year we opened our studio and we would like to thank all of our existing clients and future clients for your support.

We would like to show our thanks to you by offering you a chance to WIN one of our:

*10 Class Pass worth €100.*

How can you Enter:

All you have to do is visit our Facebook Page and Like and Share the competition post.  

The winner will be announced @ 4pm Friday 23rd Sept.

What can you Win: 

Our 10 class pass will give you access to all of our Body Maintenance Pilates Classes. 

Once you collect your pass it is valid for 12 weeks, giving you plenty of time to try our Body Maintenance Pilates Classes.

The classes we run at are designed to keep you Strong, Fit and Pain-free.

All our Body Maintenance Pilates Classes are taught by qualified Physical Therapists.

We have classes for all levels from our Beginner Body Maintenance Pilates Classes to our more advanced Body Maintenance Pilates & Kettlebell Classes.

You check out our full timetable of classes here: Class Timetable

So get Liking and Sharing and be in for a chance to win....

Pilates and Kettlebell Classes Lucan

Pilates and Kettlebell Class Lucan

Pilates and Kettlebell class Lucan is a perfect class to compliment our existing classes. Pilates and Kettlebell exercises target the full body through full body movement with resistance.

The movement used in kettlebell exercises can be easily incorporated into Pilates exercises, thus adding even more strength to your workout.

This class is designed to progress you through from Beginners to Intermediate classes and challenge your body further.

Benefits of Pilates and Kettlebell Class training:

  • In both Pilates and Kettlebell training, the exercises taught are specific to the goals of full body movement while developing core strength and stability.


  • Both training techniques have really life applications, training the full body with functional movements.


  • Where Pilates builds stability and flexibility, Kettle bells build strength and power with this stability as the foundation.


The class are on Tuesday 8-9pm starting Tuesday 6th Sept. the classes will be taught by Orlaith who is a fully qualified strength and conditioning coach with years of well as being an experienced Physical Therapist, so you will be in great hands.

New Pilates Strength Class Lucan

New Pilates Strength Class Lucan

We are introducing a NEW Pilates Strength class Lucan Monday's 8 - 9pm starting Monday 13th June. The New Pilates Strength Class Lucan will be working on building full body strength and endurance.

The New Pilates Strength Class Lucan class is building on our Beginner and Intermediate class, we will be working on developing more full body strength, building upper & lower body strength and endurance.

The New Pilates Strength Class Lucan class will be a mix of body weight and Pilates exercises, we will be holding positions for longer and introducing new challenging exercises designed to build over all body strength.

The New Pilates Strength Class Lucan class will be suitable for all levels as we will be progressing all exercises during the class for various levels.

Get booking as places are limited. (Don't worry this video is me just showing off, we will build you up to this stuff!!)


How Does Your Body Compensate?

The body has a series of fascial slings it uses to help you move. You develop these slings in early childhood as you learn to crawl, stand, walk and move. MYOFASCIAL_LINES

  • Anterior Sling
  • Posertior Sling
  • Lateral Sling
  • Functional Sling

Restrictions in these slings leads to stabilisation issues, resulting in the body having to compensate as you move.

The body uses certain signals to warn you of these compensations:

- Tightness / Stiffness
- Asymmetrical Muscle Development
- Joint fixation/subluxation (Jammed)
- Pain

Pain is the last signal the body uses to warn us. To break this Pain cycle you need to address the facial restrictions and core stabilisation issues.

It is important to release the restriction, re-activate the slings and start to re train the slings in conjunction with your normal exercise or training.

Contact us if you would like us to assess your Facial Slings and your ability to Stabilise, and break your Pain cycle.