How should rehabilitation for tibial bone stress injury (BSI) be guided by MRI findings and clinical assessment?

Doctor’s answer

The Fredericson MRI classification categorizes bone stress injury severity based on periosteal and marrow edema (Grades 1-3) through distinct cortical fracture lines (Grade 4). Return-to-running timelines should not be dictated solely by imaging grade; instead, load progression is tailored to anatomical risk location, focal bone tenderness, hopping pain, and functional progression. Low-risk lesions can advance through graded running once clinically symptom-free, without requiring complete MRI signal normalization.

This content is for education. Diagnosis, treatment, and rehabilitation require an individual assessment by a sports medicine specialist.