A NOVEL APPROACH TO TREATMENT FOR CHRONIC AVULSION FRACTURE OF THE ISCHIAL TUBEROSITY IN THREE ADOLESCENT ATHLETES: A CASE SERIES, Volume 9, Number 7, December 2014, Pages 974‐990.
The original paper “A Novel Approach to Treatment for Chronic Avulsion Fracture of the Ischial Tuberosity in Three Adolescent Athletes: A Case Series” was originally published in IJSPT in December 2014, without the Appendix describing the specific rehabilitation progression used in the case series. The editorial staff of IJSPT apologizes for the oversight and the corrected paper appears here.
Appendix 1.
Specific Rehabilitation Progression Utilized
| Phase/Time | Gait | Sitting | Manual Therapy/Exercise |
|---|---|---|---|
| Protection Weeks: 0‐2 | Crutches: NWB | Protected (decrease weight on involved side) | Supine ankle dorsiflexion/plantarflexion for neuromobilization exercise to prevent possible symptoms of hamstring syndrome. Gait with crutches NWB* hip and knee flexed. Sitting emphasis weight‐bearing on uninvolved ischial tuberosity. |
| Weeks: 2‐4 | TTWB‐50% Symptom dependent | Protected (decreased weight on involved side) | Same as above. Gentle soft tissue mobilization as needed to hamstring muscle belly not ischial tuberosity. Supine partial knee flexion/extension (straight leg raise with dorsiflexion) neuromobility exercise as needed for hamstring syndrome symptoms), Isometric exercises painfree: gluteal sets, quad sets, ankle pumps. Core exercises(crunches). |
| Weeks: 4‐6 | 75%‐WBAT | To pain tolerance | Same as above: progress home exercises (painfree exercise only) add hip abduction, gastroc‐soleus stretching, bridging, progress core ex with ball, planks/ side planks with knees flexed to decrease load proximally. |
| Strengthening, eccentric loading at 6+ weeks | WBAT no crutches | To pain tolerance | Continue above as pain tolerance allows progression. |
| Weeks: 8‐12 | FWB | Unlimited | Continued core exercises. Mini‐squats, lateral step up/downs, Eccentric loading: prone leg only eccentric lowering, crab walkouts, supine active knee flexion/extension with concurrent hamstring stretching, hip abduction walk. Progressed gym exercise, running, functional activities, eccentric loading exercises May progress slower based on symptoms, size of fracture etc. |
| Weeks: 12‐16+ | FWB Jogging‐Running | Unlimited | Return to sport criteria: no pain. Functional hop tests: 90% in bilateral comparison. Symptoms guide speed of progression. |
NWB=Non weight bearing, TTWB=toe touch weight bearing, WBAT=weight bearing as tolerated, FWB= full weight bearing