Although stress fractures of the tibia are a pretty rare occurence in the running population, we’ve seen two in our sports injury clinic in the last month. The causative factors in both cases were similar and caused by a combination of tight calves and insufficient recovery periods between runs. Rather than an in depth look at the causative factors and treatment of shin splints this is short post on the questions asked by our two clients in the last few days
1) Can I run with a stress fracture
No, No. No. Absolutely not, if it still hurts stop running. There is no option b.
2) How do I know if I have a stress fracture?
Clients often have pain on walking which intensifies and worsens on running with a local area of tenderness on the front of the shin. Clinically it can be diagnosed with the help of a thorough subjective history and with pain on direct or indirect percusion over the area. Although the first line of investigation is often the x-ray, it tends to be picked up earlier with both an MRI scan or a bone scan and sometimes a combination of two scans will be used to confirm the diagnosis.
3) What causes the stress fracture? -
Stress fractures can can occur in elite runners as easily in novice weekend plodders. They are thought to be the long term consequence of overloading the tissues on the anterior shin. As mentioned in a previous post one of the the long term effects of training is bone thickening or the osteoblastic formation of new bone. Before this happens however in the short term the tissues fatigue leading to osteoclastic re absorption of bone resulting in a weaker bone. A stress fracture occurs when the weakening phase outstrips the strengthening phase and is the long term result of overloading your tissues when you run. This can be due to direct pressure on the tibia (shin) or indirect pressure through the tissues that attach onto the shin bone. A number of intrinsic and extrinsic factors are thought to contribute to the over load injury including things as varied as duration, frequency and intensity of exercise, shoe wear,decreased flexibility, changes in muscle strength leg length discrepancies, age and sex.
4) What do I do? Rest the injured area and address any mechanical issues with a health care professional such a Physiotherapist. Assessment and prevention of recurrence may include a gait analysis, biomechaical analysis as well as a re-think of how you train. In consultation with your Physiotherapist or coach try to maintain cardio vascular fitness without directly loading your tibia or surrounding muscles.