Tibial Stress Reaction (Read 4000 times)

    Hello All,  I have been reading a few of these threads have found them very helpful and informative, and now I have a question.  I have been training for the LA Marathon March 20th (ironic given that I have live in the northeast and trained outside all winter!).  About 3 weeks ago I developed a very mild pain in my right shin.  I saw my Dr. a little over a week ago and a subsequent MRI indicated a tibial stress reaction.  The pain has not gotten worse and I have no problem hopping on the leg.  Since visiting my Dr. I have been cross training only - mostly stationary bike and some elliptical.  


    When I have my follow up with my Dr. this week I assumed he will tell me no LA Marathon, so I am expecting my goal will be to recover well and stay fit in the process. I expect that he will have plenty of advice for me.  However. I would love to hear what anyone's experience has been cross training with a stress reaction?  It seems biking or stationary bike is pretty safe and I hear people talk about deep water running but what about the elliptical.  Also, in the off chance my Dr. gives me the green light to run, has anyone run through a stress reaction?  If anyone has any other advice or guidance, I would be grateful.  


    Thanks in advance

      Greg Rowe and I had stress fractures last year.  I had a full stress fracture that showed on x-ray all the way around my tibia.  My doctor told me I would be out at least 6 weeks with no running.  I was told not to do anything on it for 3 or 4 days and then I could do any type of cross training that did not cause pain.  I found that cycling was the best workout, although I did some deep water "running" also.  I ended up being able to run 4 weeks after diagnosis.  I came back in relatively good shape and haven't had a problem since.  If felt weird to run the first week and I didn't have the same leg speed, but the biking kept my endurance up.  I was able to finish 7-stage, 100 mile race concluding with a marathon only 4 to 5 weeks after returning.  This is probably not a good idea, but it never hurt that entire week.


      I did have some "phantom" pains the first week or two when returning to running, which I hear is relatively common.  Once a stress fracture/reaction is healed, you should be able to resume running as long as you ease into. I tried to stay on dirt when making my return.  Hope some of this info helps.

      Thank you for taking the time to read my signature!

        Thanks - the info does help.  It is amazing how different peoples' recoveries are with these kinds of injuries.  It is really encouraging that yours was relatively good.  Right now I am hoping to prevent it from progressing to anything more severe, and that I can get going again relatively soon.  I will admit to holding out a sliver of hope that my dr. will give me the green light to go out and start running but I am not counting on it.  It is still very early in the spring so plenty of time to run.  

        The shirtless wonder

          As Rick mentioned I had a similar problem.  Unfortunately I didn't have a terribly speedy recovery.  Though I could hop on the affected leg without pain I certainly couldn't run on it.  I ended up taking 8 weeks off of running (excluding a couple of test runs).  Then I spent 6 more weeks following a recovery plan from Pete Pfitzinger.


          My doctor was less than helpful in some ways.  He didn't give me guidelines on when I could return to running.  I was very disappointed in that regard.


          I tried to fill the void by cycling but I didn't enjoy it.  I also tried to learn to swim.  I tried deep water running and I really didn't like that!


          I did lose fitness.  Unlike Rick I feel like I lost a lot of endurance but that's probably because I didn't bike enough and when I did bike I wasn't doing it at a very high intensity.  When I returned to running had some pain.  Some mild pain is OK.  It takes, on average, 90 days for a stress fracture to heal.  It's safe and GOOD to run on it after it has had enough time to heal.  The shock of running stimulates bone growth (which is why runners tend to have higher bone density in their legs).


          Feel free to PM me if you have any questions.  Also check out my training log.  The "FSF recovery" category is what I did during my FSF (f'ing stress fracture) recovery.  If you look at my summary page you'll see a huge purple ramp showing how my weekly mileage returned.


          I doubt it's much consolation, since I know it wouldn't have consoled me, but it WILL heal and you WILL run again without pain.

            I also wanted to add that you shouldn't use my recovery or return as a model.  I took a huge gamble by trying to get ready for a major race only 5 weeks after my return.  I knew the risk of getting injured was high and I would suggest doing what Greg did instead.  Our logs are public so you can see for yourself.  My pain started toward the end of May of 2010.  It hurt the week before a marathon and I still ran the marathon which made it much much worse.  I did not run in June of 2010 and my return started in July.

            Thank you for taking the time to read my signature!


              when I was about 6 weeks out from my last marathon (Oct '10) and at peak mileage I noticed calf tightness/pain.  It was similar to DOMS so I simply stretched and continued training.  It worsened to the point where by 4 weeks out, I was in a lot of pain on that leg.  The faster I ran the less severe the pain; however as I am not a fast runner, this was not of any use!


              I had an MRI which showed periostitis + medial tibial stress reaction.


              I could not hop on the affected leg and walking was quite impaired.


              I was advised to stop all running/weight bearing and was told I could run the marathon and "probably" not cause permanent damage.


              I decided to run the marathon "easy" and just soak up the atmosphere.  However it was very touch and go as even the day prior I was limping just walking around the house.  To my surprise I had a brilliant race - all the cards fell my way on the day and I ran a massive PB and a solid 6 mins faster than I'd hoped prior to the injury.  I think adrenaline got me through.


              The price I paid was that I could not run at all for about 6 weeks after the marathon.  Walking was painful.  There was no way I'd even try to hop as the pain was so severe. 


              As the injury healed I could slowly return to activity.  Hopping was my litmus test.  However it was weird in the beginning as I felt that the affected leg had now "power" or strength.  It was an odd feeling and I was worried it might be permanent!  However as I returned to running, leg sgrengthy also returned.


              I still get phantom pains; and any calf tightness is promplty addressed!

                thanks very much everybody.  One thing I was wondering is, how did you know it had healed?  Was it basically how it felt and trial and error?  Did you do a follow up MRI or bone scan?


                Also Maryclaire and Rick, if you were to do it again, would you have gone back to running and racing so quickly?

                  There are a couple of simple tests that I know.  Before trying this test you should be able to walk without any pain for at least a week.


                  The most common is the hop test.  If you can hop on that leg without any pain, then you may be able to run again.


                  Another test I found is a brisk walk.  If you can walk briskly for 45 minutes without pain, then you may be able to run again.


                  I probably would do what I did again just because I really wanted to do that race.  I was willing to risk being injured for months for the chance to get ready for it.  It worked out well in the end, but that entire month was spent wondering if/when my leg was going to break.  A wise person would follow the plan that Greg provided the link for.  I should also note that I was a 29 year old male with many years of running experience and no other serious injuries.  My doctor said overall I had very high bone density, so this may have sped up my recovery time.  Just because I did it doesn't make it right.  Take your time coming back so that you know it is healed.

                  Thank you for taking the time to read my signature!

                  The shirtless wonder

                    In my case I could hop on my leg even when it was at its worst.  The doctor told me the hop test is an excellent diagnostic AND prognostic.  If you can't hop you probably have a FSF.  Once you CAN hop then you are on your way to recovery.


                    Because I was able to hop when I saw my doctor he advised me to run that very day (this was before the MRI).  I ran.  It hurt. very. badly.  It took me 20 minutes to limp 1 mile back to my house!  That night my leg ached so much that it kept me awake.


                    Once I gave up on miracle cures I just did a time based approach to return.  I gave myself 6 weeks from when I had that horrible 1 mile run (8 weeks from the initial injury onset).  Then I followed that recovery plan.


                    I should also note that I tried to run (I had a brace on my leg) after 1 week of being able to hop.  Just 200 or 400 meters at a time.  When I tried this my leg ached for quite some time after.  That's when I started to doubt the advice of my doctor and started following more "conventional" recovery plans.


                    I didn't have a race planned.  I wanted to run a fall marathon but hadn't registered for anything so I just gave up plans for that. 

                      Thanks everyone for the help and advice.  I visited my Dr. yesterday, who said my injury was on the mild end of the spectrum (3 on a scale of 10).  The MRI showed fluid and signs of injury in the marrow and around the bone, but no visible sign of a crack in the bone itself yet.   Nonetheless, he said I could run if I really was determined to but I would likely pay afterwards.  So given that together with the fact that the family vacation we had scheduled around the marathon (in LA) sort of fell apart, I will let better judgement prevail and sit out to heal.  I will take a few weeks off from running then go to a recovery program. To be honest, a little indoor cross training is a good change of pace from outdoor early morning running all winter here in the Northeast....Talk to you soon and hope to report a good recovery in the Spring.  


                        I probably would not do it again; even though I somehow PB'd on the day and will forever be grateful (and never likely to run that time again), the price I paid was high and I think quite risky.


                        Your diagnsois sounds very much like mine in relation to the marrow and oedema;  I am no wimp in terms of pain (had 7 kids!) but this was one injury that could at times bring tears to my eyes.  I can't understand how some people had proper fractures and could still run/hop!!!  I take my hat off to them for their sheer toughness.