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Tibial Stress Reaction (Read 1029 times)

    Hello all.  Sorry for the long post.  Looking for a bit of advice on coming back from a tibial stress reaction.  Early last year I was coming back to running after a five or six year layoff.  My aerobic conditioning was pretty good from various other things that I do, so it seems that I did too much too quick.  Ended up with a “stress reaction” in the left tibia at about 35 miles per week. (This was about five months back into running.  I had started at around 20-25 mi/wk, I think.)  EDIT:  Looking back, I had been running closer to 30-32, some weeks more like 28 before I got hurt.  I think that suggests that the plan below might be a little aggressive and I should sit at 20 or so for awhile.

     

    Shin wouldn’t heal, spent six or eight weeks in a boot, some more in PT, got a little skittish about running on it again, etc., etc.   Anyway, I’m trying to get back slowly and looking for some feedback on whether my current plan is too aggressive or too conservative given this history.  (Following PT's orders, I started running 2 min/day and added another 2 min per day as long as everything felt OK.  I'm now at 20 min/day, a real easy 2 miles.)

    (1) I’m going to try not to run on concrete at all and rarely on asphalt.  My issue developed shortly after I began running more on concrete.  (Needed some variety in my routes.)  I’ve never been a racer so I don’t really care about any impact that policy might have on race performance.  I’d be more likely to race trails anyway.

    (2) I’m going to start around 10 miles per week and just see how that goes for the next four weeks.  After that increase one mile per week up to 20/wk.  I’d hit 20 around the end of April.  Then increase two miles per week up to 30/wk.  I’d hit 30 around early June.  Then ride out 30 for a long while, exact amount TBD.

    (3) I’d like to drop some weight.  I’m 30 lbs over what I’d consider a real good running weight for me and 15 lbs more than I find tolerable.  The extra weight cannot be helping the situation.

    I guess you might ask why I care about miles very much since I don’t care about racing and am not training for anything.  Well, I just like running long distances for the hell of it.

    Any input anybody might have would be much appreciated, especially if you’ve come back from such a problem before.

    -James

      One thing that worked for me when coming back from an Achilles injury was Gallowalking.  To get 2mi, for example, I'd do 4x[5min jog, 5min walk].  20min total jogging is easily 2mi, but my leg only had to absorb it in several 5min round instead of one 20min stint.  When you're coming back and running 5 days of 7, the cumulative pounding may be something you seek to manage.

      “Everything you need is already inside.” -- Bill Bowerman

        Thanks, Clive.  I think that's a good idea.  Probably would also help at first with fatigue in the muscles that might lead to a tweaky stride near the end of the run that would further upset the shin.

          James--

           

          It's frustrating to start slowly and conservatively, but I think it's the way to go. After a similar left tibial stress reaction this summer, I took 8 weeks off, 4 additional weeks of PT and core strengthening (especially hips and ankles), and then began the U-Wisconsin Return-to-Running program given to me by my PT. The link below will take you to it, about a third of the way down the page: 

          http://www.lifetimeendurance.com/public/219.cfm

           

          It's pretty slow, but I followed it religiously and, with continued core work and cross training, am now (three months after my first run) at about 25-30 miles a week, with no pain or reinjury.

           

          Hope it helps!

           

          Peace,

          Trey

          flauta


            James,

             

            I had a tibial stress reaction last year.  Trying to come off my first marathon onto my next too soon and too hard.  Anyway, when I was healing I used an elliptical extensively.  I was able to get a low impact but vigorous workout, maintain fitness, and give my tibia time to heal.   Good luck.

             

            Rob 

              I had this in the summer of 2010. I didn't even know a stress reaction was possible until then. I ended up "running through it" although that meant that for about two months I averaged about 20% of the running that I did when I was healthy (I hit 100mpw the week before I got it and ran 20mpw for the next couple months). I kept running on it for two reasons:

              1. I admit that I am addicted to running and racing and the thought of taking months off is not appealing, so I just don't do it.

              2. I feel that when you have a weakness if you stress it your body will over compensate and work to repair it faster. In other words, I would never wear a boot for a simple stress reaction because I want to keep a small level of stress on the leg every time I take a step so that my body knows to keep recovering the stress reaction. A stress fracture is different, I don't think you can run through those.

               

              I also made a conscious effort to drink more milk, eat cheese and yogurt. Although I am still in my 20s so I recover relatively fast.

                I had this in the summer of 2010. I didn't even know a stress reaction was possible until then. I ended up "running through it" although that meant that for about two months I averaged about 20% of the running that I did when I was healthy (I hit 100mpw the week before I got it and ran 20mpw for the next couple months). I kept running on it for two reasons:

                1. I admit that I am addicted to running and racing and the thought of taking months off is not appealing, so I just don't do it.

                2. I feel that when you have a weakness if you stress it your body will over compensate and work to repair it faster. In other words, I would never wear a boot for a simple stress reaction because I want to keep a small level of stress on the leg every time I take a step so that my body knows to keep recovering the stress reaction. A stress fracture is different, I don't think you can run through those.

                 

                I also made a conscious effort to drink more milk, eat cheese and yogurt. Although I am still in my 20s so I recover relatively fast.

                 

                 

                I think there are a wide variety of things that get tossed into the category of "stress reaction."  For me the MRI showed actual bone damage.  The injury itself wasn't even all that bad, but it would not heal even with no running at all.  One of the reasons I ended up being out for a long time was because I spent about six weeks seeing if rest would fix the issue and it just kept getting worse (even with no running at all).  A boot seemed to be necessary.  I guess everyone varies, but from what I understand both from my orthopedic surgeon and my PT, it is not usually a very good idea to run through a stress reaction.

                  I think there are a wide variety of things that get tossed into the category of "stress reaction."  For me the MRI showed actual bone damage.  The injury itself wasn't even all that bad, but it would not heal even with no running at all.  One of the reasons I ended up being out for a long time was because I spent about six weeks seeing if rest would fix the issue and it just kept getting worse (even with no running at all).  A boot seemed to be necessary.  I guess everyone varies, but from what I understand both from my orthopedic surgeon and my PT, it is not usually a very good idea to run through a stress reaction.

                   

                  Agreed. I had one. Ortho told me that the MRI showed "elevated bone metabolism." I ram through periostitis until the bone just couldn't recover from the stress. So the MRI showed that my tibia has signs of recovering from injury. No running until it didn't hurt. If i kept going it would've progressed to a fracture. Recovery took about 3 months. But I did recover. 

                   

                  Ramping miles slowly and working on my form was a big help. Over-striding, landing heavy on my heels, etc. didn't help things. Stability shoes with medial post caused problems too. But the biggest problem was too much too soon. And tight calves - they're the root of all evil. And some people just have to progress more slowly. But progress is progress no matter how slow.