Forums >Health and Nutrition>Does this sound like a tibial stress fracture?
Looking for some insight...Raced a HM on November 1 no problems, took 4 days off and did a couple weeks of easy easy running and low mileage. Ran 26 miles the past two weeks (my peak was 32 while HM training) did a 10K last Thursday, felt fine. Took a day off, did two super easy runs (4 and 6 miles) and took another day off.
Then Tuesday ran 6 and had a pain that started in my calf and eventually settled on the lower medial aspect of my leg, like 2 inches above the ankle bone. Ran 4 miles yesterday and it was bothering me again, but not horribly. Started to get worried. Had a 9 mile planned today and decided to see how it went. The pain started bothering me around mile 1, but no worse than yesterday. Didn't cause me to change my stride at all. Then by mile 5 the pain had subsided and by the end of my run I wasn't feeling it at all the last 3 miles. Was a little sore when I stopped though. Did the hop test, and had a little discomfort but not bad. Just did the hop test again and no pain at all. No bruising, swelling and not noticeabley tender to touch. No pain with walking or rest. When I do have it while running it's more so just annoying.
Considering the pain actually got better towards the end of my run I'm hoping it's not a stress fx? I would think if it were, since this is the 3rd day it's been bothering me the pain would be worse. But the location of the pain makes me nervous. Maybe a stress reaction? Either way I am going to take the next 3 days off and see how I feel Monday. Just looking for some insight.
Just because the pain gets better as the run progresses doesn't mean it isn't a stress fracture. I have had stress fractures in my tibia and metatarsals. When I had the metatarsal SF's, I remember the pain being moderate when I started my runs and then it would go away completely after about 1 mile. When I finished my runs, then the pain would be MUCH worse. The same thing happened when I recently had a tibial SF. Pain went away a few minutes into the run and came back stronger after. In both cases it was the all too familiar shooting, throbbing pain.
Anyway, you need to listen to your body and decide how you feel. If it isn't getting better then your body is telling you it needs rest.
runktrun
Your mileage does not seem unreasonable, but your symptom are pretty spot on for the beginnings of a stress fracture. You mention it doesn't hurt when you touch it - try really poking it hard, using your finger tips to palpate all around the area. If you find a spot that is more tender than the rest of your shin, it's a good bet you're developing a stress fracture. Stress reaction is just the initial damage. You complaints sound exactly like my first tibial SFX in high school - nothing horribly painful, but just "not right" and I noticed my race times suffering. Ended up running on the SFX for about a month and by the time I had it imaged, it had spiraled up my tibial. Still, not very painful.
Whether it definitely is a SFX or not, I think a few consecutive days off would be smart. Try biking, but lay off the elliptical or anything that transmits load down through your leg similar to running. Check your shoes (are they worn out, have you been wearing less supportive ones more? etc), check your diet (eating less recently? less fat?). Mild SFXs are tricky to diagnose - you really need an MRI, but by the time you get through your PCP, see a sport doc and get an MRI scheduled, it will be well on its way to healing...so why bother. In the mean time, some strength exercises like squats, single leg squats, wall sits, eccentric heel drops, etc can help strengthen surrounding muscles and reduce excessive pronation that might be stressing that one area. And ICE. This is definitely one injury that benefits from ice Good luck, don't worry too much, sounds like your planned days off may be all you need, but keep track of what activities you do and how you feel during and after. Keep us updated!
Not running for my health, but in spite of it.
SMART Approach
I deal with fractures everyday and bone healing including Tibias. I am pretty darn sure it is not a stress fracture. However, you need to be aware. It could be an early stress reaction but sounds more like a classic shit splint or soft tissue. Stress fractures are painful to touch and you would feel worse throughout a run. Soft tissue would feel better when it loosens up. You can't walk well or at all on a true stress fracture of tibia. Do calf stretching daily, dorsiflexion exercises and ice a few times per day for 15-20 min. Take a week off would be my recommendation. When you get back at it, really warm up shins with hot water, movements, toe taps etc before your runs to get blood flow there to prevent micro tearing. Good luck.
PS Also make sure your Vit D levels are optimal. We find athletes with sub optimal Vit D levels are more prone to bone stress injury or pain and soft tissue for that matter. You want a blood level above 40 and preferably 50-80. Vit K2 and magnesium also important. Most of us have levels of 30 or lower unless a lot of sun exposure with minimal sunscreen.
Run Coach. Recovery Coach. Founder of SMART Approach Training, Coaching & Recovery
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Tchuck, just curious, what's your line of work? I'm obv not a medical professional, but my experience with 3 tibial stress fractures was that I often did NOT feel worse throughout my run...hence why I kept training, thinking "if it's a SFX, then it would feel worse as I progess." First one clearly diagnosed with MRI, no imaging for the second, had a bone scan for the third showing serious uptake in the affected area. Changed to light stability shoes and fixed my problems, luckily
Thanks everyone. I'm on my feet all day at work for 12 hours and no tibial pain today, just tightness in my upper calf. I do have tight calves and stretch frequently so I'm not sure if that has something to do with it. Weird. Did the hop test and nothing. I also noticed yesterday it bothered me more when I would flex my foot and then turn it medially. So idk. Will see how I feel Monday. Thanks everyone!
I've dealt with tibial problems each of the last two springs, and what you describe seems to be an initial stress reaction that if left unchecked, will become a lot worse. My track season last year was ended by the creeping pain that showed up a few inches above the ankle, like you said, and would some days feel better than others. I am not a medical professional, but I've been down that road a couple of times. Don't push it too far or you will end up with a stress fracture.
Prairie running is peace.
Nate, or for those who have had a stress reaction but not a full blown stress fx, how long did you take off from running?
I am in orthopedic sales and work directly with orthopedic surgeons with the bone healing device I represent. We treat stress fractures regularly. The term "stress fracture" is a broad term. In many cases it may be just a stress reaction. I have had docs even prescribe it for medial tibial stress syndrome or stress reactions but list it as a stress fracture. From my experience, a true stress fracture would be very difficult to run on especially in the tibia. There are medial stress fractures and anterior stress fractures. A true stress fracture will probably show up on an x-ray after a healing response. A bone scan is a better scan for a stress fracture than a MRI but can be seen on an MRI for sure.
Runshort, generally it depends on how quickly you heal. Palpation at fracture site with less or no discomfort is a first sign of healing. You want to get to the point where it does not hurt when pressing on it and then hopping on it. This could be 2 weeks for a mild stress reaction or longer depending on the degree of reaction. It is not uncommon to go 6-8 weeks without running. On anterior tibial stress fractures with the dreaded black line, it could take 3-4 months with 6-8 weeks of NO weight bearing. Each case is unique. Proper shoes and nutrition are important as is listening to your body. If you are in tune with your body and nutritionally sound, stress fractures should not occur or should be rare. Often times we see malnutrition, low Vit D, poor calcium levels or uptake (which is where Vit K plays a part), amenorrhea etc. in patients with stress fractures. OR just stupidity in training through pain.....
Thanks everyone. Hoping it's just a stress reaction, because I've never failed the hop test and even when I press really hard on my tibia I can't pinpoint a terribly painful spot that's anymore painful than jabbing my tibia on the other leg lol. I just worked three 12 hour shifts back to back and regularly walk 3-4 miles at work a day, and had no pain whatsoever. Did a body pump class with no pain. My calf has felt tight, but other than that I've felt fine. Still haven't tried running, figure maybe I'll give it a good 2 weeks and then try a 2 mile jog.
I was just diagnosed with the "dreaded black line" in the mid-anterior tibia. My Ortho couldn't really give me a good idea what I could expect as far as healing. He said he seldom saw the DBL type fractures. He just said from the literature he read, that he didn't think it was a good outlook, and I should google (?)
I stopped running, and pain went away in 2 weeks. After 5 weeks I can fast walk with zero pain, and press hard on the tibia bump without any pain. I just started doing a bone stim unit at 5 weeks. This is the first post (below) that seems to indicate that I might have a chance at recovery from the Dreaded Black line. I was wondering if you could further elaborate about any cases you have actually seen where a DBL fracture actually healed and the person was able to run?
I am in orthopedic sales and work directly with orthopedic surgeons with the bone healing device I represent. We treat stress fractures regularly. The term "stress fracture" is a broad term. In many cases it may be just a stress reaction. I have had docs even prescribe it for medial tibial stress syndrome or stress reactions but list it as a stress fracture. From my experience, a true stress fracture would be very difficult to run on especially in the tibia. There are medial stress fractures and anterior stress fractures. A true stress fracture will probably show up on an x-ray after a healing response. A bone scan is a better scan for a stress fracture than a MRI but can be seen on an MRI for sure. Runshort, generally it depends on how quickly you heal. Palpation at fracture site with less or no discomfort is a first sign of healing. You want to get to the point where it does not hurt when pressing on it and then hopping on it. This could be 2 weeks for a mild stress reaction or longer depending on the degree of reaction. It is not uncommon to go 6-8 weeks without running. On anterior tibial stress fractures with the dreaded black line, it could take 3-4 months with 6-8 weeks of NO weight bearing. Each case is unique. Proper shoes and nutrition are important as is listening to your body. If you are in tune with your body and nutritionally sound, stress fractures should not occur or should be rare. Often times we see malnutrition, low Vit D, poor calcium levels or uptake (which is where Vit K plays a part), amenorrhea etc. in patients with stress fractures. OR just stupidity in training through pain.....
I have seen positive outcomes with the ultrasound bone stims in the DBL tibia fractures. These fractures are much higher risk than the medial tibial stress fractures. The last case I worked was fairly bad (worst of the worst) and patient was on crutches for 8 weeks until no longer sore with palpating. His x-ray at 8 weeks was jaw dropping. The doc looked at me with his mouth open after seeing all the new bone formation. This athlete healed and went back to playing basketball. He was African American who is even higher risk of vitamin D deficiency which he started taking. I encourage Vit D3, K2 (MK-7) and Magnesium intake. It will help optimize bone health.
With this fracture there there is always risk of non healing and needing a rod inserted in tibia. In your case keep doing what you are doing along with good nutrition. Don't rush your recovery and listen to your doc. Don't run before you are ready and follow a gradual plan.I will say, it is a very good sign that you no longer have pain at palpation and brisk walking. Good luck!
Connoisseur of Cookies
I encourage Vit D3, K2 (MK-7) and Magnesium intake. It will help optimize bone health.
C'mon, dude. Again? Provide some literature to back this up. And why should we listen to you?
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"C" is for cookie. That's good enough for me.
not bad for mile 25
----classic shit splint---
Hate it when that happens.
I am not sure why I feel the need to defend myself as I am not making any claims just providing tips. Cookie, you are kind of coming off In a negative fashion with your comments toward me. I have not said certain nutrients will cure anything. Have I?? I am not making stuff up-simply stating the benefits of certain nutrients to optimize bone health. Isn't this what this site is about-to provide education, tips, insight, real life experience?? I encourage everyone to do their own research. 99% of the people I talk to have not heard of Vitamin K2 (MK-7). I think it is crucial people learn more about it for not only bone health but also heart health.
Here is some recap on importance of the listed nutrients for bone health and their synergistic properties. I am here to help people, BTW.
http://www.nutritionaloutlook.com/jointbone-health/bone-health-cofactors-new-science-vitamin-d-k2-magnesium-and-zinc
http://www.lifeextension.com/magazine/2008/3/protecting-bone-and-arterial-health-with-vitamin-k2/Page-01
http://www.vitamindwiki.com/Vitamin+D,+K2,+Magnesium,+etc+increase+bone+density+when+taking+together–+Jan+2012