Ever wondered what a stress fracture is? And what are “shin spints”? Or have you ever wondered how to tell the difference between a stress fracture and a simple muscle strain/tendinopathy? Read on to learn more….
A stress fracture is an incomplete crack in a bone that develops in response to repetitive stress or strain that exceed the maximum load the bone can withstand.
The stress can be impact from weight-bearing (eg. with running) putting load through a bone, but can also be from muscle attachments pulling repetitively on the bone. Over time this can result initially in an inflammatory response on the periosteum (outer layer of bone), but can then progress to a stress fracture if the repetitive strain continues.
Where do they occur?
Common sports where stress fractures can develop generally involve impact activities. Lower limb stress fractures are most common in athletes involved in running, jumping and sprinting. The most common locations are the tibia (shin bone), navicular (inner side of foot), femur (thigh bone), calcaneus (heel) and metatarsals (foot bones). Stress fractures from impact activities can even sometimes occur in the sacrum and lower back. Upper limb stress fractures are uncommon, but can occur in the humerus (upper arm) in throwing sports.
What are shin splints?
“Shin splints” is a broad term to describe medial or lateral shin pain that can arise as a result of muscles in the shin/calf pulling repetitively on the shin bone and causing an inflammatory reaction at the periosteum (outer bone). Shin pain in the form of “shin splints” is a precursor to developing a stress fracture. Fortunately, if shin pain is caught early on and addressed with physiotherapy intervention it can be reversed and the progression to stress fracture can be avoided.
What are the symptoms?
Symptoms in lower limb stress fractures usually involve local tenderness over the site of the stress fracture, pain on weight-bearing, pain that worsens with activity and pain with palpation/tapping of the bone in the local area. The pain often has a history of developing gradually but with progressive worsening of pain as the athlete continues to train. As opposed to muscular/tendon pain, which will often “warm-up” or improve with activity, stress fracture pain does not ease with activity (it usually worsens). Stress fractures also characteristically will ache at night-time during periods of rest, whereas muscular and tendon pain tends not to have any night-time element of pain.
What is the treatment?
By resting from the aggravating activity, the body is given time to heal the bony stress fracture by laying down new bone material. This process can take months, and it is important the athlete adheres to the rest protocol during this time. So that’s all that needs to be done, right? WRONG!
Simply resting will certainly bring pain relief and allow the bony stress fracture to heal. Comprehensive, successful treatment, however, should include a thorough examination to determine why the stress fracture developed in the first place. This assessment should include flexibility tests, muscle strength testing, a technique/running gait assessment, questioning of any relevant medical history (some medical conditions can predispose to developing stress fractures), and especially questioning the training volumes/loads that may have contributed.
Comprehensive treatment, therefore, should aim to correct any imbalances, weaknesses and/or training errors so that the athlete does not develop further stress fractures when they return to their respective sport. Physio treatment can involve stretching, strengthening exercises, orthotic prescription, taping, drills to improve technique, dry needling, ice, massage, as well as education about a graduated return to sport and management of subsequent training loads.
The staff at Physio Professionals pride themselves in this comprehensive approach, which gets to the real root of the problem, rather than just offering a “band-aid” response. This approach results in a much more successful return to sport and a much lower rate of re-injury in the future.
If you are suffering from shin pain, don’t wait for it to get worse. Go to www.physioprofessionals.com.au and see one of our experienced physiotherapists who can help you address the injury, and avoid the frustrating, painful experience of developing a stress fracture.