Got pain in the lower leg while running, walking, jumping, dancing, or any activity that involves the legs? Does the pain stop when the activity stops? That pain could be caused by a tibial stress fracture.
A tibial stress fracture is not a specific injury. It merely refers to pain that occurs in the area of the shinbone (tibia bone). Thus, a tibial stress fracture is often called “shin splints”. [5] The tibia is the larger of the two bones in the lower leg.
There are other names for it as well: periostitis, medial tibial stress syndrome (MTSS), and also soleus syndrome. [1, 5]
A Tibial Stress Fracture Is Not A Broken Bone, But It Could Be, If Not Treated
Medial Tibial Stress Syndrome (MTSS) vs Tibial Stress Fracture vs Shin Splints
For most people, these are all the same thing. However, some doctors refer to the pain caused by muscles as “shin splints” and the pain caused by a not yet broken bone as a “tibial stress fracture”. Chances are pretty good that you won’t know which one you have without an X-ray, MRI or a bone scan.
Medial Tibial refers to the side of your leg that faces your other leg. Syndrome simply means a group of symptoms that occur together. Since the tibia bone is also known as the shinbone, they mean the same thing.
So, don’t be surprised if your doctor talks about shin splints, but your diagnosis or medical billing states: Medial Tibial Stress Syndrome
Splints are made from any rigid material (such as sticks) that can be bound to the leg to prevent movement. So, this term is relevant to treating the injury, but is not relevant to what the injury actually is.
What Is A Tibial Stress Fracture?
A stress fracture of any bone is a lot like bending a wooden toothpick. While the toothpick bends it is called a stress fracture, but when it snaps into two pieces, then it is a full fracture.
Why would the bone or the toothpick bend? Because it doesn’t have the physical integrity or strength to be stiff and solid like it’s supposed to be.
What Causes A Tibial Stress Fracture?
Modern science doesn’t really know the answer to that question. There are a few theories to choose from.
One theory is about an inflamed periosteum membrane that covers the exterior of most bones. There are two parts to the periosteum – the inner and outer layers.
The inner layer is fibrous and provides strength to the bone, while the inner layer (cambium) is a major contributor to bone growth and bone strength.
As we get older the inner layer becomes very thin and its ability to grow new bone and heal fractures deceases. Which leads to weaker bones and a slower recovery from a tibial bone injury. [6] As you will see, a weaker bone will increase the chances of a stress fracture.
Another theory is about increased pressure in muscles. Presumably exercise makes the muscles retain water and increase in size, which can block blood flow within the muscles. Lack of blood results in pain. [5]
Yet another theory is about the bone’s reaction to stress placed upon the bone by the muscles. [5] In other words, the muscles are pulling on both ends of the bone towards the middle. If that pull is strong enough it would bend the bone. This is much like bending the toothpick from both ends.
In this case, the body reacts by building stronger bone tissue. It does this by remodeling the bone. Which involves removing the weaker bone material and then replacing it with stronger material. That can take a month or more to accomplish.
However, if there is too much stress placed upon the bone during remodeling, then you will have a stress fracture.
Before the stress fracture occurs, you are likely to have periostitis (inflammation of the periosteum membrane that covers the bone – theory #1 mentioned above). Another possibility is demineralization of the bone. [5]
Bone demineralization is the cause of osteoporosis. Which would be even worse than a tibial stress fracture.
We are not done yet with what causes a tibial stress fracture.
Overpronation Is A common Cause Of Tibial Stress Fracture
Overpronation is known as “flat feet”. That means your ankles bend inward towards each other as you stand or walk/run. If you have ever seen children ice skating for the first time, you will get a vastly exaggerated idea of what overpronation looks like.
It’s a fact that overpronation creates more stress for the feet and is a leading cause of a tibial stress fracture. [1] The bones and muscles in the feet, ankles and legs all try to compensate for the bone misalignment caused by flat feet. Which creates more stress and strain on the tibia bone which supports most of your body weight.
Tibial Stress Fracture Symptoms
Minor cases will produce pain after a period of physical exertion. Whereas, a more serious case will produce pain around the tibia after little or no physical exertion. [5]
The pain varies from a feeling of soreness or dull aching up to greater pain and cramping. The pain is usually localized, but can extend into the foot. [5]
There may be swelling, due to fluid retention, or a group of muscles may feel tight. The skin of the affected area may be callused. [5]
How To Self Diagnose A Tibial Stress Fracture
To start your tibial stress fracture self-diagnosis, answer these questions:
When you press or squeeze along the inside of the leg from the knee to the ankle, does it just feel sore or does one spot hurt more than any other?
If one spot hurts more, then that indicates a bone break. Otherwise it indicates that the bone is not yet broken.
Does the leg feel better in the morning when you wake up, and does it hurt more and more as you walk?
That indicates a stress fracture. Whereas, if it feels worse in the morning that would be the muscles. That’s because the muscles will have tightened up during the night.
You can do this next test yourself, but it’s easier (and better) if someone helps. I do this by crossing my injured keg over the thigh of my other leg. Then turn your foot upwards. Use your hands to push against the foot – trying to push it downward. Does that hurt? If it does hurt that indicates muscle pains and not a stress fracture.
This next test is almost the same as the last one. Cross your injured leg over your other thigh, and turn your toes towards your knee. Then use your hands to try and push the toes back down again. Again, if it hurts, that would be muscles, but if it doesn’t hurt it would likely be a stress fracture.
Finally, skip rope. If the pain is severe in the injured area when you put weight on that foot/leg, that is a pretty sure sign.
When To See The Doctor
If your self-diagnoses indicates a stress fracture, go see your doctor. The doctor will do an X-ray to see how bad it is. However, if your symptoms have just started, an X-ray might not detect a beginning fracture. Which could lead to a misdiagnosis. [3]
The misdiagnosis occurs, because the symptoms are quite similar to: [3]
- Knee tendon bursitis (pes anserinus bursitis) which is inflammation between the tibia bone and the knee.
- A meniscal injury. Such as a torn meniscus.
So, until your injury gets worse, or in some borderline cases, an MRI, bone scan (skeletal scintigraphy), or CT scan (computed tomography) might be needed. [1, 3]
If you don’t have a stress fracture (according to your self-diagnosis), then check out the treatment options list below, and treat yourself to better health. Although (to keep me out of legal trouble) I still recommend that you go see your doctor. It’s your body and your choice.
Pain Relief For Tibial Stress Fracture
Most people will grab the first NSAID (Nonsteroidal Anti-inflammatory Drug) pain medicine they can find. That would include aspirin, and ibuprofen (Motrin, Advil). They are convenient and effective, but have side effects including liver or kidney damage.
I will rarely take an aspirin for a headache caused by eye strain from writing these articles. However, I won’t take any of the others.
Doctors prescribe NSAIDs to relieve pain and to reduce inflammation. Which just happens to be the two things that CBD Hemp Oil does best. That is what I now recommend, and what I use.
The other thing that provides pain relief is a walking boot or leg brace. The air-filled ones are the best, because the comfort level can be precisely adjusted to what feels best. They work by preventing the body parts from moving and creating pain. They also support the injured parts so that they can heal faster.
You will find that a little more air pressure in them is more comfortable during the day, and a little less air pressure is better when sleeping.
Tibial Stress Fracture Treatment
Various treatments have been used. [4]
Such as:
- Placing a cold pack on the painful area. This could be done both before and after physical exertion – such as running.
- Ultrasound by itself or as phonophoresis. Phonophoresis is the use of ultrasound to aid the penetration of anti-inflammatory and pain-relieving medications that are applied directly to the skin.
- Taking oral anti-inflammatory medicines.
- Surgery for tibial stress fracture isn’t usually considered, except on a case by case basis. [1]
- Resting the legs from exertion.
- Extracorporeal Shockwave Therapy (ESWT) appears to be highly effective. [1, 2]
- A pneumatic leg brace tested by the military did not improve the rate of healing. [7] That was in 2010. Leg brace technology has improved since then.
- Fascial Distortion Model (FDM) produces faster results than Extracorporeal Shockwave Therapy or standard physiotherapy. However, it is quite painful. [4] The fascia is a band of tissue that holds the various body tissues in place, and encloses muscles. The theory is that the fascia is distorted or “out of place” and just needs to be re-positioned. The fascia is pressed and manipulated back into place with the hands or small tools.
- Using a walking boot for tibial stress fracture pain relief, and to prevent further injury.
Alternative Tibial Stress Fracture Treatments To Consider
The best thing you can do is to stay off that leg altogether, but that isn’t very practical. If you are a marathoner, you would rather give up your 4th child instead of giving up running. What to do, what to do…
Get in the pool and aqua jog or start cycling (preferably at the gym). The idea is to not put any weight pressure on a stress fracture, or to further strain any of the muscles.
If you haven’t actually fractured the bone, you should recover completely by resting the leg.
Obviously, you don’t want to lose your muscle tone and strength. So, that’s where I recommend the water jogging. The water provides some resistance and some support at the same time.
In addition to everything I mention in this article, I highly recommend the herbal remedy I used for a torn meniscus.
Cycling & Elliptical Use After Stress Injury
This is probably better left until you have done some aqua jogging. How long that will be depends on your personal situation. It could be several weeks. Obviously, you should ask your doctor about this.
Should You Use A Tibial Stress Fracture Boot Or Crutches?
Using a walking boot for tibial stress fracture should be a “no brainer”. It’s bad enough to have limited use of your legs, but crutches also result in the limited uses of your arms. At least with a tibial stress fracture boot, you can stand and walk AND use your hands at the same time.
I realize that wearing a boot could be too warm or too cold depending on the weather, and that having that 2 pound weight on your leg is pretty clunky. However, you are missing the point of the boot.
The tibial stress fracture boot provides the support to relieve pain, and to permit the bone and muscles to heal as fast as possible. You just can’t get that with crutches.
Walking Boot vs Pneumatic Leg Brace
Although these are commonly referred to as the same thing, a leg brace does not absolutely have to have a boot attached. As mentioned earlier, leg braces were not significantly better than no leg braces for military personnel recovering from fractures. [7] That study was done in 2010 and I think the technology has probably come a long ways since then.
However, in my humble opinion, had they used a (one piece) leg brace and boot combination, the result would have improved. I base this on the idea that the muscles that connect the legs to the ankles and feet were not properly supported without the boot.
A Pneumatic Leg Brace for Tibial Stress Fracture – No Boot
This pneumatic leg brace for tibial stress fracture injuries is low bulk, and better than a compression sleeve. This design permits you to wear your own shoes.
It has “shells” that are made with air filled cells that create a pulsing compression when walking. That pulsing action improves blood circulation for faster healing, and reduces water retention and swelling.
So, if a compression sleeve isn’t good enough for your needs, and a pneumatic walking boot is overkill, this is your best choice.
What Is A Cam Walker Boot?
This CAM boot is adjustable by pumping air into it.
CAM stands for Controlled Ankle Movement. This is a boot that was designed to support and heal ankle and foot injuries. In my opinion, it is also essential for healing stress fractures in the leg.
This is the Air Cast brand. One reviewer was a medical professional, and highly recommended this brand.
These are preferable to compression sleeves, because they can be adjusted to your exact needs.
Is Your Stress Fracture Not Healing?
Chances are pretty good that something else in your life is complicating the healing process.
Women who are not having the monthly period (amenorrhea) need to see their doctor. This is because your bone density may be decreasing and leading to osteoporosis. Also, weaker bones from demineralization will lead to a greater chance of a stress fracture.
Both men and women need enough calcium, magnesium and phosphate to have strong healthy bones.
Something most people don’t know, and doctors get wrong, is this: You need more magnesium than calcium, because the magnesium drives the calcium into the bone. Without the magnesium, the calcium ends up in your joints where it is called arthritis.
Plant derived minerals are easily absorbed by the body, because it is bound by the carbon in the plant. It is this natural carbon bonding that ensures that you get all of the nutrition you paid for.
I eat a lot of seaweed (algae) to get all of the trace minerals in addition to the calcium and magnesium.
I don’t expect you to eat like I do, but I do want you to get good nutrition. So, give this product a try.
Have you had your feet checked for proper alignment? As I mentioned earlier, being flat footed is a prime reason for fractures. Also, you don’t need to be flat footed to have other foot related problems. Generally, a good foot orthotic (shoe insert) will make a huge difference in foot alignment and the healing/prevention of fractures.
My Personal Experience With Foot Orthotics
I had tried several foot orthotics, including custom made ones, and didn’t get any relief from heal pain. To be honest, I think the custom orthotics tech that took my foot imprint, didn’t let me put my full weight on the foot as I stepped into the foam.
So, I gave up the search for a few years. Finally, I decided to try the (then new) Dr. Scholl’s Custom Fit Orthotic Inserts. That is what I wear now, because they solved my achy feet, when the others didn’t.
That’s where you go into the store and stand on the foot mapping machine (barefoot). The machine then tells you which insole to buy. I wear the CF130. What a difference that made to my foot comfort.
However, I have to say that the Dr. Scholl’s Custom Fit Orthotic insert is not for everyone. They do not fill the shoe, because they are only 3/4 size. That means that they MIGHT move around in the shoe. I have not had that problem, but if your shoes don’t fit well that might be a problem.
What Is A Tibial Plateau Stress Fracture?
The tibial plateau is the top end of the bone at the knee joint. So, this refers to the location of the stress fracture.
A medial tibial plateau stress fracture would be on the side of the bone that faces the other leg. This type of stress fracture is rather rare. [3]
Most tibial stress fractures occur on the tibial shaft or what is known as the main portion of the bone. [3]
Anterior Tibial Stress Fracture Dreaded Black Line
An anterior tibial stress fracture is simply a stress fracture on the front (anterior) of the tibia bone.
The anterior blackline tibial stress fracture is “dreaded” because it means that the fracture has not healed. The “black line” refers to how the fracture looks on an X-ray. The black line would not be on the X-ray if the bone had properly healed up.
Preventing Stress Fractures
First thing to do is, to make sure your bones are strong. That means getting the minerals needed to grow new bone. Particularly calcium and magnesium. Of course, you should also be taking a multivitamin and mineral supplement to get the other essentials.
A gradual build-up during any exercise routine is needed to permit adequate time for the body to adapt to the new stresses.
As I briefly mentioned earlier, when the body determines that the bones need to be stronger as a result of your new exercise routine, it starts remodeling the bone.
It actually removes bone material and then replaces it with stronger bone material. So, your bone is actually weaker than it was before the remodeling started. Therefore, you can’t quickly jump to a much higher activity level without risking a stress fracture.
When you exercise a muscle, it tightens up which can cause painful “knots” to develop. The solution is to stretch those muscles so that they relax again. This is related to the “toothpick” theory where tight muscles can cause a stress fracture in the tibia bone.
Wearing proper shoes to support the foot. For many people that requires an orthotic foot support to properly align the bones in the feet. If the foot bones are not aligned properly, it stresses the attached muscles. Those same muscles are attached to the lower leg bones, which can cause shin splints or stress fractures.
Shock-absorbing insoles have been used to reduce tibial stress fractures in the military. [1] So, insoles should be standard equipment.
Once again, if you have flat feet, get a shoe insert to correct that. Otherwise you are very likely to get a stress fracture. [5]
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Stress Fracture Recovery
Recovery time for tibial stress fracture will vary quite a bit from person to person.
I’m not an expert on this, but a minor case of shin splints, where just the muscles are involved, it could be three weeks.
Whereas I have read stories where people spent 2 months in a cast, then several weeks in a walking boot, and only then allowed to start exercising again.
Recovery Time Warning
Generally a stress fracture (tibia) recovery time could be 1-4 months. That will depend on how serious the injury is, your age (older people heal slower), and the type of activity you want to return to.
Don’t rush this! There is a real possibility of creating complications that could affect you for the rest of your life. A simple stress fracture will heal, but if you interfere with the healing process, you could have a fully broken bone.
Fixing a fully broken bone could require metal pins and plates. Do you really want to take that chance?
Probably the worst thing you could do is too much activity of the wrong kind. That would be anything that requires weight bearing or that physically strikes or impacts the leg.
Perhaps the second worst thing would be, to do no physical exercise at all (unless that is what your doctor requires).
Talk to you doctor about what you can do to maintain your current level of fitness.
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Source References
[1] Medial tibial stress syndrome.
[3] Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study.
[5] Shin splints–a literature review. P Bates
[6] The periosteum: what is it, where is it, and what mimics it in its absence?
