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Sunday, February 1, 2015

Tibial Stress Fracture: General Treatment Thoughts

Tibial Stress Fracture: General Treatment Thoughts

    Stress Fractures are areas on a bone that fatigue with either chronic overuse or an acute load that is more than the bone are tolerate. Stress fractures can develop into complete fractures as demonstrated by the photo above, so diagnosis is important if the demands of the activity allowed in rehabilitation could make the injury worse. So often the athlete is diagnosed with shin splints, and allowed to continue running. In this case, that was a mistake. So when is a shin splint really a stress fracture? Compression of the bone from side to side typically is sore with stress fractures not shin splints. A tuning fork, x rays, bone scan, and MRI are all used to help with the diagnosis. If the pain came on suddenly in an impact sport, the Golden Rule of Foot is that it is a stress fracture until proven otherwise. I am surprised on how many runners say the pain of their stress fracture was never more than a 3 or 4, so a low pain level may not be a good diagnostic tool with this injury. In runners, the tibial stress fractures are typically behind (posterior) the bone, and in ballet dancers the front or anterior aspects.
    The top 10 initial treatments with tibial stress fractures are:
  1. Create a pain free environment emphasizing biking and swimming and weights.
  2. Take x rays if the pain is above 4 at any time
  3. Take x rays if the pain is 4 or below after 3 weeks, if the symptoms are not improving.
  4. If there is a possibility of a stress fracture, do not have the patient run.
  5. As running is allowed, avoid running hard downhills with a passion (up to 5-7 times body weight needs to be handled running down hills).dreamstime_m_10687224.jpg
  6. Ice pack the shin area for 30 minutes 3 times per day to get deep cooling of the tissues.
  7. Make sure you are taking 1500 mg of calcium and 1000 units of Vit D3 (most can be gotten in a healthy diet).
  8. I love emphasizing 1-2 hours per day of cycling if a runner can not run, but you have to build up to this. dreamstime_m_31349919.jpg
  9. If you need to know immediately, like when you are on a sports team, I love bone scans which are hot within 24 hours.
  10. Many patients love calf sleeves to take pressure away from the bone.dreamstime_m_25630091.jpg
Yes, even race horses can get shin pain.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.