T Nation

Shin Splints vs. Stress Fractures

Lately, I just started training with a new coach and team and the training has been pretty intense for the whole 3 weeks that I’ve been here so far. In the past I’ve experienced shin splints but in the past the training hasn’t been as intense or as frequent (6 days a week - supposed to be 2 workouts a day).

So about a week after I started training in this new program, my shin splints came back - hardcore. So basically right now, the shin splints are so bad that when I wake up in the morning, even before I get out of bed I can feel the pain right around medial/posterior of my tibia with the most tender area being towards the bottom.

I’ve been using a DARD (tibialis anterior strengthening devise), I’ve been stretching my tibialis anterior and my calves, I bought a new pair of running shoes, and yesterday I went to get acupuncture for the problem. I think it worked to a certain extent because I woke up pain free this morning but as soon as I started my warm-up jog for today’s workout, I could feel them coming back and getting progressively worse.

The only thing I’ve found that works for the pain is ibuprofen.

So my question is, are stress fractures essentially what you get in really severe cases of shin splints? And how can you tell when severe shin splints become stress fractures? I’m guessing that since the ibuprofen helps the problem (temporarily) they haven’t become stress fractures.

And yes, I did do a search for shin splints but everybody’s cases I found in the archives were fixed with new running shoes, a DARD, or massage.

Well, I’m glad to see you’ve done your research concerning this issue and it’s all on the right track. So, with that being said I can only recommend a few things which are based purely on my own experience with shin splints.

  1. The only way you’re going to differentiate splints vs. stress fx’s is an x-ray study. Go to the doc and get them done to rule it out.

  2. I had them pretty hard core a few years ago. What helped me the most was ibuprofen (400mg’s 4x a day with food). A common misconception is that you only take ibuprofen when the pain comes on. It’s NOT a pain reliever, it’s an anti-inflamitory medication. So it needs to be taken consistently with food in order to maintain the proper efficacy for your problem.

  3. Not just massage, but ICE massage worked best for me. Freeze some paper dixie cups about 3/4 full of water. After each workout, and maybe for your case specifically in the morning, take a couple of cups peel some of the paper off the top and really work the ice into the affected areas for at least ten minutes. Deep ice massage is the ultimate analgesic as well as anti-inflamitory, in my opinion.

  4. don’t just purchase new shoes. Go to a running shoe store like “Road Runner” and have the employees put you in the RIGHT shoe. They look at your body size and running gate then find the best shoe for you. For me, since I’m a bigger dude, I need a shoe like the Brooks Beast. Once I got in the RIGHT shoe, my splints were much more managable.

Hope this helps bro, good luck.

B.

Stress fractures are different than shinsplints. They are micro-fractures of the bone. Typically, the pain is localized compared to shinsplints. It’s much sharper, more concentrated in a particular spot, and you’re more likely to only have a stress fracture in one leg. But I would get it looked at by a professional and get an X-ray.

[quote]chrismcl wrote:

So my question is, are stress fractures essentially what you get in really severe cases of shin splints? And how can you tell when severe shin splints become stress fractures? I’m guessing that since the ibuprofen helps the problem (temporarily) they haven’t become stress fractures.

And yes, I did do a search for shin splints but everybody’s cases I found in the archives were fixed with new running shoes, a DARD, or massage. [/quote]

i dealt w/ shin splints from running hills and i was told they are soft tissue inflammation caused by overuse. could be tendonitis, could be muscle swelling which can. lead to fascia seperation. i was told that the lower leg is less able to deal with swelling because everything is much tighter and the fascia surrounding the muscle is inelastic. so any swelling will cause you pain…if the source is muscle swelling. if you don’t allow it to heal those swollen sections will compartmentalize, basically seperate your muscle and always cause problem.

anyway, whatever the reasons, because it’s inflammation heat will make it worse. massage will make it worse. exercise will make it worse. rest ice compression elevation is the way to go.

i dicked aroung with them for 3 weeks: they’d feel better so i’d run again and then they came back worse. finally i bit the bullet, wrapped my shin everyday for a month and didn’t run for 6 weeks and i was rid of it.

shin splints being soft tissue don’t become stress fractures which are cracks in your bone. you could take a coffee mug and tap it gently on the table 100 times and it’ll form visible cracks in the surface. that’s a stress fracture.

the pain you feel from a shin splint will be more general, while a stress fracture you can pinpoint with pressure. just press on your shin and if you hit a point that makes you jump out of your chair, it’s time to think x-ray.

i read an study from the army once that said recruits are most prone to stress fractures @ 5-6 weeks of basic training and again after 13 weeks. from what i remember bone response to stress is to break down its structure so it can rebuild stronger.

this means your bone is first getting thinner before it gets denser. combine this with the fact that novice runners are feeling much stronger after 6 weeks and increasing their work load because of it and you have an injury-prone situation. although their muscles and aerobics are much stronger, and able to handle the increase, their bones are likely weaker than when they started and need some back-off time.

I have no clue how much merit this has, but I came across an interesting article on this topic a few days ago. It made the assertion that the “cause” of most shin splints is due to improper heel-strike/load bearing brought about by poor gait, and that all this could be corrected by training barefoot.

Supposedly, the pain experienced during barefoot training will force you to adopt a more natural (biomechanically efficient) gait to lessen the pain of impact, enhancing gluteal recruitment and shifting your center of gravity towards the mid-foot.

I wish I had the link now, but it went on to talk about how this carries over into the prevention of PFPS due to significantly decreased Q angle (brought about by gluteal strengthening and increased tonus; tonus here being the state of low-level contraction during “rest”)

Running barefoot will NOT cure shin splints. The conditioning that it confers to the feet and lower legs may very well help prevent the problem but it will NOT cure an existing injury- in fact it may very well exascerbate it. The only thing that will truly fix the problem is rest.

As I have said before on here…
SHIN SPLINTS is generic term that can refer to any one of dozens of conditions affecting the lower leg, stress fracture among them. However, pain along the distal posteromedial border of the tibia is usually caused by damage to the deep crural fascia at its attachment to the bone.

What you need to do is rest. STOP taking anti-inflammatory drugs as these do absolutely nothing but eliminate the pain associated with inflammation; they do NOT facilitate healing and may even disrupt it.

If a doctor tells you to take a drug for this, ignore him. It is a mechanical problem that cannot be fixed or even helped by drug administration.

By the way, the DARD will not do anything to help medial shin splints. Keep stretching your calves though.

[quote]belligerent wrote:
Running barefoot will NOT cure shin splints. The conditioning that it confers to the feet and lower legs may very well help prevent the problem but it will NOT cure an existing injury- in fact it may very well exascerbate it. The only thing that will truly fix the problem is rest.

As I have said before on here…
SHIN SPLINTS is generic term that can refer to any one of dozens of conditions affecting the lower leg, stress fracture among them. However, pain along the distal posteromedial border of the tibia is usually caused by damage to the deep crural fascia at its attachment to the bone.

What you need to do is rest. STOP taking anti-inflammatory drugs as these do absolutely nothing but eliminate the pain associated with inflammation; they do NOT facilitate healing and may even disrupt it.

If a doctor tells you to take a drug for this, ignore him. It is a mechanical problem that cannot be fixed or even helped by drug administration. [/quote]

I don’t think I said anything about curing shin splints, I had meant that running barefoot was purported to prevent them. What good is ice and elevation if you are only going to induce the same injury over and over and over? Shin splints, while painful, are only a symptom, not the problem itself.

To cure the problem, you must fix what is causing the splints to begin with, that is, after healing.

Ok, agreed. good post

Hopefully this will give you all the information you need:

Essentially, shin splints are a general term for pain around the shin and ankle often caused by overexertion of muscle. In your particular case, it sounds as if you have tibialis posterior tendinitis due to overuse and the sharpey’s fibers where the muscle and bone attachment occur are being pulled slowly off of the periosteum, which is a highly sensitive area that is richly innervated with nociceptive (pain receiving) nerve endings. This separation accounts for higher levels of swelling as there is more room for an inflammatory process to work, as well as any trauma will generally have an inflammatory process.

How a stress fracture fits into the picture is when the tendinitis turns into a tendinosis (acute --> chronic). As this occurs, a tibial periostitis can occur (inflammation of the periosteum) When this happens, the bone can be broken down. If this occurs during a period when there is no cessation in the activity that caused the pain, then a tibial shaft stress fracture can occur. A stress fracture doesn’t necessarily show up on an X-ray, though.

Stress fx. symptoms (later stage): deep ache during and after exercise, and even after resting the affected area with no weight bearing. Point tenderness will reside along the tibial shaft, a “heel pound” test will be positive (someone hits the bottom of your foot on the heel hard, and a positive is if you hit your therapist because of searing pain). In the military, if a stress fracture is suspected and a negative x-ray occurs, a bone scan is usually performed and the person is in a state on no weight bearing for approximately 3 weeks with a gradual, graded return to weight bearing and exercise.

I hope this helps a little bit. If there are any more questions, feel free to PM me.

James

[quote]the MaxX wrote:
In your particular case, it sounds as if you have tibialis posterior tendinitis due to overuse and the sharpey’s fibers where the muscle and bone attachment occur are being pulled slowly off of the periosteum, which is a highly sensitive area that is richly innervated with nociceptive (pain receiving) nerve endings. [/quote]

Tibialis posterior tendonitis does not cause shin- that is a common misconception even among professionals. If the tendon gets injured it is either in the midfoot region or right behind the malleolus.

[quote]BradTGIF wrote:
I had them pretty hard core a few years ago. What helped me the most was ibuprofen (400mg’s 4x a day with food). A common misconception is that you only take ibuprofen when the pain comes on. It’s NOT a pain reliever, it’s an anti-inflamitory medication. So it needs to be taken consistently with food in order to maintain the proper efficacy for your problem.
[/quote]

Lately I’ve been taking the ibuprofen only before workouts because that is the only time I truly need relief from the pain. And although it isn’t technically a pain-reliever, the pain goes away when I take it. By only taking it intermittently I’m trying to avoid the supposed side-effects of chronic ibuprofen use of dependence (headaches upon cessation) and down-regulation. And I know that taking it during workouts is probably the worst time to take it because that way I can’t really feel if something I’m doing is aggrivating the problem. However, until I can get a true fix, the temporary (ibuprofen) will have to do.

[quote] BradTGIF wrote:
don’t just purchase new shoes. Go to a running shoe store like “Road Runner” and have the employees put you in the RIGHT shoe. They look at your body size and running gate then find the best shoe for you. For me, since I’m a bigger dude, I need a shoe like the Brooks Beast. Once I got in the RIGHT shoe, my splints were much more managable. [/quote]

I did do this. In the past I’ve always been a cheap bastard when it comes to shoes and I’ll just pretty much go to a store and buy whatever name-brand sneakers are on sale and as long as they fit me. This time I went to a running store and had them look at my gait, etc, tried on a few pairs. However, the new shoes didn’t do anything as far as making the pain more manageable.

[quote] Trogdor wrote:
I have no clue how much merit this has, but I came across an interesting article on this topic a few days ago. It made the assertion that the “cause” of most shin splints is due to improper heel-strike/load bearing brought about by poor gait, and that all this could be corrected by training barefoot.
[/quote]

This makes the most sense to me. However, as another poster mentioned, doing this sort of training after something like shin splints has become an issue will make it worse. But if I were able to start from scratch and gradually build up everything over a few weeks, this would be the most fundamentally sound way to go. However, hindsight is 20/20.

Thanks for everybody else’s input - everything was helpful even if I didn’t respond to it directly.

A little update about whats going on now. I bought a pair of semi-custom orthotics. The store I got them from had a force-plate device that measured the compressive forces at every point on the bottom of your foot. The whole orthotic thing makes sense to me as well for somebody in my situation with pre-existing conditions simply because of how it realigns the arch of your foot and thus changes the way force travels up your leg. Again, as I mentioned, starting from ground zero I’d probably try the barefoot running thing, but in my situation its more like putting a cast on a broken arm so it can heal.

You need rest man. I know it sucks but it’s best.

In the future, follow the 10% rule. Only increase mileage and/or intensity by 10% per week.

What shoes are you wearing (Brand and Model)? Do you over pronate? What is your weekly mileage? Age? Weight?

Try bouncing on one leg. If you have a stress fracture, there will be an intense pain in the spot.

In order to tell if there is indeed a stress fracture. You have to get a bone scan. X-ray won’t do the job unless the stress fractures were huge. If that were true you wouldn?t be walking without massive pain.

Does the pain occur more in the soft tissue or the bone itself?

I had a lot of trouble like you. At one time I thought I could work through the pain and kept training. The pain got so bad. I couldn’t even sleep at night without ibuprofen. I had to give up running for two week and them start again very slowly. I was convinced I had a stress fracture and went in for a bone scan. The doctor told me there was no stress fracture but he could see a lot of stress reaction in the tibs. It?s probably the same thing you have going on. My suggestion…take at least 2 weeks off of running and see what happens. Regardless of what it is, the remedy is the same…rest.

I used to run a lot and had trouble with shin splints on occasion. Here are a couple things that really helped (on of them is extremely strange, but keep an open mind!)

  1. Are you taking a high quality fish oil? Start. Its anti inflammatory effects will help you heal quicker from your shin splints.

  2. Never, ever run on concrete. In fact, if at all possible, run only on dirt or sand. Black top if that’s all you can find. But concrete is simply too hard, period, for large framed runners, and even quite light people can do their body a lot of damage with the impact.

  3. This is the wierd one (you can try it for yourself and immediately see what a difference it makes): when you run concentrate on the following things (practice them religiously!) (1.) relax, head up, don’t clench your fists, your face should feel soft and loose as you run, (2.) if you land thunderously down on your heels or the balls of your feet, stop!!!, work on landing on the mid-foot and turning over your gait more quickly, not long slow strides, but quick, short ones (3.) this is the most important and the strangest: when you go out tomorrow for your run, hold your pelvis in an slightly pushed forward fashion (so if you look down, you can easily see your genitals). Yes, you look strange doing so, but if you have doubts about it take a look at the strides of elite runners. Anyway, just try it; you’ll be shocked at how much pain disappears at once.

Good luck on your recovery.

I have suffered from shin-splints for many years also. I recently went to a podiatrist(sp?) for pain in my foot and I brought up my shin-splints. He told me a few things.

  1. The bone structure in feet are supposed to support the weight of your body. (I have flat feet, therefor, my bone structure is not properly supporting my bodyweight.)

  2. If your bones in your feet are not supporting your body weight the weight will be supported by your lower legs and back.

  3. When I first noticed shin-splints I was around 165lbs and the pain was mild. As I have gotten older and heavier, 200lbs, they have gotten much worse. Obviously more weight on your body would mean more weight for your feet to support resulting in more stress to the shin and back.

  4. He took a mold of my foot and made some inserts for me to wear in my shoes. I have been wearing them for about a month now and everything seems to be going fine. I haven’t run a country mile or anything but I feel like I have more support and less back and shin pain.

Just my .02. Good luck.