Bone Stress Injuries

Have you ever had lower leg pain that gradually gets worse during exercise and slowly goes away after activity? What about some swelling or redness around a specific area that comes with a sensation of a deep dull ache? If so, you’ve probably heard of a very common condition called shin splints, but it could be something more serious. 

Lower leg and shin pain is a common complaint among runners, athletes, and active adults, but knowing whether you’re dealing with shin splints, a stress reaction, or a stress fracture is essential for proper treatment. Although these conditions are often grouped together, they’re very different types of bone stress injuries with unique symptoms, causes, and recovery timelines. So how do you tell the difference? 

Shin Splints

Shin splints, also known as tibial stress syndrome, are a soft tissue injury caused by overuse activity, such as running, and is stress induced at the periosteum (covering of the bone) caused by pulling of tendons at their attachment to the bone (typically the tibia and less of the fibula).  The pain is also due to inflammation of these muscles and tendons that attach to the leg bones.

Poor biomechanics, flat feet, and longer strides can contribute to shin splints.

Shin splints affect the soft tissue (periosteum, muscles, tendons) without causing changes in the actual bone. This usually causes a more diffuse pain. 

Stress reactions are when there are changes and inflammation in the bone.  The pain is more localized compared to shin splints.

Stress Reaction vs Stress Fracture

Stress injuries occur from overuse (increasing your activity level too quickly)  and are worse with activity, including running, jumping, and possibly walking.  The pain will dissipate with rest and non-weight bearing and will restart with activity.

One might be able to perform more activities or perform activities for longer periods of time with shin splints, and may not even be able to walk without pain with a stress fracture.

How are they diagnosed?

Stress injuries are usually diagnosed by a thorough history and physical exam with your sports medicine physician.  Imaging, such as x-rays, ultrasound, and especially MRIs can help confirm a diagnosis of a stress reaction/fracture.

Treatment

Treatment involves rest, avoiding pain, and possibly a walking boot or crutches. Once pain improves then physical therapy can start to fix muscle imbalances and provide guidance back to sport.

The treatment is generally the same and the goal is to avoid pain.  A walking boot and crutches may be necessary to accomplish this goal.  Stress fractures will take longer to heal than shin splints.

When should you see a doctor?

You should visit a doctor if you notice pain from running or walking for multiple days in a row.  You should see a doctor sooner if your pain is localized/pinpoint to an area of bone.

Preventing Overuse Injuries

“Start low and go slow”.  Increase your activity level gradually over weeks, not days.  Make sure you have at least 1 rest day a week and possibly have rest days in between activity days, especially at the start/beginning of a new activity.

Stay well hydrated, replenish with a well balanced diet, and sleep 8 hours per night.