This is a condition characterized by an incomplete crack in the shin bone (tibia). During weight-bearing activity (such as running), compressive forces are placed through the tibia. In addition, several muscles attach to the tibia, so that when they contract, a pulling force is exerted on the bone. When these forces are excessive, or too repetitive, and beyond what the bone can withstand, bony damage can gradually occur. This initially results in a bony stress reaction, however, with continued damage may progress to a tibial stress fracture. The condition often occurs following a recent increase in activity or change in training conditions.
Patients with this condition typically experience a gradual onset of localized pain at the inner aspect of the shin bone. The pain is often sharp or acute in nature and typically increases with impact activity and decreases with rest.
Patients with this condition typically experience tenderness on firmly touching the inner aspect of the shin bone. A thorough examination from a physiotherapist may be sufficient to diagnose a tibial stress fracture. Further investigations such as an X-ray, MRI scan and CT scan are usually required to confirm diagnosis and determine the severity of injury.
There are several factors that may contribute to the development of this condition:
- Inappropriate or excessive training
- High arches or flat feet
- Poor biomechanics
- Leg length discrepancies
- Inappropriate footwear
- Muscle weakness/tightness
- Joint stiffness (particularly of the ankle)
Treatment for Tibial Stress Fracture
Physiotherapy treatment for patients with this condition is vital to hasten the healing process, ensure an optimal outcome and decrease the likelihood of injury recurrence. Treatment may comprise:
- Exercise programs to stretch, self treat and improve proprioception, balance and strength
- Biomechanical assessment
- Education / training advise/ phased return to exercise
- Activity modification advice
- Joint mobilisation
- Deep tissue massage/myofascial release
- Dry needling /acupuncture
- Orthotic/insole advice
- Ice or heat treatment