Sports Medicine: Tibial Stress Fracture

The tibia (shin bone) is the larger, and major weight bearing bone, of the two lower leg bones. A tibial stress fracture is a complete or incomplete break that develops over time, usually as a result of repeated activity. It can occur anywhere within the tibia, but it is most common in the middle to lower one third of the bone.

Signs and Symptoms

• pain and tenderness in just one specific area of the leg
• worsening pain that develops over a period of weeks to months
• pain increases with impact activity (running or jumping)

Increased Risk

• sudden increase in the length, intensity or frequency of physical activity
• extreme training with limited rest periods
• those who participate in high intensity training (military recruits, distance runners)
• previous stress fracture
• poor physical conditioning, including poor flexibility and weak calf muscles
• running on hard surfaces
• flat feet or high arches
• improper footwear or poor shock-absorbing capacity or worn-out equipment
• bone health issues or bony defects (including osteoporosis, tumors, cysts)
• metabolic disorders, hormone problems and nutritional disorders (anorexia, bulimia)
• loss or irregular menstrual periods in females

Treatment

• Medicine
  
  • Anti-inflammatory medicines, such as ibuprofen (Motrin® or Advil®) or naproxen (Aleve®) may be recommended. Take these as directed by your health care provider.
  • Other minor pain relivers, such as acetaminophen (Tylenol®), may be used.
• Use Cold
  
  • Cold should be applied for 10 to 15 minutes every 2 to 3 hours and after any activity that makes symptoms worse. Use ice packs or an ice massage.
• Orthopedic Aids  
  • A boot, cast, brace or crutches may be used to protect the bones while healing.
• Rehab
  • After a period of rest, rehab may be needed. This will help with flexibility and strength.
• Surgery
  
  • Rarely, surgery may be needed for fractures at a high risk of not healing.

How to Prevent

• Do correct warm-up and stretching before practice or competition.
• Maintain suitable conditioning, leg and ankle flexibility, strength and endurance, and cardiovascular fitness.
• Use proper technique with training and activity. Gradually increase amount and intensity of training and activity. Modify activity level to ensure proper rest.
• Wear proper footwear (for example, change shoes after 300 to 500 miles of running).
• Correct hormonal, metabolic and nutrition disorders.

When to Call the Health Care Provider

Call your health care provider or the Sports Medicine team at 614-355-6000 if:

• symptoms get worse or do not improve in 2 weeks despite treatment
• new, unexplained symptoms develop, or there are side effects with drugs in treatment 

Sports Medicine: Tibial Stress Fracture (PDF)

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