Sports Medicine: Tibial Stress Fracture

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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


  • 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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