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Anterior tibial woes
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Hello all,

After looking and finding quite varied information online, I thought I would ask on here whether any members have struggled long term with anterior shin pain, especially after stress fractures.

Background: I am a 31y/o Male, 178cm and 65kg. I started as a runner in my early twenties after very little sport growing up. I had a few good years of just running improved (16:00 5k, 33:45 10k, 74:01 HM), but after a few injuries it was highlighted that I have a 10mm leg length discrepancy and quite flat feet/high ankle mobility. I have typically opted for more supportive running shoes with a 4mm lift under the in sole on the shorter leg

In Spring 2016 I started to notice a dull pain on the outside of my shin bone (shorter leg) whilst running and afterwards. This would only be pinpointed by pressing firmly on the bone, and was not a sharp pain, just tender. It has never been severe and never stopped me running (In fact running quickly is almost painless), but noticeable when walking down stairs. It seemed to get more persistent, and an X-ray highlighted what was believed to be a minor stress fracture. At this point I stopped running for a few months upon recommendation, and mainly focused on steady cycling.

My first attempt to run again was met with a slightly dull pain, so I chose to rest for another few months. After this point I started to run again and seemed to be okay, with only occasional anterior muscle tightness every now and then. A repeat X-Ray in Spring 2017 showed no inflammation on the bone. Since then I have turned down run volume (40k per week max) and moved into Duathlons.

Through the 2018 season I noticed some tightness in the shin area again, both muscular and locally on the bone building up after runs, and on the build up to my final A race (ETU Standard Duathlon AG champs) I was becoming more aware of it. An X-ray after that was a little inconclusive, with some inflammation close to the bone and a general doctors opinion of 'maybe it is stress fractured again'. Given it was my off season, opted to rest for 8 weeks, still maintaining some steady cycling as cross training. After a few weeks rest I started to focus on strengthening calves, along with a general S&C programme for whole body.

I am now 3 weeks into a gentle taper into running again with short walk/run sessions on the treadmill. Over the winter my calf strength and general foot stability has improved greatly, but I have noticed a little muscular tightness on the anterior muscle, though no pain along the bone. I am certainly approaching any pain with elevated levels of caution at this point!

Summary: My goal of this post is to get any experiences that others have had of shin stress fracture rehab, repeat issues and ongoing pain. I am also interested in the general symptoms of shin stress fractures, as those that led to my initial diagnosis were always very mild, making me wonder whether it was correct, or if this symptoms suggest a different issue? Many thanks and apologies for the essay!
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Re: Anterior tibial woes [JayEmmPee] [ In reply to ]
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Hello JayEmmPee,

I can tell you about my stress fracture drama, although mine was next to the right pubic symphysis (hip).
After an 8 year period off high-intensity triathlon training, I started again quite drastically. Two years into my come back (with a few muscle tears along the way), after a few weeks of specific running speed work, I started to feel the dull pain deep in the hip, near the groint, with muscle tightness along the inner leg. It got worst very quickly, and in days I was not able to run as I kept training. Checked with a few physiotherapist (no doctor nor scans...), and they just told me it was nothing very serious, muscle overload, local muscle fatigue, blablabla... After an olympic tri were I merely save the day running 4 min/km with DEEP PAIN, next day I could not walk nor stand in one leg (right). Stopped running for a few weeks, the pain backed off, and I was running again. Another calf strain kept me off running for a few more weeks, but once over that, started training (thought) totally recover. So less than 10 months later since the last triathlon, the inner muscle tightness started again, and this time with no speed worked involved but with a few 20h/week training, the dull pain and the limp came back from one day to the other. Long story short and after a lost of €€ spent in physios, chiropractics, doctors, and massages, a MR scan showed an stress fracture in the right pubic symphysis NEXT to an scar of a similar injury (the one 12 months before never diagnosed).
I am over 40, so 15 weeks with no running, no jumping, very easy seated riding, and regular light leg gym workouts. After the 15 weeks, started with pool running, firstly not touching the bottom, then touching it lightly, and slowly progressing for 5 more weeks. Then, walks-run in soft surface, keeping the gym work, and finally 38 weeks after the diagnosis, I run a 100km/week without any issues.
Now I am injured again, but that is another story...

STRAVA INSTAGRAM
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Re: Anterior tibial woes [JayEmmPee] [ In reply to ]
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I'm curious if you have anterior shin splints and not a stress fracture. I've had shin splints in the exact same area. Hurt so bad I had to hold on to a shopping cart in a store at times. Caused me to limp. Only way I got rid of it was a complete change of shoes and anterior leg massage plus icing.

The bad part about regular X-rays, is they are very difficult to ever pick up a stress fracture. A typical fracture, yes, but a stress fracture, no. For a stress fracture, you usually need an MRI and/or nuclear study for more conclusive evidence.
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Re: Anterior tibial woes [eye3md] [ In reply to ]
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Hi eye3md, thanks that's an interesting point, a few bits I had read on the web seemed to suggest that anterior shin splints would likely lead to a stress fracture, so I kind of associated them. Did your symptoms disappear quite quickly after making changes to footwear/recovery?

I have only dealt with general doctors at diagnosis stage, and in all cases it has been quite obvious that they aren't specialists in the areas of stress fractures. The X-ray in 2016 did appear to highlight a crack in the bone (i will see if I can find the screenshot) but all subsequent images haven't had anything like the same clarity. Equally an MRI in 2017 highlighted no issues. Certainly the symptoms I have had never seemed to align with the pain levels that are described with a full stress fracture, hence the slight confusion!
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Re: Anterior tibial woes [JayEmmPee] [ In reply to ]
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JayEmmPee wrote:
Hi eye3md, thanks that's an interesting point, a few bits I had read on the web seemed to suggest that anterior shin splints would likely lead to a stress fracture, so I kind of associated them. Did your symptoms disappear quite quickly after making changes to footwear/recovery?

I have only dealt with general doctors at diagnosis stage, and in all cases it has been quite obvious that they aren't specialists in the areas of stress fractures. The X-ray in 2016 did appear to highlight a crack in the bone (i will see if I can find the screenshot) but all subsequent images haven't had anything like the same clarity. Equally an MRI in 2017 highlighted no issues. Certainly the symptoms I have had never seemed to align with the pain levels that are described with a full stress fracture, hence the slight confusion!


At the time, I was wearing Asics. Probably no association but I decided to switch just to be safe. Started running in Hoka. Also, constantly iced the painful area. Once I did this, I believe it took about two weeks to go away.
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