I obviously don't know the specifics of your situation and I'm not a doctor but unfortunately I had something similar but in my fibula. Didn't initially show up on the x-ray and about 3 weeks later (and no running) it did show up. As I understand it, stress fractures that don't initially show up on an x-ray can sometimes appear on subsequent ones when they start healing.

For me, I was 10 weeks in a walking boot with no running. But it took me almost a month between noticing a pain in my fibula and doing something about it so it was a pretty bad stress fracture.

Same here about not being a medical professional. But I do know that stress fractures commonly do not show up on Xrays. The sports medicine doctor should be able to order an MRI if he thinks it is fractured. This happened to me after a bad bike accident. My elbow (radial) break clearly showed up in the Xray but I kept feeling significant pain in my wrist. MRI revealed a fracture on one of my tiny wrist bones. My wrist hurt more than the bigger break on my elbow.

MRI can reveal the stress fractures but sometimes they don't show even if they exist. The sports medicine doctor will also be able to put pressure on different parts to narrow where the injury may be. Either way, it's smarter not to run until you can figure out what's happening. Even if it is less serious, the rest will help you heal.

If there's ANY suspicion that it's a SF and you've never had one to know what it feels like, STOP RUNNING until you know for sure.

Trust me.



My undiagnosed SF turned into a real fracture at mile 19 of Boston. Not the most enjoyable closing 10k I've ever run :)

---

Eliot
blog thing - strava thing

Your unwillingness to capitalize the first word of sentences aside, from experience, I concur with what others said, diagnosed or not, this will only go away with rest. Please don't risk an actual fracture. Good luck.

That does not really sound that typical of a stress fracture to be honest (coming from someone who has had three....!).
There is not enough information to get a full picture-where in the shin is it located? (How high up and in the middle, outer or inner side) What sort of milage were you doing? Is it sore when you first run or OK and just gets worse as you go along?
Going straight to a plain x-ray is not normally the first imaging test if they are really worried about a fracture. An MRI or bone scan is better placed to detect it if they are really worried, did you see someone with any sports medical/sports injury experience as doing this test first would suggest they might have not quite known what they were doing.
FYI: medical doctor, not an orthopaedic surgeon or sports doctor though

I have had two stress fractures, and I was told (after the fact of course) that an x-ray won't show a stress fracture until it starts healing. An MRI will, so I'd try to get one of those. I had to sit in the doctors office and refuse to leave until I got one written up. "Wow! It lit up like a Christmas tree!" was the response when looking at the MRI results. Don't risk it, it ruined a season for me.

Thanks for all the advice.

I went to my GP
They suggested XRay

I’ll push for MRI. I’m not scheduled to see Sports Med person until 7/16. I’m not planning to do any running until then to be safe. I’m not trying to do anything else stupid.

Thanks all!

---

Merge Multisport Founder & Head Coach
USAT Level 2 - Short & Long Course
Ironman Certified
Brevard, NC

Unfortunately GPs may not be the best for a sports related injury like this. Have you have shin splints (medial tibial stress syndrome) before? Where in your tibia is it located? Does it go away with simple pain relief (anti-inflammatories)? Can you hop on the affected side easily without pain?

You may not have to rest it completely until your sports med appointment, I would be really surprised if it is a stress fracture as opposed to a stress injury, from what you have said so far your symptoms just don't seem severe enough that it would be at the fractured end of the spectrum.

A sports med doctor and a decent physiotherapist will likely be what you need. A physio can help in the interim before the sports doc appointment as well.

I can’t tell you the last time I had shin splints. Maybe 9-10 years ago. I would say I notice it on the middle third of the medial side of my shin.

I actually haven’t tried taking any meds bc I hate having to. Maybe I should?

I can hop on it ok. Yesterday I went to the local soccer field and VERY gently jogged the short sides and walked the long. I have maybe 4x20 seconds of light jogging. It didn’t bother me during but I definitely noticed it as uncomfortable later yesterday. It’s very mild this morning.

I’ll try to see if I can find a physiotherapist in the area to go see. Thanks for the thought!

---

Merge Multisport Founder & Head Coach
USAT Level 2 - Short & Long Course
Ironman Certified
Brevard, NC

I bent my knees backwards far enough once for my patella to break my tibia on the very top of it.

Two sets of xrays showed nothing, knee specialist thought it was an ACL tear (based on mechanism of injury). MRI showed the top of my tibia, which he said looked like the shell of a hard boiled egg smashed into a table.

So yeah, you can fracture your tibia and it not show up on X-ray. You could also have a muscular issue in your shins too. The front compartment of muscles on the shin can get really irritated and feel like shin splints.

Even the medial side?

---

Merge Multisport Founder & Head Coach
USAT Level 2 - Short & Long Course
Ironman Certified
Brevard, NC

These are always tough as posterior tibialis stress is often part and parcel to stress fractures of the medial tibia shaft. The pain you are feeling is not from a stress fracture (if it exists) it is likely from the soft tissue attachment to the bone in that area or the muscle itself.

Regardless, get a differential diagnosis and consider load dynamics on this muscle and its association with pronation and some compensated foot types. Lots of other stuff to consider.

Could be a one-off due to excessive ramp, but you may have some compromise there that you will want to address in conjunction with rehab so it is less likely to happen again.

Good luck!

You shouldn't need an MRI, a bone scan and/or CT scan should show it (often done together).

At least here in Canada it is -much- easier to get in for a bone scan, like a matter of a few weeks, whereas a wait for our 'free' MRI can be several months. So I'm assuming it would be easier and/or cheaper in the US too.

stretch your calves. Sounds like medial tibial stress syndrome

---

maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

Roger that. You know, the past few months I’ve been working on my stride rate as well...which has definitely put me more towards mid foot. That combined with mileage build too quickly could have a lot to do with it

---

Merge Multisport Founder & Head Coach
USAT Level 2 - Short & Long Course
Ironman Certified
Brevard, NC

(I'm a sports physio)
You won't see a stress reaction appear on XR in the tibia until about 3 weeks after onset of symptoms.

Hopping is a good quick dirty test. If you can't hop without pain, don't run

MRI avoids the significant and unnecessary radiation exposure of bone scan +/- CT, and also shows more detail.

Get a bone scan. It will show if it is fractured.

---

http://www.savagesentiments.blogspot.com/
http://www.tricoachmartin.com/
https://www.facebook.com/teameverymanjack

For symtomatic bone stress reactions, your scan does not change the strategy. You better back off the aggrevating activity until it settles. I'm no big fan of letting pain guide you (for most MSK injuries painful rehab works just as good as painfree is not better) but for bone stress reactions you better back of and progress with what your pain allows, otherwise it will take forever. It sucks to drastically reduce activity levels but it will allow the stress reaction to settle much quicker.

Getting a scan is a waste of time and doctor resources. If you need any help, see a good physio (one that doesnt do a ton of passive stuff to you or sells you dysfunctions, but instead understands the patho-physiology if your complaint). The scan can show plenty of stuff which might even be unrelated. Maybe you have equal amounts of stress reactions in both of your tibias but only symtoms in one...

---

Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede

A bone scan will show increased activity but does not differentiate between stress reaction and stress fracture

Sports med doc here. I’m posting this not as a medical recommendation for anyone in particular or as medical advice. I’m posting just as a reference from a sports med doctor and triathlete as stress fractures are common in our community.

Like many have said stress fractures often don’t show up on plain radiographs. If a stress fracture has been going on for awhile it can progress to the point you can see a clear fracture on X-ray but most of the time people end up in clinic prior to that because of the pain. What you can often see on plain films is evidence of healing sometimes. Typically this takes 3 weeks or so to be evident. Sometimes you see periosteal reaction where there is a hazy shadow in the region of the bone that is a sign of healing. You can sometimes see more sclerosis or whitening of the bone when new bone is being laid down.

X-rays are not very sensitive for stress fracture however. Meaning they can’t rule it out - probably 50% of stress fractures don’t appear on plain films. So they are a helpful test to do because we can get the same day and they are relatively inexpensive. Also if I try to get an insurance company to cover the mri they will immediately refuse of an X-ray hasn’t been done. So I always start with xrays when concerned for a stress fracture. If they show a stress fracture they are helpful. If they look normal I discuss options with my patients.

Bone scan can show stress fractures. It used to be the gold standard prior to mri. The advantages are it’s a good test for accurately detecting stress fractures and it’s cheaper than mri. Downsides are it does involve exposing patients to radiation. Bone scans work by giving patients a radionucleotide Iv infusion - typically technetium. So basically you get an iv infusion of radioactive dye that soaks into your bones. The areas where your bones are more metabolic you active light up. Another downside is when you detect an increased area of uptake on the bone scan from a stress fracture it could also be something else. Other things can cause uptake - infection, tumor etc. so depending on the images and clinical scenario you can often have to do more imaging to confirm what it is with ct. which is more radiation.

I typically avoid ordering bone scans due to the radiation.

MRI is really more the gold standard now for diagnosis. It’s accurate in detection and involves no ionizing radiation.(cancer causing radiation). When someone has a stress fracture on mri it shows up as “bony edema” in the region of the stress fracture. Basically the bone lights up from the stress and healing. As it progresses you can start to see fracture lines developing that can’t be seen on plain films.

Whether to get an mri is a discussion I have with my patients. If they have a normal X-ray and I’m suspicious for a stress fracture I discuss we could do an mri for definitive diagnosis - benefit of mri is if it’s normal I won’t shut them down as long. Downside is cost. The other option is to treat them conservatively - basically treat it as a stress fracture and save the cost of the mri. But then they are ina boot for 4 weeks or longer and once pain free it’s a slow return to activity.

Ordering an mri often comes down to the situation and weighing up and down sides. Often if it’s not the height of their season my patients at will just choose to rest and treat it. Most of these situations if it’s not a stress feature it’s likely mtss medial Tibial stress syndrome (shin splints) or another soft tissue cause. It’s important to understand though all of these are overuse injuries. So basically anyone presenting to me with pain like this could benefit from some rest and pt :)

But it’s important to be evaluated and have these discussions with someone who regularly treats stress fractures like a sports doc or orthopedist rather than self treat. Some stress fractures are lower risk for serious problems and some are higher risk if you keep running and make them worse. For instance if one has a stress fracture in the metatarsal of their foot and they keep running on it and it fractures through then they may just need casting or a boot and rest. However some bones and locations of injuries are at high risk for not healing well. If you fracture though your navicular or develop an anterior tibial stress fracture it can result in non union - the bone not healing which can result in permanent pain and disability that sometimes can’t be fixed. A stress fracture of the hip that goes undiagnosed can be a devastating life changing injury. So it’s important to work with someone who regularly treats stress fractures.

When I have someone who is a serious runner with a stress fracture who wants to maintain fitness I have them do water running. They go to their local pool and wear a floatation belt around their midsection then do run workouts in the deep end of the pool without touching the bottom. While boring it can be a good workout and allows the bones to heal without the stress of impact and it helps to minimize fitness loss.

Hope that helps

Hi T Skelton3
I read your post, and figured I could have written the exact same thing, myself. I have had a very similar experience with my tibia. Kinda nice to hear about others who have had similar issues. I don't have a stress fracture, but it is more of a stress reaction. That is, my tibia is sensitive if I touch that one spot, but I can operate just fine. However, when I run, I always ice my tibia afterwards. That seems to put me back together. I saw several doctors and the consensus was just to move forward (I had previously stopped running for 12 wks and had no improvement) and monitor the situation. So, that is how I'm handling it. I am in a build phase for and Ironman right now and I'm getting along just fine. I use lots of ice and run on trails/treadmills whenever possible. It is not getting worse - but it's not improving either. But I can do pretty much everything I want.

Well, I was thinking of the compartment on the outside, but the medial side has muscles that can get sticky and irritated too.