So I got my first tibial stress fracture in 2003 training for my first Ironman. It took me out for 3 months. So then I started running in more supportive shoes, and that slowed down the process a little. But the stress reactions came back. I went to more low impact treadmill running to get off the pavement. Helped a little, but still they would come back. Then I really started to get cautious with building my mileage back up and not running consecutive days. Still they come back. Then I started running on only grass and trails, and I still have problems, but a little less. Now this winter starting my running again I had kept all my runs in the 30-40 minute range, on soft surfaces, with supportive shoes, and for the first two weeks only running for the first workout of the day…but again, I have got another stress reaction. So now I will try and use the TP massage stuff before every run, be even more slow in starting my run volume, and try to only run first thing in the day…any other suggestions, if this doesnt work I am going to be pretty much out of ideas.
Also at the end of each season, and after most of the ironmans I am taking 3-5 weeks off running to repair the damage. Also mid season I would take 5-14 days usually off running to try and heal up each stress reaction…probably been atleast 10-15 occurances of this type of mid season rest training for the 9 IM’s I have attempted.
Try looking at something other than running for the problem?
well…I am now riding a little different of a cycling position. more on the whole saddle, sitting on teh sit bones. It is less of a “mashing” position, and a more roadie type of muscle recruitment…its a big change for me, so it definately could eliminate any type of problem I had developed from previous riding style
After taking those 3-5 weeks off are you ramping your milage up gradually, or starting right back at a mid season or end of season milage?
Have you considered your nutritional intake? Are you getting enough calories? Are you getting good calories? Are you getting enough calcium/minerals? Stress fractures are pretty common in women with eating disorders/who do not get enough calories (I know you are a man 
) but poor nutrition-> poor bone mineralization + stress on bone ->fracture.
Do you drink a lot of soda? It contains phosphorus and may contribute to poor bone mineralization.
Do you lift weights? I know you are a pro and many people/coaches disparage the role of weight lifting for triathlon - but one thing weight lifting does is increase bone density. Swimming and biking do not improve bone density because you are not bearing weight through the bones. Only weightbearing exercise improves bone density (walking, running, weight lifting)
Just some thoughts. Best of luck in finding an answer.
Well, since this has been going on consistenly for 4-5 years all the different eating habits I have went through during those years have been tested against. I have had times of having a 12 pack of coke in the fridge and drinking a little sip before workouts…or I have gone years at a time not drinking any pop. I have eatin really nutrient dense diets, and eatin diets high in calories from white bread, rice, cereal and not many nutrient dense foods (fruits veggies). I have always taken multivitamins during the periods of eating less nutrient dense foods. I remember reading a thread a while back about calcium supplementation post workout, b/c he found he was losing alot in his sweat? Not sure if anyone else has tried this.
When I get the stress reactions mid season I usually eas back in quicker than at the start of a season. Like I said, I usually have about a month or more of no running at all after each Ironman and when the next training season starts I am much more gradual in building miles up than I would be mid season (b/c I know if I make it to the start line of my final race I can smash it and then rest)
No I dont lift weights, I did have a job last year that I was walking around alot and thought that would help with injury resistance being on my feet more and building up some bone density, but did not seem to help.
stress fractures:
diet (crappy diet, but most important the over consumption of protein including, yup, dairy products)
body weight/size (due to simple physics, heavier folks often have more problems than twigs because their bones undergo more force per cross-sectional area)
mileage (the kind of miles necessary for IM are not every body, but people refuse to listen)
rest (how many hours off your feet each day)
anyway, post complete and very detailed info on those 4 things for a month or two during your ramp up of training and, bingo, i bet i can guess what the problem is.
How are your running bio-mechanics? What is your cadence? Are you a heel striker? Do you train in cold environs? Are your shoes warm (as opposed to frozen in the garage) when you start your run? Do you cover your legs when you run in temps < 45F? Do you walk for 5mins to warm up before running? Why do you wear “supportive” shoes? Have you tried “neutral” shoes? Have your tried Newtons? Do you regularly get your tib joints checked by a PT? Do you have narrow hips? Do you pronate? Do you have a good masseur who you see on a consistent basis? Have you tried compression socks? Is there a strength imbalance relative to your calves?
This should give you some more ideas.
I train in all conditions (last year or so has been 50 degrees or warmer (endless summer)), shoes are kept inside, when I was training in sub freezing I was wearing only shorts and extra underwear to keep from dreaded penis frostbite, I usually stretch a bit before workouts and loosen up…but not 5 min walking, I wear NB 991’s b/c they are the only shoe I have had success with…I have tried to go back to cushioned neutral shoes but after evern a 30 minute run I will have a tender spot on my tibia, I can run in supportive flats maybe once a week…but have to be careful, cadence is in the 90 range, I am a heel striker…but the last two weeks I was going to more midfoot strike/pointing toes in/more forward lean/more heel kick…I have sort of wide hips and have problems with SI joint movement and leg length discrepency, I have had my tibia checked by a friend who is a PT back home…she said there is alot of scar tissue, and she has done ASTEM? on it quite a few times to try and clear it up a bit, Yes I pronate…but never been told its excessive…which is weird b/c the really supportive shoes like teh 991’s have worked best for me?, there may be a strength imbalance so I have tried a few different time periods of really strenghting anterior tibialis muscles…no success,
HAVE NOT,
Tried Newtons, compression socks, have a good massuer that I see on a regular basis
WHEW!!!
Tibial Joints…are you talking all the attachment sites for tendons/soleus muscle on the back side of the tibia? This is where the PT did alot of work to break of scar tissue…
Or are talking about the ankle and knee joints?
See a real PT who has a background in biomechanics. Get filmed and work on your form. Train in a neutral “supportive” shoe like Brooks Adrenaline. Try compression socks. Warm up more, especially when cold. Tape handwarmers to your tender spots when really cold. Cover your legs under 40F. Try ice baths post heavy workouts. Stretch more. Work on ankle flexibility. Try note to heel strike as much . . . POSE.
I remember reading a thread a while back about calcium supplementation post workout, b/c he found he was losing alot in his sweat? Not sure if anyone else has tried this.
That was me (and I’m a SHE darnit!). I’m dealing with basically the same thing but in my femoral neck.
Sfx’s in the shin are compression-related (ie pounding). Perhaps the TP stuff will help a bit. It will at least help the supporting muscles be able to help do some stabilizing. But, it really sounds like your bones aren’t taking the pounding.
My issue is that I have celiac disease. I just figured this out in the last couple months. My bones are really weak since I haven’t been absorbing nutrients properly over the last 28 years. I had a DEXA scan earlier this year to check my bone density and then additional tests for celiac, gluten intolerance, genetic predisposition, egg, yeast, and milk sensitivities (www.enterolab.com). I have celiac, the gene for celiac, the gene for gluten intolerance, and a casein (milk protein) intolerance. I’m supplementing with AdvoCal Ultra 500mg 2x/day; vitamin D3 5000 IU 5 days/week; BioSil (Jarrow Formulas) - 6 drops (6mg silicon) 1x/day; glucosamine (3000 mg) + Chondroitin (2400 mg) + MSM (600mg) per day. For workouts over 1 hr, I take powdered Ca with D before and after. I’m also taking a few other things for B-vitamin deficiency.
I’m also on a weight-training program to boost bone density.
I am monitoring bone loss thru a test called an NTX study, which measures broken-down bone protein in urine. I did my baseline test a few months ago, and I will be doing my first follow-up test soon to see how my supplements and dietary changes are altering my bone-loss.
I hope this helps. Feel free to PM me.
PS - I heard you liked the cookies I sent Jonny.
Also I have had my biomechanics tested on the treadmill a couple of times through the Ball State Biomechanics lab, and at a new motion analysis facility that recently opened in Muncie. It was done digitally and with the sensors placed at all the anatomical reference points with six different cameras taking images to give a full 3-d digital image. Nothing out of the ordinary. Also anytime I go into a running shoe store they try and put me in neutral shoes after doing their “gait analysis”…or “do you pronate or not” analysis. But like I said, neutral shoes + me = stress reaction —>stress fracture
will send a PM after I ride…Jonny wants to go NOW!! Thanks for the cookies…I ate some :-).
See a real PT who has a background in biomechanics. Get filmed and work on your form. Train in a neutral “supportive” shoe like Brooks Adrenaline. Try compression socks. Warm up more, especially when cold. Tape handwarmers to your tender spots when really cold. Cover your legs under 40F. Try ice baths post heavy workouts. Stretch more. Work on ankle flexibility. Try note to heel strike as much . . . POSE.
This is not all the greatest advice…ASTYM is a good modality that has had a lot of success for treatment of shin splints/tibial stress. I am sure his friend is not a “fake” PT. All PT’s have a background in biomechanics. It’s what all our school work is based on.
Compression in this case might be a bad idea. Compression to an area of inflammation is a bad bad bad idea. There is no where for inflammation to go in the anterior tibial compartment. This is why some people with shin splints end up with compartment syndrome and have to have a fasciotomy to reduce pressure so that they do not compress the nerves in the compartment. Ice is harmless +might help decrease inflammation.
Applying heat to the painful areas might alleviate pain but it is not going to affect the cause of the problem.
He already said that training in a neutral shoe brings the pain right on. Shin splints are often caused by overpronation. The more supportive shoe is helping him. Zach- is it possible that an even MORE supportive shoe might help? I don’t know NB shoes. Didn’t you also have ITB issues? Also caused by over pronation…maybe a big alignment problem at your foot. If you have such a difference in pain between types of shoes I would try to keep going further down that road. Possibly custom orthotic inserts? Have any podiatrist friends?
Changing your form radically, especially moving to a forefoot or toe first contact such as advocated in POSE can CAUSE additional stress on the tibia, because attachment sites that were not stressed when you were heel striking are being stressed repeatedly now. Be careful about making extreme changes. A little change in form x 1000’s of footsteps is big inside the system of your body.
Above all else…BE CAREFUL ABOUT GETTING ADVICE ON AN INTERNET FORUM!!!
yes, but look at both ends . . . at the knee too. Also make sure your forefoot is not jammed up . . . I think I have heard it said that if a joint is 1mm off it can increase the load/stress by up to 40%. That can be a lot of stress running up the shin . . .
Zach -
I normally love to help around here, but I agree with Nicole here. Since I feel I know you (from your posts, races, times, others over the years here), I won’t offer even one little bit of advice except to start ruling out the very rare entities (like austin79’s celiac sprue or whatever she has). After that, any biomechanical help for an elite level athlete like you would need to be hands on/in person for sure. You seemed to have the basics covered (as would be expected) and I don’t usually post past this.
See a real PT who has a background in biomechanics. Get filmed and work on your form. Train in a neutral “supportive” shoe like Brooks Adrenaline. Try compression socks. Warm up more, especially when cold. Tape handwarmers to your tender spots when really cold. Cover your legs under 40F. Try ice baths post heavy workouts. Stretch more. Work on ankle flexibility. Try note to heel strike as much . . . POSE.
Above all else…BE CAREFUL ABOUT GETTING ADVICE ON AN INTERNET FORUM!!!
Eh (throwing that in for Canadian-effect), it’s not as rare as people think:
http://www.webmd.com/diet/guide/gluten-intolerance-against-grain
“Until fairly recently, celiac disease was considered rare among Americans. In 2003, the results of a large, multi-center study published in the Archives of Internal Medicine found celiac disease in one in 133 Americans. Among those with parents, siblings, or children with celiac disease, up to one in 22 people in the study had it. As many as three million Americans have celiac disease. Most of them don’t know it, largely because celiac disease can be difficult to nail down.”
Yes - taught as rare in MY pathology class (13-14 years ago) and still now AFAIK. Internet research and personal experience often conflict and trump professional school 
Recent research looks to be far more common than thought, but those “numbers” are tough since so many have antigens to many proteins (specific glutens) and thus get classified (via the studies). 2 of my kids friends have celiac sprue (usually diagnosed in kids as you know) of varying degrees, so it is certainly common. I certainly don’t remember any friends/kids with it growing up. Some new environmental link will likely eventually turn up that trigger people with autoimmune issues (usually female 3:1 over men) to this and other AI disorders (sure seeing more of Sjogren’s, RA, Lupus, etc. now as well).
My group does consist of a gastroenterologist who sees very little though since pediatric gastro is becoming more of a mainstream specialty (away from large med centers that is).
I would think it odd to have early osteoporosis/penia without some GI issues preceeding for Zach though. However, as I mentioned, it is a good idea for Zach to have this ruled out (amongst other entities like parathyroid issues). Would need some serious prodding by him to his internist/Rheum/GE with immunoassays, etc. to get a dx though since I think this is a pretty hard dx to nail down I think.
Lastly, on the osteoporosis panels/studies that I’m on, celiac disease still isn’t getting much “attention” with research compared to other issues.