Background - my 19yo son started running last year. Developed shin pain in past 2 months or so. Longest single run he has ever done is 15km, longest single training week around 30km.
MRI scan last week is below. His physiotherapist said he needs to stay off his feet as much as possible for probably 4-6 weeks.
Is there anything he should be concerned about other that it just needs time to heal?
Disclaimer: MD here but not a radiologist but have had my fair share of stress fractures and nasty ones at that, including my tibia.
This is an angry sounding MRI and this will take some time to heal. He needs proper review by a qualified sports medicine specialist or orthopaedic surgeon who manages sports injuries. He definitely needs to be off this leg now, he should probably be in a boot and crutches.
Depending on your access to scans you may want to also look at getting a CT scan done as that can define and see any stress fractures more readily than an MRI (its complex and the radiologists in this forum will hassle me for my subpar description of things!).
I had similar findings which progressed to the point I almost needed a tibial nail. It is really important that he gets off that leg, immobilises it in a boot (the boot will slow him down dramatically which is one reason why my doc recommends them).
He is likely pretty sore with that periosteal and bone marrow oedema, I imagine his tibia has a discrete sore spot but he has some diffuse aching in that leg as well.
Good luck, if you can keep the thread updated that would be appreciated.
https://radiopaedia.org/articles/mri-grading-systems-for-bone-stress-injuries
This is a simple link to the grading systems used showing your son has the worst classification unfortunately (which indicates it is likely fractured).
You can see further down that you are looking at 16 weeks + for return to activity, which sounds rough but these are nasty and that MRI does sound really angry.
Get proper medical help ASAP!!
Yeah. That’s a pretty bad stress reaction that’s developed into a hairline fracture.
As Amnesia mentioned – refer to full sports ortho. Also likely want to have calcium / vitamin D levels checked, and you’re most likely looking at some type of supplementation for that.
Recovery time is going to be lengthy, and then a very gradual return to sport protocol.
thanks for the replies so far.
His physio recommended a boot so will look into that further.
He is not in any pain at all, only when he runs. He actually rode 50km a couple of days ago with no pain.
So it a bit perplexing that it’s such a serious stress fracture and he’s not in any pain at all.
Will seek some more specific medical advice.
That’s how stress fracture pain works, it’s often only noticeable under stress. You need to encourage him to stay off it. If it doesn’t heal he’s looking at a lifetime of never running, so compared to that what’s 16 weeks?
Yep. I had a very mild (medial tibial) stress fracture back in April while training for an ultra (grade 1).
Like your son, I had zero pain during normal daily life, and zero pain while running. I only had what felt like a bruise on the front of my shin that was sore AFTER running. None of the basic diagnostic tests showed any indications of a stress fracture (hop test, etc). Only the mri revealed it.
Even at grade 1, it took 10 weeks of zero running before I couldn’t find that spot anymore…and, I’m just now back to 30mpw (I was at 80mpw before the diagnosis).
Granted I’m 56, so healing rates may be completely different.
Hello, I am a radiologist. Not much to add what has already been said, except for a paragraph on how stress fractures most commonly develop in runners.
Great descriptions above of the extrinsic/intrinsic factors causing the development of the stress reaction. Takes time to cross over into running at any age but especially when you have power, speed and enthusiasm.
I’d like to add a little on the mechanics of the bone stress.
The bone stress is likely to come from tibialis posterior and soleus muscles pulling on the medial(inner) and posterior (rear) sides of the tibia causing a Tensile force on those borders when landing, which is to a much greater degree during running than walking. He therefore probably doesn’t feel it much day to day walking around as the forces through the bone overall are more of a compressive nature, with only mild tensile stress.
Furthermore, on the bike there is minimal compressive or tensile forces as the saddle and handlebars take most of the weight, which is why he gets no reaction there.
Without getting too specific. Treatment based on your description of his having no pain except when running, and taking into account the radiological findings would be:
I’d agree with those above about having an ortho or sports medicine specialist look at him stationary and moving and coming up with a proper plan. Stiff feet/ankles, varus/valgus alignments all play a roll.
Lastly, this is the internet. Good answers if you know where and how to look but doesn’t beat good eyes on for specific advice.
UPDATE
My son saw a sports doctor a few days ago.
Low/non impact exercise is OK (seated low intensity cycling).
Doc recommended he NOT wear a boot at this stage, as low impact movement will increase the blood flow around the injury and assist recovery.
Will get another MRI in 4-5 weeks and follow up from there.
Son also reminded me that he’s a lot younger than me and probably (almost definitely) recovers from injuries a lot quicker than I would.
But he definitely knows no running until given the all clear.
FYI, there’s a new thread with a link to a podcast about triathletes dealing with stress fractures. May be of interest to you and son.
