i’m still waiting on bone scans and xrays, but the pain presents in a very convincing stress-fracturish way.
here’s the confusing part:
it developed last fall. i self diagnosed and self medicated: i didn’t run a step between Nov 1 and March 1, figuring that would be plenty time for the SF to heal. i strenghtened muscles i discovered to be weak (left plantar Tib was significantly weaker than the right PT muscle).
i resumed running in march, and very slowly built frequency, then volume and recently, intensity.
the pain is coming back.
QUESTION:
is it likely that a stress fracture could “re open” after healing?
is there a soft tissue injury that presents exactly like a SF? the pain is very very localized. it’s tolerable on action, disappears on rest and makes me gasp on palpatation.
I would help, but you failed to mention anywhere in your post where your stress fx is!
Assuming it is the 2nd metatarsal (most common in runners), then yes, 2nd MPJ capsulitis can mimmick this or rarely an intermetatarsal (Morton’s) neuroma
I have had two stress fractures. After 6 weeks off, they healed with no subsequent pain. OTOH, I ramped verrry slowly (20mpw initially, 10% increase each week).
Perhaps you could get an x-ray so that you know for sure.
the pain is localized to a point the breadth of my index finger on the medial anterior of my left tibia, about half way between knee and ankle.
in case i’ve got my anatomical language messed up:
the finger-width spot of pain is found by running my thumb down the in-side of my shin bone. mild pain is found this way. strong pain is found by pressing harder on the specific point - moving the muscle out of the way and feeling as far ‘under’ the tibia as possible.
to be clear - the whole calf muscle is fine. the muscle in question - i believe - is the tibialis posterior as it inserts into the back of the tibia.
I have had stress fractures in both my tibias (overtrain… me?) and it felt the same as what you are describing leading up the actual fracture (where is swelled up and I was limping). For a time by doctor thought I might have compartment syndrome. Occasionally I “feel” something there but have not had another fracture.
what if this isn’t a stress fracture at all? i mean, it presented after running too fast, too far, too soon after a 3 month period of not running.
so i took time off to rest it.
i started running again after 4 months. short slow runs. add frequency. add duration…the injury came back.
is it possible that the tibialis posterior muscle is pulling away from the bone at it’s attachement? to me, that would present a similar sort of pain. source: click here
question is: if that’s the case, how does one heal it? remember: i’ve tried 4 months of rest and the f’er came back.
your kind of in the same case as a close friend of mine. She was experiencing pain on medial anterior of her tibia, a point pain like a stress fracture so she got an MRI. THREE fractures showed up, one in her left leg and two in her right. I guess that’s what doing the trianing and racing the IM Xterra double can do to you. 3 months off, most of it on crutches and in an air cast and she’s finally started cyclind and a little running again. One fracture site feels like it still might be a problem though, basically the same spot you are having problems. She still feels it burning and although the doctor says it should be healed by now it’s really hurting and she’s going to try and go in for another MRI. She took a lot of time off and it’s confusing why she’d still be having problems.
I can help you here having had 7 confirmed stress fractures in my tibia (tibia alone, not including 2 fractures in sacrum and 1 in my femur) between high school and now (i’m 28)
There were many times I have expereinced pain that resembles the pain from a previous stress fracture at the exact location that has turned out to be nothing to worry about. It is hard to rebreak the bone (hard not impossible as I did my sacrum in the same place, but never a tibia fracture) but you have developed bone calus at the spot of fracture that can cause the tendons to stretch differently over the point of injury causing discomfort. I have always found a week or two of ice along with heel lifts and other shin excercises to be very helpful, continue to run through it but baby it with extra attention afterwards.
Also don’t go jabbing your finger on the spot all day along trying to manipulate the pain to feel as it does when excercising. You know you are doing this right now as you reas this post! stop put some ice on it instead.
pete www.runpistol.com
one DNF this week Du Nationals will go better
I’d like to see responses to this too. I currently have stress fractures in my patella from doing IMA. These were confirmed by MRI, a radiologist and orthopedist. The two orthopedists I’ve spoken with said this is so rare they’ve never even seen it (stress fractures to the patella, that is.) I’ve taken a few weeks off from running and riding and just rode twice this week on the trainer for an hour each time. As I sit here my patella aches and I’m totally pissed about it. I’m still swimming but I’d like to at least be able to ride too.
As an aside, I also had VERY similar medial shin pain leading up to an IM a few years ago. It hurt bad just to touch it. I could literally hear it snap when I walked at times. I had an MRI and it wasn’t fractured. Just medial shin splints. I still did the IM, but then took time off and it healed.
Triwiz- have your doctor look at the mri or bone scan again. I had 2 fractures (same time) in the tibial plateau that the first orthopedist diagnosed as in the patella but were later corrected.
My tibal plateau fractures were the easiest ones I went through 8 weeks and they have never caused me problems again
pete www.runpistol.com
triwz - Wow, I’ve never seen a stress fracture of the patella either. Saw 3 runnnig stress fractures today with patients
Ash - you may be correct in describing posterior shin splints. Anterior shin spints are more common though. Lastly, your clue as to “focal” pain tends to point more towards the stress fx. A simple triphasic bone scan will rule the 2 out. An MRI is specific (but no sensitive) for a tibial stress fx and don’t show “shin splints” well. Plain film X-rays only reveal a stress fx once it begins to heal. Most tibial stress fx heal in about 6-12 weeks if you don’t run/pound on them (walkin is fine).
Okay, I’ll reply, although my fracture was probably obtained differently than most here. Two years ago I fractured my shin while kickboxing. Kicked a guy really hard. He didn’t move and it took everything I had to not bust into tears. The pain was unbearable was I went to the ER later that night. Compartment syndorme and stress fracture, or maybe it was hairline fracture. Is there a difference? Anyway, took about two month before it felt good to run. Interesting thing is, my roller blades hit my shin very close to the spot I injured. Last week-end was the first time I have been able to rollerblade since, almost two years later. Good luck in the healing. I think my went fairly quickly, as I have had friends that struggled for extended periods. I used a lot of ice and elevation and tried to stay completely off of it for the first week.
i’m scheduled in for a bone scan next week along with some x-rays.
at the same time we’re pursuing the soft-tissue question - if it isn’t a stress fracture, then what’s going on with the tibialis posterior that’s causing the pain? time will tell; i’ll post up an overview of his differential diagnosis when he’s done along with an overview of my treatment plan.
i’ve been putting in big (for me) volume in the last three weeks, including 4 runs in the last 4 days totalling 5 hours. i’m sitting here with a frozen mickey of vodka (fits the shin nicely) and feeling “some tightness”. if i were to go looking with my fingers i’m sure i’d find some pain.
my wife asks “why would you keep running? just be a cyclist”. we’re very different people sometimes
