Abstract
CLINICAL PRESENTATION & EXAM: A patient with a tibial stress fracture will have pain that gradually builds over time. This pain will be located on the tibia, or shin bone, most commonly in the middle to lower third of the tibia, but could occur anywhere on the bone. This occurs from overloading the tibia which can happen for multiple reasons. The patient could have insufficient muscle supporting the lower leg, incorrect footwear while training, poor biomechanics, or simply just overtraining. This will present itself with tenderness on the bone which will be felt during weight bearing activities. The patient will have pain progressing over time if they continue weight bearing exercises which could lead to a clean fracture of the tibia if it goes untreated. ANATOMY & PATHOLOGY: A tibial stress fracture is an incomplete fracture or fractures of the tibia in the lower leg. A tibial stress fracture most commonly occurs about two to three inches above the inside of the ankle on the medial malleolus of the tibia bone due to compressive forces absorbed in the lower leg during physical activity. This will initially begin with bony stress reactions and transform into stress fractures if stress overload continues. The tibia is the second largest bone in the body and typically only breaks after a traumatic event, such as a car crash. It also supports body weight during activities which is why it is important to identify these fractures before further overloading and damage occurs. DIAGNOSTIC TESTING & CONSIDERATIONS: A tibial stress fracture can be diagnosed through a physical examination. The physician will pinpoint the exact location of the pain and determine whether or not the patient will need an MRI, X-ray, or both. The practitioner can determine the severity of the stress fracture based on the level of pain the patient has during movements or activities. X-rays can be used to determine if the bone has begun to heal which is the only way to confirm there was a stress fracture. Practitioners must also consider if shin splints or medial tibial stress syndrome (MTSS) are present. While similar, they are different because a MTSS will have small tears and inflammation in the muscle, while the tibial stress fracture does not. TREATMENT & RETURN TO ACTIVITY: After a tibial stress fracture is diagnosed, the patient should immediately halt any athletic or strenuous activities involving weight bearing on the affected leg. Wrapping the injured area provides compression which will help pull the muscles closer to the leg allowing less movement of the tibia and reducing pain. Typically, the patient should rest for approximately 8 weeks or until the symptoms subside. Mobility exercises of the ankle may be used to facilitate return to play. However, once a tibial stress fracture has occurred there is a greater susceptibility of reinjury.
Recommended Citation
Tittle, Garrett; Ruot, Chuck; and Spindler, Lindsay
(2025)
"Tibial Stress Fracture,"
International Journal of Exercise Science: Conference Proceedings: Vol. 2:
Iss.
17, Article 172.
Available at:
https://digitalcommons.wku.edu/ijesab/vol2/iss17/172
