Abstract
CLINICAL PRESENTATION & EXAM: Patients present pain and tenderness at a specific point on the leg that progresses in severity over a period of weeks to months. Most tibial stress fractures occur in the middle to lower one-third of the bone on the posterior-medial side, where compressive forces are the greatest. Pain may also be felt in the anterior region of the bone, which is under constant stress due to the activation of the gastrocnemius and soleus muscles. The pain is associated with an increase in impact activities such as running or jumping. Fractures tend to arise 8 to 12 weeks following the initiation of activity. ANATOMY & PATHOLOGY: The tibia, also known as the shin bone, runs from the tibiofemoral joint to the tibiotalar joint. The tibia is an important insertion point for the sartorius, gracilis, rectus femoris, semimembranosus, semitendinosus, and popliteus muscles. It is also the origin point for the tibialis anterior, extensor digitorum longus, soleus, tibialis posterior, and flexor digitorum longus muscles. The tibia plays a major role in the stabilization and support of body weight in stationary and dynamic movements, which makes it susceptible to the pathologies of a stress fracture. The repetitive action of submaximal loading disrupts osteocyte production, causing microdamage and apoptosis. If the bone cavity is unable to be fully recovered before a continuous cycle of submaximal loading occurs, the microcracks can progress to microfractures and then further into true fractures. DIAGNOSTIC TESTING & CONSIDERATIONS: The initial testing of a tibial stress fracture (TSF) can be conducted through five primary tests. These include the tibial fulcrum test, focal tenderness to palpation, the heel percussion test, the therapeutic ultrasound test, and the 128-Hz tuning fork test. The presence of pain in specific regions of the tibia is the primary symptom in the evaluation. To assess the accuracy of clinical testing, a Magnetic Resonance Imaging (MRI) can be obtained to optimize early injury management. This may prevent further damage from occurring through continued training and weight bearing. TREATMENT & RETURN TO ACTIVITY: Anti-inflammatory medication may reduce pain. Ice or a cold compress should be applied for up to 15 minutes every 2 to 3 hours, after activities that exacerbate symptoms. Orthopedic surgery and rehab are rarely needed. Before returning to play, the subject should go under a benchmark of 1 mile of walking without persistent symptoms. Intensity should be a gradual increase with a focus on biomechanics. Imaging is sometimes needed, especially for high-risk tibial stress fractures, to confirm healing. Lower extremity strength should be within 75-85% of the uninjured side.
Recommended Citation
Camacho, Jeremiah A.; Lewis, Ethan; Spindler, Lindsay; and Ruot, Chuck
(2026)
"A Clinical Teaching of Tibial Stress Fractures,"
International Journal of Exercise Science: Conference Proceedings: Vol. 2:
Iss.
18, Article 195.
Available at:
https://digitalcommons.wku.edu/ijesab/vol2/iss18/195