I am a 25-year-old sports nut. I am recovering from a shin stress fracture and after about 8-10 weeks of recovery, I began running, lightly at first then I ran at about 75%. During that quick speed increase I felt a slight pain in my shin and it was sore the next day. Could I have reopened the fracture or could it just be soreness because I began running after a long break?
Mr Roger Hackney, Consultant Orthopaedic Surgeon:
Firstly, are you sure you had a stress fracture? Other causes of shin pain include compartment syndrome and medial tibial periostitis.
Compartment syndrome is caused by a build up of blood in a tight muscle compartment during exercise. Pain comes on after 15 minutes of exercise then settles quickly on stopping exercise. Pain can be in the front of the shin, anterior compartment, or back, posterior compartment syndrome. The condition is treated by simple surgery.
Medial tibial periostitis is felt along the inner border of the shin bone. This also comes on with exercise, but does not settle quickly on resting. This is often associated with over-pronation. Over-pronation is when the arch flattens, collapses, and soft tissues stretch. This causes the joint surfaces to function at unnatural angles to each other. When this happens, joints that should be stable now become very loose and flexible. This can be managed by specialist physiotherapy to improve running style, often with core stability exercises and orthotic support in footwear.
Stress fractures are characterised by pain which gets worse with weight bearing exercise, and pain at rest after exercise. They are the bony equivalent of bending a paper clip until it breaks. Fortunately pain usually prevents runners progressing to that state, but this is exactly what happens with the footballer’s dreaded metatarsal fracture.
An X-ray should show if the fracture has not healed, and if so, then, stop running. You may even be asked to go non-weight bearing on crutches. You can exercise by swimming or cycling to maintain fitness.