Written by Nic Bartolotta
Nic Bartolotta is a physical therapist and holistic health practitioner. He holds a Master of Physical Therapy (MPT) degree from Cal State University - Long Beach and has worked with hundreds of professional athletes from the MLB, NFL, NBA, and NHL. Nic is known for his expertise in injury prevention, rehabilitation, and sports performance enhancement. He specializes in myofascial release techniques to address soft tissue restrictions. He is also the Chief Clinical Officer of Rolflex.
A tibial stress fracture is one of the most common running injuries — the repetitive impact on hard surfaces, combined with increases in pace and mileage, can place excess stress on the shin bone and lead to a fracture. And once it develops, this condition can sideline you for anywhere from 6 weeks to 6 months.
To avoid lengthening that time, it’s important to identify the symptoms early and take the proper time to heal. From foam rolling to re-examining your nutrition to picking out a different pair of running shoes, be reassured there are changes you can make that will help you assist in your own recovery and avoid future occurrences. Let this be your ultimate guide to navigating stress fractures.
What Is a Stress Fracture?
A stress fracture is a crack in the bone caused by repetitive stress, specifically when overused muscles are unable to absorb the shock. As a result, the load is transferred to the bone which fractures under stress. Stress fractures can occur in any weight-bearing bone in the human body but are most common in the foot, shin, and femoral bones.
How Does Running Cause Stress Fractures?
Although it varies between individuals, stress fractures can occur within a few weeks of sudden increases in mileage, speed, or pace. This is especially the case in runners who are in their first year of training. Even though their muscles and cardiovascular system adjust to the higher workload within a week or two, their bones take longer. In fact, they actually weaken before getting stronger, a process that takes several months.
The repetitive stress from hard, uneven surfaces on the tibia makes runners more susceptible to stress fractures than most athletes. And compared to bone injuries in the foot, pelvis, and femur, tibial fractures are low-risk stress fractures. Nonetheless, they’re serious injuries that must be carefully diagnosed.
Symptoms of a Tibial Stress Fracture
It’s important to treat stress fractures as early as possible. An early diagnosis may indicate just a “stress reaction,” which is similar to a bone bruise. But left untreated, a stress reaction could eventually worsen to become a stress fracture. If you have one or more of these symptoms, visit your doctor for an official diagnosis:
- Swelling in your leg
- Deep pain that appears out of nowhere and only worsens with use
- Constant soreness, even when you’re not running
- Aching or burning at a specific, isolated location on the bone
- Discomfort when you press directly against the bone
- Pain when you land while performing a hop test (jump 3 to 5 inches off the ground)
Tibial Stress Fracture Treatment and Recovery
As an athlete, taking time off is the last thing you want to do. But most stress fractures take at least 6 to 8 weeks to heal completely. First, your doctor will likely use a bone scan or MRI to determine the exact location and severity of the stress fracture. Then they’ll determine whether you need a boot, crutches, physiotherapy, or another treatment. Here are three things you can do to assist your recovery.
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Rest your legs. If you resume running before your fracture heals fully, you’ll risk a complete tibial fracture, which could put you on crutches and in a boot for upwards of 6 months. To heal properly, you need to avoid any unnecessary load on your shin. This means no running, jumping, or lower-body strength training. Take the recommended time off to prevent further damaging the bone.
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Foam roll. Tibial stress fractures are often exacerbated by tight calves. So at least once per day, give yourself a deep tissue calf massage to release muscle tension and alleviate pain near the fracture. However, don’t massage the bone, which would cause a sharp pain and delay the healing process.
- Cross-train. While you’re taking time off from running, you can maintain your cardiovascular endurance and muscle mass by cross-training with an exercise bike, swimming, and or aqua-jogging.
How to Prevent Stress Fractures
Some individuals are genetically predisposed to developing stress fractures. For example, biological females are at a greater risk for stress fractures compared to biological males as a result of factors like irregular menstruation, low energy availability, decreased bone mineral density, inadequate estrogen production, menopause, birth control, and wider hip structures.
But the good news is, there are some things you can control when it comes to preventing stress fractures. Let’s take a look at a handful of the actions you can take.
Adjust your training program and weekly mileage
If you’re training for a marathon or half marathon, increase your mileage gradually, by only 10% each week, to prevent stress fractures and other overuse injuries. Take 1 to 2 days off per week, and schedule a down week once per month, reducing your mileage by 40% to 60% for the entire week. Down weeks help your bones rest and recover from the repetitive stress.
Change running surfaces
This will strengthen the muscles around your tibia and reduce the repetitive force on your bones. Add hills, trails, treadmills, and sand into your program to strengthen your lower leg muscles and reduce the likelihood of future stress fractures.
Incorporate strength exercises into your training program
Stronger muscles protect your bones from stress fractures. They’ll also help you improve your mileage, pace, and recovery times. The calf is the largest of these muscles and can be trained with calf raise variations, a jump rope, and single-leg jumping exercises. Train the rest of your lower body with exercises that target the glutes, hamstrings, quadriceps, and hips.
Make time to warm up, cool down, and recover
Neglecting to warm up before running or forgetting to stretch or cool down afterward places you at a greater risk of injury. Stimulate blood flow and release muscle tension before easing your way into a training pace. And once you’re done, foam roll your lower body to break down scar tissue, drink plenty of water, and consume nutritious food to support your recovery.
Fix your running form
Poor form and postural abnormalities are common causes of stress fractures and other running injuries. Overstriding or a hard heel strike can increase the likelihood of tibial fractures, hip injuries, and upper leg/femoral fractures. Shorter strides, which force your entire body’s weight onto the forefoot, can also result in a stress-related fracture or patellar tendonitis. Your running shoes can even cause stress fractures. Choose a shoe that hugs your foot, has ample cushioning, and a near-flat arch for adequate support.
Upgrade your nutrition
Your diet plays a critical role in athletic performance. Ensure you’re getting enough calcium and vitamin D, both of which are necessary for strong bones. If you don’t get much sunlight on a daily basis or consume only a plant-based diet, you may want to take supplements for both calcium and vitamin D. Also, double-check how much coffee or other caffeinated beverages you drink in a day. Excessive caffeine intake puts individuals at a greater risk of bone fractures since it draws calcium directly out of the bones. Excess sodium can also cause you to lose calcium through your urine and sweat.
Stress fractures from running aren’t fun, and neither is the recovery. But if you focus on resting for 6 to 8 weeks (or the length of time your doctor recommends), strengthening your muscles, improving your mobility, and treating your body right, you’ll be well on your way to a healthier future.