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Tibial Stress FractureInjuries > Lower Leg > Tibial Stress Fracture
(Also known as Stress Fracture of the Tibia, Medial Tibial Stress Fracture)
What is a tibial stress fracture?A tibial stress fracture is a condition characterized by an incomplete crack in the lower leg bone / shin bone (tibia) (figure 1). During weight-bearing activity (such as running), compressive forces are placed through the tibia. In addition, several muscles attach to the tibia, so that when they contract, a pulling force is exerted on the bone. When these forces are excessive, or too repetitive, and beyond what the bone can withstand, bony damage can gradually occur. This initially results in a bony stress reaction, however, with continued damage may progress to a tibial stress fracture. Causes of a tibial stress fractureA stress fracture of the tibia is an overuse injury that typically develops gradually over time due to excessive weight bearing activity such as running, sprinting or jumping. It often occurs following a recent increase in activity or change in training conditions. Signs and symptoms of a tibial stress fracturePatients with this condition typically experience a gradual onset of localized pain to the inner aspect of the shin bone. The pain is often sharp or acute in nature and typically increases with impact activity and decreases with rest. Sometimes, however, pain may occur at rest or even at night. In severe cases, walking may be enough to aggravate symptoms. In patients with this condition, it is typically tender to firmly touch the inner aspect of the shin bone. Occasionally, a tibial stress fracture may present as calf pain rather than shin pain. Diagnosis of a tibial stress fractureA thorough subjective and objective examination from a physiotherapist may be sufficient to diagnose a tibial stress fracture. Further investigations such as an X-ray, bone scan and CT scan are usually required to confirm diagnosis and determine the severity of injury. Treatment for a tibial stress fractureTreatment for a stress fracture of the tibia typically involves an initial period of rest. This may involve a period of non-weight bearing on crutches to protect the fracture and allow healing to occur. This may be for a period of 2 - 6 weeks depending on the severity of the stress fracture. Following this, a gradual increase in weight bearing activity and exercise can usually occur as tolerated, provided symptoms do not increase. This should take place over a period of weeks to months with direction from the treating physiotherapist and will vary depending on the severity of the injury. Patients should also perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. Alternative exercises placing minimal weight bearing forces through the affected bone should be performed to maintain fitness such as swimming, cycling and water running. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced. A review with a podiatrist may be required for the prescription of orthotics and footwear advice, particularly in those patients whose foot posture and lower limb biomechanics have contributed to the development of the condition. Contributing factors to the development of a tibial stress fractureThere are several factors that may contribute to the development of this condition. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include:
Physiotherapy for a tibial stress fracturePhysiotherapy treatment for patients with this condition is vital in to hasten healing, prevent injury recurrence and ensure an optimal outcome. Treatment may comprise:
Other intervention for a tibial stress fractureDespite appropriate physiotherapy management, some patients with this condition do not improve and require other intervention to ensure an optimal outcome. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, bone scan, CT scan or MRI, extended periods of non-weight bearing or immobilization, review with a podiatrist for orthotics or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition. Exercises for a tibial stress fractureThe following exercises are commonly prescribed to patients with a stress fracture of the tibia. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms. Foot and ankle up and downMove your foot and ankle up and down as far as possible and comfortable without pain (figure 2). Repeat 20 times provided there is no increase in symptoms.
Figure 2 – Foot and ankle up and down Foot and ankle in and outMove your foot and ankle in and out as far as possible and comfortable without pain (figure 3). Repeat 20 times provided there is no increase in symptoms.
Figure 3 – Foot and ankle in and out Products for a tibial stress fractureSome of the most commonly recommended products by physiotherapists for patients with this condition include:
To purchase physiotherapy products for a tibial stress fracture visit the PhysioAdvisor Shop. Other ExercisesView calf flexibility exercises. View calf strengthening exercises. View balance exercises. Find a Physio for a tibial stress fractureFind a physiotherapist in your local area who can treat a tibial stress fracture.
Further InformationRead about correct footwear.
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Figure 1 – The tibia |
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