Imagine. You are a distance runner. You have been running for years—perhaps starting as early as elementary school and participating in activities like Girls on the Run. You were on the track and field team and cross country team all throughout middle school. You even went to a Notre Dame cross country camp where you learned about proper nutrition for fueling your body and new workouts to help maximize your speed. You get to high school. It is summer conditioning right before your freshman year. You have put in 300+ miles that summer. Your times are dropping and you are looking forward to securing your spot on the varsity team. Then all of a sudden, it is all over in the blink of an eye. You are diagnosed with a tibial stress fracture in your right leg and the next thing you know, you are hobbling around in a boot and crutches. You are out for the season and in charge of filling up your teammates’ water bottles. For most runners, this is your worst nightmare—being on the sidelines and unable to run for 6-8 weeks. For me, this was my reality. And it happened three times.
WHAT IS A STRESS FRACTURE?
According to the Mayo Clinic, stress fractures are defined as “tiny cracks in a bone…caused by repetitive force, often from overuse—such as repeatedly jumping up and down or running long distances” (Mayo Clinic Staff, 2019). They are widely evident in the lower leg bones like the tibia and fibula as well as in parts of the ankle and the foot. Anyone is susceptible to a stress fracture; however, they are more prominent in high impact athletes like runners and gymnasts, dancers, and military recruits who are undergoing basic training. Stress fractures might also occur in an individual who recently started a new workout regimen and might be doing too much too soon. The initial pain of a stress fracture might be unnoticeable at first but will worsen with time. The pain tends to concentrate to a certain area with noticeable swelling. Pain can be evident when walking and at night when trying to sleep. When this happens, it might be beneficial to make an appointment with your doctor or primary care provider.
SHIN SPLINTS VS. STRESS FRACTURES
Stress fractures may start out by feeling like shin splints. It is important to know the differences between the two different diagnoses in order to be able to identify the signs and different pain levels associated with each. Stress fracture pain tends to be more of a throbbing pain that is concentrated to one area of the bone, whereas shin splint pain is more of a dull pain that radiates throughout the entire affected tibia. Shin splints, also known as medial tibial stress syndrome, occur from inflammation of the muscles, tendons, and bone tissue around the tibia (University Hospitals Staff, 2020). Like stress fractures, shin splints are common in high impact athletes and runners who might have recently intensified their training regimen causing overuse in the associated muscles, tendons, and bone tissue of the tibia. Shin splints often do not require medical attention and are often treated with ice and rest. With any shin pain, it is important not to ignore the pain and keep pushing through and continuing with your running workouts like normal. Instead, perhaps try incorporating strength training and cross training activities like swimming or cycling until pain begins to subside.
STRIKE PATTERN AND FOOT PRONATION
While stress fractures often occur because of overuse, foot biomechanics can also be a contributing factor. Overpronation (the way the foot rolls inward when taking a step) and oversupination (the way the foot rolls outward when taking a step) can cause abnormal tibial torsion resulting in increased stress on the tibia bone. This in turn automatically increases one’s chance of developing shin splints or a stress fracture. Additionally, overpronation and oversupination can alter one’s gait, causing pain in the hips and spine. Therefore, it is important to be mindful of your foot pronation. Certain exercises can help strengthen the muscles that support the arches of your feet. This may lead to a mitigation of overpronation and oversupination and slightly lessen one’s chance of tibial injury. Additionally, strike pattern (how you land on your foot when taking a step) is important to account for when trying to avoid tibial injury. Studies have shown that a midfoot strike pattern is the most efficient and is the most injury-preventative way to run. This is because the heel and the ball of the foot touch the ground simultaneously at each foot strike. Therefore, the lower leg muscles do not have to work as much and less stress is put onto the bones of the lower leg.
Proper footwear, correct running form, and efficient strike patterns are crucial to prevent the onset of any tibial pain associated with running. Having the proper shoe to meet the specific needs of your foot structure is critical. While there is not one running shoe that is perfect for all individuals, some are certainly better than others. For example, if you have flat arches, try a shoe that has more stability and support. If you have high arches, choose a shoe that is supportive and cushiony but also flexible. As a rule of thumb, avid runners should replace their running shoes after every 350-500 miles. However, one of the most important things you can do to help prevent injury is going barefoot! Yes, that’s right. Going barefoot is important for strengthening the muscles, tendons, and ligaments in your feet. Like Sam has addressed in previous blog posts, going barefoot is also important for proprioception—your body’s awareness of its position in space. Being barefoot not only strengthens the foot musculature, but it has also been proven to enhance balance. So next time you are sitting around your house or doing an at home workout, kick your socks and shoes off and give going barefoot a try. Your feet will thank you later.
A HAPPY ENDING
It is evident that numerous factors play a role in the prevention of tibial injury. For me, I look back on my high school running career and can point out several things that went wrong that lead me to incur three stress fractures. I believe that overpronation, an inefficient foot strike pattern, and ramping up my weekly mileage too quickly all were factors that lead to my injuries. However, today I have become more knowledgeable about these factors and have corrected my strike pattern and work on my foot pronation. I have completed two half marathons since high school and have ambitions of completing a full marathon within the next year. It took almost four years to get to where I am today. There for a while, I never thought I would be able to run long distance again. However, with hard work and perseverance I have made significant progress and continue to strive to be a better runner each and every day.
Strive for progress, not perfection
About the Author
My name is Taylor, and I have had the pleasure of working for Sam at the Fitness Clinic of Indy this summer. I will be a senior at Butler University this fall. Working as an intern, I have learned a great deal about personal training from Sam and am currently studying to become a certified personal trainer through the American College of Sports Medicine.