Tibial Stress Fracture

Ok, so after 2 months of waiting to be referred for a bone scan I've finally be diagnosed with a tibial stress fracture.

I stopped running as soon as I got the injury and started doing alternatives ie cycling, swimming etc , no progress was made so had a complete break from any cardio activity.  That also made no difference so have started cycling again which doesn't seem to have any ill effect.

 The last physio I saw suggested an aircast might be useful as they aid recovery, does anyone have any experience of stress fractures.  Any advice/suggestions would be very welcome.

 Thanks

Hi, I'm 7 weeks down the line with my tibial stress fracture.  Didn't have a scan, was diagnosed by my physio but to be honest I knew what it was before I went to see her.  She was extremely thorough and when she came to the same conclusion as me I believed her  - plus when she tapped my tibia I nearly hit the ceiling!

Mine is high up on the tibia, on the inside of my right leg, not that far below the knee.  As such she said an air cast wouldn't make any difference.  If it had been a low down one nr the ankle she would have recommended one.

I was told absolutely zero running for 6 wks, and to not go for walks but obviously to walk when necessary.  I had to wear supportive shoes (ironically this meant my running shoes) and not carry heavy things (hard when you have a toddler that demands to be carried all the time!!)

I don't belong to a gym but I swim and have been swimming like mad - frontcrawl only, pushing off with one leg.  Initially it did hurt when I kicked with that leg - not so much that I had to stop but I could feel it.

As of last wk I was allowed to jog on the spot for 5 mins, then hop on that leg.  It felt fine so I was then allowed to do a couple of laps of the track.  I am now up to 6 laps and so far so good..........Once I'm up to 3 miles on the track, I am allowed back on the rd.  I will also go to the forest more now the weather's better and try and run on softer surfaces where possible.

I am having a bone scan next wk - not for diagnosis but to check my bone density and make sure I am not osteopenic or anything.

Good luck!

Hi there - I've recently had a SF in my femur diagnosed, I'm currenty hobbling about on crutches! No weight bearing etc etc

Hope to be on those for no more than 3 weeks but no running for a good 3 mths. Allowed to swim (currenlty turning into a mermaid that ALWAYS smells of chlorine no matter how many times I shower ) can also cycle but taking it really gently as my leg aches if i do too much. 

Very lucky to have a consultant that works with the British Olympic team (check me out )  he diganosed me after 20 mins after it had taken my fizz 4 weeks to refer me to him and for her to think it was my back, lost faith in her a bit

I've not heard of anyone else with an aircast for an SF, but perhaps others know different.

Good luck with it, lets hope we're all back on the road soon hey

Hinkit,

You asked about braces for tibial stress fracture.

 The Aircast XP walker is certainly helpful and I prescribe it for my patients with a significant stress fracture and difficulty weight bearing.

If my patients have a small undisplaced stress fracture seen on bone scan and not on xray I would put them into the Aircast Leg brace with and anterior splint.  I use this in the former type of patient after the Aircast XP Walker.  These things take a long time to heal and there are other influences that may have a bearing on healing like concommitant disease,  malnutrition, osteoporosis, smoking and steroids so ask your surgeon for advice in your case.

Hope this helps

John Hardy

Thanks so much for your replies.

I've thought all along that it was a stress fracture but just wanted it to be confirmed.

I have tried swimming but I'm not great at it and find it boring.  Breast stroke hurts my leg so thats a no go, I have never learnt to do front crawl properly so have invested in a kickboard so using that and gently kicking.  Can only manage half an hour though and then I'm bored.  Been doing some nice cycle rides though, it's very flat where I live so don't have to contend with hills that would put unnecessary pressure on my leg.

I have not run now since 2nd week in February and although if I'd have carried on running it would be a million times worse, I'm no way near being able to run.  I have tried to limit walking but have 2 dogs to walk so it can be difficult at times - although my boyfriend does do a lot of the walking now.

Carovet - good to hear your making progress, fingers crossed you'll be back out on the roads soon

 John Hardy - thanks for your advice its much appreciated, the stress fracture didn't show on an xray so the aircast leg brace could be the way to go.

 Thank you all

BEEN THERE!!! had stress fractures in the tibias of BOTH legs!! im only 17, and they were caused from too much training and racing on the roads including 10k's and half marathons...which later found out...while im still growing and bones are still soft..was stupid!!!

after MRI scans, extensive doctors appointments and rehab programmes Im finally back training! Im a pentathlete on the GB team so keeping myself busy with swimming and shooting was easy (two of the other 5 sports). Its bone...so all you can do is rest. Luckily for me im at a college with great training and rehab facilities so could ease the pain with ice baths and physio. I was on crutches for 3 weeks which makes THE BIGGEST DIFFERENCE EVER. Being able to take your weight off your leg (or in my case alternating legs) was a god send and made getting through the day without having pain at the end of it so much easier however much of a faf crutches are!!!

I am back training now, and although soon to make a transition from petnathlon to just focusing on my running, i have been told by my physio and doctor to stay off the roads for a few months and start looking at upping my mileage to 50miles or so a week for futre in distance running in the winter of 2010. Road races of a long distance wont be in the diary until 2011.

 Frustrating...but less frustrating taking things slow than being sat down doing nothing from doing much!!!!!

I strongly suggest crutches to ease the weight off, even if you can walk...it heals the bone faster as no weight on it!!!

Good luck with the recovery xxxxxxxxxxx

Katie-Jemima,

Undisplaced stress fractures of the tibia heal slowly.

Healing occurs by a bony bridge that forms over the fracture gap in the small clot of blood under the periosteral layer (medullary callus) and under the skin of the bone (periosteal callus).

The periosteum is the skin on the bone formed from two tissue layers. The bone producing layer (cambial) and strong layer (fibrous). The size of the callus is dependent on the size of the clot, fracture site movement and the presence of the periosteum.

There are four phases of fracture healing. The haematoma phase, the inflammatory phase, the callus phase and the remodelling phase. The fracture is healed when the fracture site movement stops. Following this the bone remodells over a period of 2 years or more. My research demonstrated that each of these phases differ in time between patients. Also, the callus size differs depending on its initial stability and the presence or absence of an intact periosteum. Each of these phases can be influenced by changing the environment both biomechanically and chemically.

You have said that "I strongly suggest crutches to ease the weight off, even if you can walk...it heals the bone faster as no weight on it!!!" Nothing could be further from the truth regarding the speed of healing of a fracture.

Fracture site movement, or the lack of it (the mechanical environment), works best depending on the overall stability of the fracture and works best during the inflammatory and callus phases of fracture healing.

To assess the need to change the mechanical environment in an individual with a stress fracture (deciding to weight bear or not weight bear) your Orthopaedic and Trauma Surgeon needs to take a history, examine you and take xrays of the fracture. Non-weight bearing can lead to its own complications like disuse osteoporosis, contractures, thrombosis, and possibly RSD so it should never be advocated without a clinical assessment (your get out of jail free card K-J).

The biggest influences on the rate of callus formation appear to be the initial energy of injury, age, smoking, corticosteroid use, fracture site movement and malnourishment. The biggest problem with a stress fracture is that it is undisplaced and not fully broken. This means there is little fracture site movement and little callus healing. Therefore, many take the 1-2 years of remodelling to fill the gap at the fracture site.

In undisplaced stress fractures of the tibia it is important to maintain weight bearing for some stimulus to the callus through fracture site movement.  This is why I use an Aircast XP Walker first and then the Aircast Leg Brace during the later phases and keep my patinet weight bearing for rapid rehabilitation.

Hope this helps.

John Hardy

P.S. My MD thesis was entitled Tibial Diaphyseal Fracture Healing.

Crutches were reccomended to me by a sports doctor who travelled to Beijjing  Olympics with the Pentathletes, as i was barely able to walk from the pain, crutches DID make the biggest difference. ..but thanks for your info...

Katie

K-J,

Crutches are important for pain relief but do not confuse that with bone healing!

John Hardy

Hi John,

 I ordered one of your leg braces and it arrived today - have to admit that it's a little more bulky than it looked in the picture so feel a bit self concious wearing it.

Have been at home today so haven't worn it a huge amount, but found walking up and down stairs was pain free with the brace which is a good thing.

I now believe the injury occured when I was on holiday at the end of Jan, it was very hot so I switch to shorter more intense runs whic included intervals and hill running (on roads), I think the extra pressure through the front of my leg on the hill running is was has caused this.

I have not run now for 2 1/2 months, my recovery seems to have got so far and stopped which I am hoping the leg brace will help with.  I know everyone is different but as a guide how long could it be until I can start doing some running again?  My GP is writing to a specilist at the hospital to enquire about bone density tests as I was underweight for a number of years.

Thanks

Hinkit,

It is longer than the aircast ankle brace but it should do the job for stress fracture according to an interesting study performed by Prof Batt in Nottingham.  For advice on how long before running again you need to wait nutil you have enjoyed at least 3 months of being pain free and then ask a physio for a graded rehabilitation to the running. Depending on the DEXA scan results to exclude osteoporosis.  I suspect you are correct about the hill running and cause. Seems the same reason you get pain climbing stairs.  Great that the brace relieves this symptom.  It means it is working.

Best of luck.

John Hardy

John - Have been diagnosed with SF via isotope bone scan (MRI Showed nothing). I ahve the report which says "mild uptake in mid tibia......plain film does not show obvious changes, but features would be in keeping with an early SF".

I have been 'resting' for 4 weeks now, but the early part of that went non-weight bearing and into aircast walker - ended up with RSD (reflext sympathetic dystrophy)...which I would NOT recommend (i have a thread associated with it)

I assume that an aircast leg brace would be advisable, and less likely to cause reoccurence of the RSD? I am concerned that the report states 'early stress fracture'....and that even though I have been resting it for over 4 weeks (and believe me I have NOT run/hopped or done anything stupid!) it is still considered 'early'. I have been swimming and cycling and aqua-jogging, but wondering if I am doing too much...im not pushing hard when I cycle and trying to walk around 'gently' and taking weight off when going up/down stairs.

Hi Nick,

Sorry to hear you're suffering from a SF, so very annoying, I did mine end Jan/early Feb and am still not running!!!  I'm not wearing the aircast leg brace anymore, I wore it for just over a month and am now just wearing a supoort bandage.

What type of swimming are you doing?  Reason I ask is I was doing breast stroke and found that really aggrevated the stress fracture.

I had been painfree for a good while and started building up my running again, eventually got to 5k but then it started to hurt again .  So am going to give it another month of rest before trying again!!!

One of the things which I found caused the most pain was stairs!!!  So as much as I hate lifts and feel very lazy for using them, since having the SF properly diagnosed I have been using lifts instead of stairs whenever possible.

Hope these comments are somewhat helpful.

Hinkit - not running still - sheesh, however I get the impression that tibia SF can be problematic. ALso the comments about the size of the fracture site (small taking longer to heal) suggesting that a bigger fracture would result in a better/quicker mend.

Ive onyl been swimming a few times but do crawl, and I find swimming incredibly dull anyway. I have also borrowed an Aquajogger - which I am sure I will become familiar with again.

I have been taking care going up/down stairs as that was one thing when I could feel something. I have not had a great deal of pain, so suspect that the SF is very small/early more the stress reaction stage, as nothing was shown on an MRI - but the bone scan picked it up.

I know, not being able to running is driving me insane!!!!

I agree on the swimming front - very dull!!!  Haven't tried aqua jogging am going out and anout on my bike a lot though.

I had a lot of pain at first, so painful I couldn't walk properly - only have a tiny tiny bit of pain now if I touch it and occassionally it aches.  So compared to when I first did it, its a lot better, just not "better enough" for running.

...I wonder what John and others consider about this?

http://www.ingentaconnect.com/content/amsus/zmm/2004/00000169/00000011/art00018

I was diagnosed with a tibial sf 2 days ago but have had 'lump' for a couple of months.  I was uncomfortable for the first mile or so of a run but then the pain went.  I've trained and raced on it with only mild discomfort. I don't have a high pain threshold either!

I am now on crutches and non weight bearing for 10 days until I get reviewed. 

Is there any hope out there?