Shin Splints vs. Stress Fracture: Here’s how to tell the difference

If there’s one thing that most runners dread even more than sub-zero temperatures and torrential downpours -- it’s getting injured. Whether it’s a shin splint or a stress fracture, neither are fun. How can you tell the difference and what can you do about it so that you can back to the business of running?

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If you are already facing an injury, you might need help. Perhaps you’ve spent too much time denying the truth about your throbbing, aching shins. It’s time to listen to your body.

Surely taking a few weeks off from running is not worth conquering the elements. Here’s what you need to know.

What are shin splints and what causes it?

Firstly, shin splints can be defined as pain along the inner edge of the shin bone. This injury is typically located in the middle or lower parts of the front or sides of the shin bone.

In simple terms, shin splints are caused by overloading the lower leg. This generally happens through a rapid increase in the frequency or intensity of activity levels. In other words, doing too much, too soon.

As a result, muscles in the lower leg tire out too quickly and are unable to absorb the stress placed on the lower leg. This forces the shin bone to absorb high levels of stress, which leads to injury. Shin splints are common among beginner runners.

In addition to doing too much, too soon when it comes to running, a number of other factors may also contribute to the development of shin splints. These are:

  • Muscle imbalances

  • Overpronation

  • Over-striding

  • Inflexibility

  • Improper footwear

  • Worn-out running shoes

  • Training on slanted roads

  • Never switching direction when training on a track

  • Abruptly changing your running regimen, e.g. switching from flat surfaces to hills

How are shin splints diagnosed?

A dull ache or intense pain, and even swelling, in the lower front or side of the leg will give you a good indication that you might have shin splints. It is crucial to get a proper diagnosis from a physician, who will take your medical history and do a complete physical examination.

Shin Splints

Image Source Flickr user Matthew Frederickson

What is a stress fracture and how is it caused?

A stress fracture is a fatigue-induced fracture of the bone caused by repeated stress over time. Although stress fractures commonly occur in the shin bone, it can also develop in other weight-bearing bones, such as the bones of the foot, upper leg, pelvis and sacrum.

It can be described as a very small crack in the relevant bone. A stress fracture is the result of repeated overloading. It is a common overuse injury in runners completing high impact, high volume training.

How is a stress fracture diagnosed?

As with shin splints, there is usually an area of localised tenderness and swelling on or near the affected bone. Three easy ways in which to distinguish between shin splints and a stress fracture are:

  1. The pain associated with shin splints is more generalised, while pain associated with a stress fracture is localised. If you can locate a specific spot of sharp pain along your shin bone, the chances are good that you have a stress fracture.

  2. Stress fractures often feel better after a night’s rest, while shin splints often feel worse in the mornings as a result of the tightening of soft tissue overnight.

  3. Shin splints are often most painful when you attempt to lift your foot up at the ankle and flex it.

While shin splints often require only a physical examination, bone scintigraphy and MRI scans are required to formally differentiate between shin splints and a stress fracture.

Because the symptoms of shin splints and a stress fracture may overlap, it is vital to get a correct diagnosis from a physician in order to determine the most effective and appropriate treatment.

Treatment of shin splints and stress fractures

Commonly used treatments for shin splints include the following:

  • Adequate rest

  • The application of ice (although not all specialists agree on the effectivity of this treatment)

  • Stretching

  • The strengthening of the affected and supporting areas

  • Very gradual returning to activity levels

Other more conservative and complementary treatment methods include balance training with the aid of a balance board, manual therapy, cortisone injections, and calcium and vitamin D supplementation.

With proper treatment, the pain of shin splints usually subsides within three to six weeks. Keep in mind that the pain and swelling caused by shin splints should be significantly reduced before returning to activity and doing strength exercises.

Additional precautionary measures when returning to running include:

  • Running on soft surfaces, such as grass, trails or asphalt

  • Frequently changing direction when training on a track

  • Avoiding slanted training surfaces

  • Getting properly fitted for the correct running shoes

  • Using insoles or orthotics to assist with biomechanical issues

  • Alternating between two or more pairs of running shoes

  • Replacing worn-out running shoes

  • Correcting your running stride, i.e. upping your cadence to at least 165

  • Initially avoiding and then very gradually reintroducing hill training

Leaving shin splints untreated may cause it to progress to a stress fracture.

The treatment of a stress fracture is a bit more lengthy and complex than that of shin splints. Complete rest and the use of a cast or walking boot for a period of four to eight weeks or more is generally prescribed.

It is, however, important to keep in mind that bone remodelling continues to take place for months after the stress fracture feels healed. This makes it important to make a gradual return to running.

In very severe cases, surgery may be required to treat a stress fracture. In such instances rehabilitation may take up to six months.

The bottom line is to rest and seek professional help as soon as you feel pain or discomfort in your lower leg. More importantly, follow the treatment and rehabilitation regimen prescribed by your physician.

You might miss out on running for a couple of weeks while you recover, but not heeding your doctor’s advice could make things worse. Once you’ve fully recovered and are back to running, always remember and implement the golden rule of running: Listen to your body!

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