We are two weeks from the 28th Steamtown Marathon. I trained for the first seven Steamtown races and, even now, Columbus Day weekend always brings the event to mind.
This time of year many runners come to my clinic complaining of intense shin pain commonly called shin splints. Left unchecked, that discomfort can progress to a stress fracture — a more serious bone injury.
A stress fracture is microscopic fatigue damage in bone that can grow into a partial or complete break in the cortex from repeated loading. Plain X-rays often miss early injury; a bone scan or MRI is more sensitive. Stress fractures most frequently affect the tibia, but they can also occur in the femur, foot and, less commonly, the arm.
Competitive athletes face a substantial risk. Estimates put incidence between 10% and 21% in this group, with track, cross-country runners and military recruits at highest risk. Women are about twice as likely as men to sustain a stress fracture.
Other high-risk groups include sprinters, soccer and basketball players, jumpers and ballet dancers, where the legs and feet are most commonly involved. Gymnasts may get spinal stress fractures, while rowers and athletes in sports
requiring repetitive upper-body motion can rarely develop stress injuries in the ribs or arm.
Sports that involve heavy, repetitive loading — especially where low body weight is valued or beneficial — carry greater risk. Distance running, gymnastics and ballet are notable examples.
Early symptoms are often vague: a dull, poorly localized ache during or after activity, similar to shin splints. Over time the pain becomes more focal and tender during exercise, then progresses to discomfort with daily activities and at rest.
Common causes are clear. Overuse from too much mileage, intensity or frequency is the primary culprit. Rapid increases in training or returning to activity after a break can precipitate injury.
Biomechanical issues also contribute. Poor foot mechanics, such as excessive pronation, alter shock absorption and shift forces to the shin and other structures. Changes in training surface or footwear that increase impact, and improper shoe support, can also provoke stress fractures.
Body composition plays a role. Carrying extra weight raises impact forces and may predispose an athlete to injury when they resume running aggressively. Conversely, underweight athletes — particularly women with menstrual irregularities or eating disorders — have a much higher risk.
A prior stress fracture doubles the chance of recurrence. That history should prompt careful prevention and monitoring if training resumes.
Treatment starts with early recognition and medical evaluation. Initial management often requires immobilization, rest and anti-inflammatory medication for four to six weeks, combined with non-weight-bearing cross-training.
Rehabilitation includes physical therapy modalities such as ultrasound, electrical stimulation with cold, biomechanical taping and strengthening exercises for the foot and ankle. Orthotics or properly fitted running shoes and corrective measures for biomechanical faults are essential.
Prevention focuses on sensible training: increase mileage and intensity gradually, mix in low-impact cross-training like cycling or swimming, and introduce new shoes or surfaces slowly. Overweight runners should combine modest dietary changes with a walk/run approach. Underweight athletes need nutritional rehabilitation and restoration of healthy body fat.
Consult your primary care physician or a sports medicine specialist if pain persists. Early diagnosis and prompt management prevent progression and shorten recovery time.
Paul J. Mackarey, P.T., D.H.Sc., is an orthopedic and sports physical therapist in private practice in Scranton and Clarks Summit and an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. Email: [email protected].
