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Stress Fracture or Shin Splints?

This might be the most frustrating question known to running.  On one hand it could be a painful inconvenience that causes you to have to grit your teeth a little harder on workouts.  On the other hand you could be one bad step away from your bone shattering.  One of these things is not like the other.

But in terms of how it feels as they develop, these things may be exactly identical.  So how do you know which is which?  How do you know if you should keep training or take 8 weeks off?

First a little medical background: shin splints is an irritation of the periosteum, the dense tissue surrounding the bones in your body.  Muscle tightness and/or constant pounding of the leg can cause this tissue to become irritated, then swollen, then painful.  In extreme cases the tissue will become so enflamed it separates from the bone - this being a very serious injury, potentially requiring surgery to correct.

Stress fractures can occur in two stages, the stress reaction and the fracture.  The stress reaction is a weakening of the bone by repeated impact causing a soft spot or structural weakness.  If the soft spot is not given proper time to heal the bone will fail and a fracture forms.  The fracture is a crack in the bone, generally penetrating through the outer layers of the bone.  If the bone suffers catastrophic failure and fractures the whole way through, that is a broken bone.

Running on shin splints can end two ways, either it gets better or it gets worse.  If it gets worse it may eventually separate from the bone.  Running on a stress fracture only ends one way; it gets worse.  If you continue to run on it the bone will break.  *This happened to me in high school.

Last month I notices an uncomfortable twinge on the inside edge of my right tibia, as I was about 8 mi into a daily 10 mi run.  My immediate assumption was that I had irritated the muscles and I may develop mild shin splints.  Later in the day as the pain persisted, then intensified, I started to wonder if I may have a stress fracture.  The previous three days had been a 21 mi tempo, an 11 mi easy, then 10 mi of track work with an 11 mi double that night.  The injury occuring on the morning of April 4th.  I called my coach, warned him, and we decided to wait and see what happened.

After a day of biking, I ran 10 mi on the sixth day and the pain was very localized, shooting from the inside edge of the bone across the front toward the anterior compartment.  I concluded a fracture was immenent, and scheduled an x-ray.  This is where things got very frustrating and led to the blog.

The first x-ray was April 19th and came back negative - no fracture visible.  However the doctor reminded me that a fracture may not be visible until 3-4 weeks after the injury, so the first x-ray really did not mean anything.  However from the pain and an obvious lump on the bone, it was clear that I had a stress syndrome.  But was it shin splints?  or a Fracture?  She wasn't sure.  Her suggestion was to take two more weeks off and get another x-ray.

My goal marathon for the spring is May 27, so this injury came at the worst of times.  But I decided to be safe and follow the doctors suggestion, taking off until the end of April.  I then resumed running 2 mi a day, all uphill to reduce impact, until today when I get the second x-ray.  Today's x-ray, still negative.  So I did not have a fracture, but I may still have had a stress reaction.  And as of now, I do most certainly have shin splints regardless of whether or not there was bone damage.

But I've lost 6 weeks of training, and still don't know what my injury was or how bad it was.  So should I be pissed I wasted my time, or glad I took off right away and avoided potentially worse injury?  It's hard to say.

For you, all I can say is that if the pain is very local, close to one spot with  a clear feeling of being on or in the bone running right or left, it's likely a stress reaction or fracture.  If the pain seems to follow the edge of the bone running up or down, and is not clearly defined, it's likely shin splints.  Both feel about the same, both get treated about the same (lots of time off, and ice a lot).  But they are not the same.  And if you have a bad doctor or high-school trainer - like I did in 2002 - you may end up ruining your self. 

Be careful until you're sure of what your injury is, and don't always take the first opinion you hear.  Becaue these injuries are too close to each other for most people to tell the difference.  You just have to trust your self and listen to your body.