Re-Stressed
Interpret My MRI Results (Stress Reaction?) 3/6/2009 7:20PM Reply | Return to Index | Report Post
After being out of running for two weeks with recurring pains where I had a stress fracture last fall (in the left fibula), I got an MRI this week and just got the results from my doctor-- he says it shows "stress reactions" in the left fibula AND tibia, plus some minor muscle strains in the area. This is frustrating; I was just starting to get back to real training after my stress fracture. And I have no idea how the hell I damaged my tibia; I haven't done any hard or high volume training since that injury in the fall.

It would be really helpful if someone who knows what they are talking about could give me a plain-language summary of what the MRI results mean. What would have led to this injury? What can I do besides rest to heal it and stop it coming back again? How long can I expect to be out/cross-training?

Here is what the report says:

"There is intramedullary bone marrow edema along the anterior aspect of the tibial and fibular shafts extending from about 7cm below the knee joint line to 5cm above the ankle joint line. There is cortical thickening, which is seen on prior radiographs. No fracture lines are identified. Adjacent soft tissues are unremarkable. There is increased signal within the Kager's fat pad and gastrocnemius tendinous junction, likely muscle strain and Achilles peritendinitis. Achilles tendon is intact. Vascular structures are preserved. There is no joint effusion in the knee or ankle. There is a bone island in the proximal tibia and distal tibia."

Any help would be greatly appreciated. It's been 4 months since I was last training seriously and I am slowly going nuts!
not a med student
RE: Interpret My MRI Results (Stress Reaction?) 3/6/2009 9:43PM - in reply to Re-Stressed Reply | Return to Index | Report Post

Re-Stressed wrote:

After being out of running for two weeks with recurring pains where I had a stress fracture last fall (in the left fibula), I got an MRI this week and just got the results from my doctor-- he says it shows "stress reactions" in the left fibula AND tibia, plus some minor muscle strains in the area. This is frustrating; I was just starting to get back to real training after my stress fracture. And I have no idea how the hell I damaged my tibia; I haven't done any hard or high volume training since that injury in the fall.

It would be really helpful if someone who knows what they are talking about could give me a plain-language summary of what the MRI results mean. What would have led to this injury? What can I do besides rest to heal it and stop it coming back again? How long can I expect to be out/cross-training?

Here is what the report says:

"There is intramedullary bone marrow edema along the anterior aspect of the tibial and fibular shafts extending from about 7cm below the knee joint line to 5cm above the ankle joint line. There is cortical thickening, which is seen on prior radiographs. No fracture lines are identified. Adjacent soft tissues are unremarkable. There is increased signal within the Kager's fat pad and gastrocnemius tendinous junction, likely muscle strain and Achilles peritendinitis. Achilles tendon is intact. Vascular structures are preserved. There is no joint effusion in the knee or ankle. There is a bone island in the proximal tibia and distal tibia."

Any help would be greatly appreciated. It's been 4 months since I was last training seriously and I am slowly going nuts!




ya your dr was right on, assuming of course the radiology report is correct. edemas form when the bone is stressed. they are basically fluid inside the bone that form when it starts to break down. ya a terribly not scientific way of putting it but basically that is what happens. no fracture line is good (most likely) and hopefully means it is just in the reaction or early phase. take it easy! a pair of them is also pretty odd. have any orthotics? you may want to check out your gait with a chiro/pod.
Re-Stressed
RE: Interpret My MRI Results (Stress Reaction?) 3/8/2009 8:13AM - in reply to not a med student Reply | Return to Index | Report Post
Thank you. I don't wear orthotics and am wondering if I ought to or not? I tend to supinate/under-pronate in my footstrike.
Re-Stressed
RE: Interpret My MRI Results (Stress Reaction?) 3/8/2009 6:43PM - in reply to Re-Stressed Reply | Return to Index | Report Post
Bump
BA
RE: Interpret My MRI Results (Stress Reaction?) 3/8/2009 7:01PM - in reply to Re-Stressed Reply | Return to Index | Report Post
i can't offer any judgment of your MRI results, but i had an SF on the inside of my shin about 5-6 inches above my ankle about two years ago. i have not been able to train consistently since then. as soon as i start running more than every other day, even at very low volumes, the area becomes tender to the touch and then pain while running isn't far behind. i've had follow-up MRI's that have shown a stress reaction, although i can't give you details as to what the MRI's actually read.

i've tried orthotics and they seem to help a little bit, but haven't fixed the problem entirely. i'd be interested to hear what you learn about your issues because they seem similar to mine. good luck.
Ngihe
RE: Interpret My MRI Results (Stress Reaction?) 3/8/2009 9:45PM - in reply to Re-Stressed Reply | Return to Index | Report Post
Your MRI could be showing calcium deposit from before. The second MRI really doesn't tell you anything if the fracture is healed. It can only show you a full line if it happens again.
Hmmmmmm
RE: Interpret My MRI Results (Stress Reaction?) 3/8/2009 10:26PM - in reply to Re-Stressed Reply | Return to Index | Report Post
Your doctor put it clear. Stress reaction as the medical term and correct term for what we in the running world like to refer to as shin splits.
common
RE: Interpret My MRI Results (Stress Reaction?) 3/9/2009 5:45AM - in reply to Hmmmmmm Reply | Return to Index | Report Post
Here's the deal...you can start running again, very soon.

I had a tibial stress reaction (edema, no actual fracture) back in July 08. It still hurts briefly when starting a run maybe one of every five days, but now it's generally muscle cramping, not the bone. I got through it by being patient, and by being patient. I can't stress patience enough.

First thing, get an Aircast for your leg. Wearing an Aircast as much as possible during the day can heal the problem as much as 40% faster. I wore mine for about three weeks, and it helped a lot. It costs a bit ($150 w/o insurance), but you can reuse it if you are prone to SFx, etc. It works.

During that time, get in a pool or on a bike to hold on to as much fitness as possible.

Following that, let pain be your guide. Gradually phase in running on a nice, soft surface like a treadmill. Supplement heavily with pool and bike, and gradually shift toward running more as the leg (pain) allows. If it hurts, stop.

Over time you will learn the difference between bone stress pain (bad pain) and the cramping and muscle aches of healing (good pain), and be able to make adjustments, but in the first couple of months, just stop when it hurts.

Stay off the roads until you have substantial healing and lack of pain, then add harder surfaces gradually just like when coming off the pool/bike phase.

I would recommend checking into more minimal shoes as well as orthotics. I've used both, and lightweight racing flats have worked better for me long term.

I am still healing (it can take up to a year to fully remodel), but have been able to run 70+ miles per week on average by using the above approach. Good luck!
Tasha
RE: Interpret My MRI Results (Stress Reaction?) 2/9/2013 2:52PM - in reply to common Reply | Return to Index | Report Post
Thank you for this. This post gave me hope. I have a bone edema in my lower left leg. I got it after I started training for a 5k. This post actually made me feel like I am going to get better. The dr. told me to wear my air cast all the time for 2 weeks. However, you have convinced me to wear it for 3 weeks. I have been having pain while wearing the air cast lately which scares me. I am hoping I have a quick recovery. I hate not being able to run or work out!