Tibial Stress Fracture NOT Healing…What Gives?

Just continuing to keep the diary here for future reference. With this coming weekend marking 11 weeks since my last run, and after a week or two of just biking (no elliptical), the fracture site is feeling a lot better.

I’m still having some aching and diffuse pain, but I’m starting to think it’s phantom / recovery pain and may try a run soon.

Results of a follow-up MRI 8 weeks after the first and 12+ weeks after cessation of running. Not great news :(

“ Osseous: 10 cm below the medial joint line posteriorly again evidence stress fracture there is worsening intramedullary edema. There is decreased periosteal edema. Again evident is increased signal intensity within the posterior tibial cortex however the cortex is now thickened thigh with some healing. The fibula of appears unremarkable.

Compared with the prior examination performed in November 2021 there has occurred some interval healing of a stress fracture of the proximal tibial cortex posteromedially.“

Vitamin D, 5000 IU or what does your medical doctor recommend?

Calcium 1200mg from date of injury for six months or what does your doctor recommend?

K2, 100mg daily or what does your physician recommend?

Are you a vegan? Are you consuming a beverage daily with calcium such as milk or soy drink with calcium or almond drink with calcium or oat drink with calcium or orange juice with calcium?

Hi, have you had a DXA scan for bone density? Mine showed osteopenia bordering on osteoporosis this week, which surprised me, but explains the fact that I got calcaneal stress fractures in both feet in Oct and more recent follow up MRIs this week still showed grade 3 stress injuries (severe edema but not quite a distinct hairline) in both heels even though I’ve been pain free for many weeks and had even resumed light running with a protocol blessed by my doc since mid-Dec.

My vitamin D showed up as 29.4, which is considered “insufficient” but not quite “deficient” and I’ve been supplementing that too, but it doesn’t seem to have changed at all this far in 3 weeks. My doc thinks “vitamin D supplementation may not necessarily be protective against stress fractures”, but several papers I found online suggest vitamin D supplementation increases bone density reducing stress fracture risk.

Try to find out the underlying cause in your case for the fracture not healing timely.

I'm planning to get my Vitamin D checked via my primary care doc ASAP; I had it checked in July 2021, and even though I was running outside every day at the time, my levels were still borderline low.

When I visited the orthopedist to have my MRI results read, he theorized that, since I haven't been outside much at all since I stopped running on 17 October, my VitD levels are almost certainly low and possibly contributing to poor healing.

I've since been supplementing with 500%+ DV of Vitamin D, as well as extra calcium and Vitamin K2. These are all readily found in a bone-building supplement that my ortho recommended called BoneUp.

BrokenLeggy wrote:

I'm planning to get my Vitamin D checked via my primary care doc ASAP; I had it checked in July 2021, and even though I was running outside every day at the time, my levels were still borderline low.

When I visited the orthopedist to have my MRI results read, he theorized that, since I haven't been outside much at all since I stopped running on 17 October, my VitD levels are almost certainly low and possibly contributing to poor healing.

I've since been supplementing with 500%+ DV of Vitamin D, as well as extra calcium and Vitamin K2. These are all readily found in a bone-building supplement that my ortho recommended called BoneUp.

Does the supplement your ortho doc recommend equal mg of calcium & K2 I recommended or different mg amount? If different, curious the exact amount of mg your physician recommends of K2 and calcium?

Are you a female? Are you a vegan? Both influence what is going on with healing.

Hello! I appreciated your recommendation about the K2; bringing that up with the doc was why he recommended the BoneUp supplement. He didn't mention any specific values for the K2, D, and calcium, but the BoneUp contains the nutrients as follows:

-Vitamin D: 1000 IU, 130% DV

-Vitamin K2: 45mcg, 40% DV

-Calcium (microcrystalline hydroxapatite): 1000mg, 80% DV

-Magnesium: 50mg, 120% DV

So, it seems like it might be worth adding some additional Vitamin K2. I am neither vegan nor female, although I have struggled with iron deficiency anemia and was recently diagnosed with RED-S.

Had a follow-up appointment with a new sports orthopedist today after my pain came back with a vengeance last week. Today marked 105 days since the beginning of my tibial stress fracture symptoms.

She read an MRI taken on 4 January, and it still showed a clear fracture line. Although the fracture itself was smaller than on my 3 November MRI, it was surrounded my worsened edema.

Meanwhile, an X-ray taken today showed massive bulges on the bone on both the medial edge and posterior side. The orthopedist theorized that it was likely edema, new bone, or a combination of the two. She recommended that I wear a boot walking around for a couple of weeks and continue taking time off.

I’m at a loss and more than demoralized. At this point, it’s been 15 weeks; I’ve taken calcium, Vitamin D, done my PT, lifted, did low- or no-impact crosstraining, and still nothing.

sorry to hear it, keep the crosstraining up

BrokenLeggy wrote:

Hello! I appreciated your recommendation about the K2; bringing that up with the doc was why he recommended the BoneUp supplement. He didn't mention any specific values for the K2, D, and calcium, but the BoneUp contains the nutrients as follows:

-Vitamin D: 1000 IU, 130% DV

-Vitamin K2: 45mcg, 40% DV

-Calcium (microcrystalline hydroxapatite): 1000mg, 80% DV

-Magnesium: 50mg, 120% DV

So, it seems like it might be worth adding some additional Vitamin K2. I am neither vegan nor female, although I have struggled with iron deficiency anemia and was recently diagnosed with RED-S.

I need 4000 plus calories a day to stay healthy. I was diagnosed with iron deficiency anemia after military basic training, forced to live on their 3000 calorie per day diet. It is a concern that you are a male, not vegan but still iron deficient. You most likely will take longer to heal. Be patient. One of my hands was torn up, multiple compound fractures. Surgery required. Took awhile to heal. If you are a slow healer due to anemia, talk about that with your medical personnel.

What you are describing is what we called Shin Splints back in the 1950-1970 range of time. I managed to set national and provincial records once I learned how to get rid of them so that they never came back because I was aware of the symptoms before they interfered with my running once I had healed them for good. I'm still running (very slowly, but then I'm 78). No short cuts work. Being smart does. Here is what I have posted on my website on healing them

Shin Splints The problem is caused by four major factors:

1) this is the most used area of the body that is served by the least blood supply

2) before you notice the pain, the area has been damaged for about 3 weeks. Contrary to popular belief you don't get shin splints from one workout. When you first feel them, they have been there, but you haven't had any reason to run your hand down the shin and press against the shin to feel the pain.

3) wrong training at the wrong time (overuse). You know when shin splints are severe when they hurt after the workout when you walk. If you are lucky to catch them soon enough, it will be when they hurt while you run, but not when you walk. Don't ignore the pain thinking they will go away.

4) not allowing the shins to be completely healed before doing stupid things on them.

----------------------------------------------------------------------

Doing nothing while you have shin splints, will not stop them from reoccurring when training resumes unless you quickly monitor them each morning by running your hand between the muscle and the tibia.

If you follow the procedure given below, you should be able to heal up your shin splints and run without reinjuring them.

You must keep a diary of what you do athletically each day. The total time expended each day to follow this program is very short. The only failures I've had are with those persons who don't take the time to follow the program, indicating to me that there are other more important things in their life than being an athlete. I have made up a chart that you can use to make it easier to record the data.

Each night write down what you did for a workout that day (anything athletic).

Each morning write down the length of the area of pain in each leg to the nearest mm (for example, 4.1 cm....not just 4 cm). A measuring tape is great. Put pressure on your shin beginning just below the knee, continue down the knee until you feel pain. Mark the spot where the pain begins with a pen. Continue on down the leg until the pain quits. Mark the spot where the pain quits with a pen. Measure the distance between the two marks to the nearest tenth of a mm. Write this down next to yesterdays workout.

Have someone or you look over the workouts to determine which workouts or exercises therein are causing your problem after 2 weeks and then modify your program to include less of the type of workouts (or exercises) that seem to injure your shins.

Continue the measurements until you are fully healed (three weeks after the pain goes away!!).

Shin Splint Program

Measurement Next Morning Measurement

Date Workout Right Left

11/30/92 30 minute ride, 20 minutes of aerobic exercises

(how hard? what kind of aerobic exercises? 12.1 13.4

I ask this with Peace and Love, are you a vegetarian? Something I read that the proteins in red meat will help heal bones and tissue structures faster. Just wondering. Camille Herron did some research study I think on this

My recommendation is Netflix. Lay on the couch and watch Netflix for however long it takes to heal. From what you've said it seems pretty clear to me that this cross-training, elliptical, etc. that you are doing to try to maintain some fitness is simply too much for it to heal. I do next to nothing when I'm injured on the theory that this is the fastest way to get back to running. I know it is super frustrating to allow yourself to lose so much fitness, but I think you need to accept the reality of this injury and stop stressing it. Take up a new hobby for a few months. Your fitness will come back eventually once you are fully healthy and can train injury-free again.

BrokenLeggy wrote:

She read an MRI taken on 4 January, and it still showed a clear fracture line. Although the fracture itself was smaller than on my 3 November MRI, it was surrounded my worsened edema.

Meanwhile, an X-ray taken today showed massive bulges on the bone on both the medial edge and posterior side. The orthopedist theorized that it was likely edema, new bone, or a combination of the two. She recommended that I wear a boot walking around for a couple of weeks and continue taking time off.

Ask your doc to refer a DXA scan which will show any bone density issues that might be prolonging healing as well as body fat sufficiency (especially since you also mentioned RED-S).

15+ weeks isn’t abnormal as the typical times are averages on a distribution with a long tail, and it is not unusual for edema to stick around for longer. My follow-up MRIs, for example, were similar and just showed a muted T1 hypointense irregular linear signal (the hairline) with continued extensive edema even after two+ months of the first MRI and closer to three months after the when the injury first happened, but my pain had long gone by then. Your pain ought to be significantly lessened in 15 weeks, has it?

George Smith wrote:

What you are describing is what we called Shin Splints back in the 1950-1970 range of time.

A visible stress fracture on an MRI is different from shin splints, which are microtears and damage to the bone. They’re still commonly talked about. A stress fracture can progress FROM shin splints if not properly addressed, but you’ve hit a whole other level of injury once a fracture line is visible on imagery (vs just indicators of inflammation).

The methodology here might be fine for true shin splints, which you can run through. It doesn’t seem advisable if you have a true fracture.

I had a tibial stress fracture right below my knee. The residual pain lasted for about six months. I started running after about 8 weeks after the doctor gave me green light. But the pain/discomfort stayed for quite a while and it felt scary sometimes. But eventually, I was back to normal.

ViperDom wrote:

appleapple wrote:

sheesh with multiple previous tibial stress fractures it sounds like you should probably examine your running form.

+1

3D laser gait analysis. Do it.

^This! Helped me immensely after I had a SF in my cuboid.

When I had mine, I stayed off the eliptical for the first 5 weeks. I felt fit enough after crushing the bike and pool. FWIW, I went into the stress fracture at 55mpw, 16:00 5k PR to a 15:15 on an indoor 200. Head up!

This.

Take time, rest well. Cross train in the pool. Look at nutrition closely. You’ll be back. Stay positive.

George Smith wrote:

What you are describing is what we called Shin Splints back in the 1950-1970 range of time. I managed to set national and provincial records once I learned how to get rid of them so that they never came back because I was aware of the symptoms before they interfered with my running once I had healed them for good. I'm still running (very slowly, but then I'm 78). No short cuts work. Being smart does.

Interesting. I got shin splits when I first started training seriously as a junior in college. They got worse and worse. Then I stumbled across a cure. They went away and never came back. I've been engaging in the same cure for the past45 years as a runner. It works.

After every run, back then, I pulled on white cotton athletic socks and filled each of them with most of a tray of ice cubes. The cubes should be lined up, in two rows, on the medial (inner) tibial side--i.e., where the line of pain is.

I'd let the ice sit there for 20 minutes, right on my flesh. Then remove. Don't take a hot shower right away. Let the cold sit there, then ebb.

My shin splits went away in about two weeks. Done. I continued to ice. I still ice. I only do it for 10 minutes now, and I only need to do it on my right leg. I use crushed ice, and I push it down past the ankle to where the medial tibial tendon attaches: that bump.

Here's another thing: at one point about 20 years ago it seemed that the ice was no longer needed. So I stopped. And I developed a stress fracture on the right side. I never had it diagnosed, but it was a doozy. I was limping like a mofo. Ice didn't really help. I mean I iced, but it didn't go away in two weeks! I stopped running for 10 weeks. ZERO CROSS TRAINING. I tried elliptical once or twice, but I could just tell I wasn't helping the healing.

Eventually I was okay. But when I started running, I iced that R medial tibial side. I still do that. And the stress fracture, or medial tibial tendonitis, or very bad shin split, or whatever the hell it was, stays away. I'm fine. I can pound up and down hills. As long as I ice that side, I'm fine. If I don't, my arch starts hurting and the shin starts tweaking.

One more thing: when you do get to the point where it's pretty much healed, you may still have occasional phantom pains in that spot. This will freak you out, because you obviously don't want to kill off another three months with another stress fracture. But just know that even when the x-rays show full healing, and you start to run again, you may have a few little ghosty tweaky feelings there. They will eventually go away.

My suggestion: stay away from the elliptical. Just stay away. Wear the recommended boot for a couple of weeks. Forget about your fading fitness. You'll get it back once you're fully healed, but you can't do a damned thing to GET fit until you're fully healed. Once you start running again, take it easy. And, crucially, use my ice-trick. Pull on a mid-calf sock and shove some ice cubes or crushed ice in there and let it sit for 10 minutes.

IT IS YOUR INSURANCE POLICY. Your tibia will thank you.