by Dr. Tim Maggs, © November 1999
Q: My 14-year-old daughter is being treated for a stress fracture in her right tibia, mid shaft. She is a competitive runner, having run for 6-7 years. This is her first year in high school and they run 2.5 miles in cross country. Over the summer, her training consisted of increments in mileage to where she was running around 30 miles per week once the season started. She first began complaining of pain in the shin, but was still able to run. She ran hard for two races after her initial complaint and thereafter was unable to even jog without pain.Diagnosis: Stress Fracture.
This situation is all too common, as this condition is typically found in adolescent runners. During these prime growing years, we need to implement a better management of the biomechanics and muscular systems of our young runners. We should never wait for symptoms to move us, as symptoms are a clear indication we've pushed the envelope too far. With competition as fierce as it can be in junior and senior high school students, we should at least give these young athletes a clean bill of "structural" health before they attack the season.
Shin Splints and Stress Fractures
Shin splints and stress fractures are typically a result of repetitive motion injury in one or more supportive muscles in the lower leg. Very often, these muscles work without ever fully recovering before being asked to perform again. All athletes use similar muscles as they participate in sport specific movements, and runners are subjected to this same scenario. Unfortunately, young runners seem to have lower leg problems more frequently than older runners, probably a mere result of growing and having a musculo-skeletal system which is not yet fully developed.
Also, our sports medicine industry doesn't provide pre-season structural exams, which would pick up imbalances, structural defects or any other causative factors that influence the onset of these type conditions. All kids should be biomechanically evaluated before, during and after the season because our structures are like our fingerprints, totally unique. The only way anyone will ever know who is predisposed to injuries or who needs structural rehabilitation prior to a blowout is with this evaluation.
A thorough history should be taken to determine pre-existing conditions, prior traumas or any other influencing factors. The evaluation should then consist of a leg-length check, a visual exam of the athlete in the standing position (ear heights, shoulder heights, shoulder blade heights, hip heights, arm lengths, etc.) The spine should be checked for any obvious, gross curvature problems. Range of motion of the entire spine should be done to rule out fixations and abnormal motion. Pulses, respiration and blood pressure should be taken.
The evaluation should also check for range of motion of the hip joints, the knee joints and the ankle joints. The feet should be checked for pronation, supination or any other abnormalities. Shoes should be checked for abnormal wear and tear. Muscle strengths should be checked, right vs. left and front vs. back. Reflexes and sensory tests would round out the exam. If possible, low back x-rays should be taken in the standing position to determine the angle of the pelvis, the weight bearing line through the low back and any other supportive information, which can be seen on an x-ray.
Now that the young athlete is suffering with either shin splints or a stress fracture in the lower leg, crisis care is needed vs. preventative care (if a pre-season evaluation had been done). The first thing the athlete needs to do is develop a strategy, which will include giving the leg time to heal. Reduce or eliminate workouts until acuteness is down. Ice treatments should be used 4-5 times per day, with a wrap around the involved area. The repetitive motion of the involved muscles has most likely produced a tight, non-compliant muscle, which has accumulated toxins and a deprived blood flow. The shortening of this muscle is the cause of the increased tension and slow recovery of the muscle after workouts. A deep pressure massage needs to be done multiple times per day to this involved muscle. It's easiest for the athlete to perform this on himself or herself, and applying some lotion under the thumbs makes for a more comfortable treatment. This should be done two or three times per day. Proper nutritional supplementation, to promote healing and reduce inflammation, is also a benefit.
Finally, getting that biomechanical exam is still a must. Just because it is now post-injury doesn't mean that this critical information isn't needed. The future will hold far fewer problems if weak, imbalanced and stressed areas of the body can be detected before injuries occur. With a proper evaluation, correct treatment and rehabilitation and management of the program, all athletes can greatly reduce and minimize future problems such as horrid shin splints and stress fractures.