Stress Fracture or Shin Splints? How to tell the difference

In time for running season, here’s what you need to know about how to prevent and treat shin splints and stress fractures.

These common overuse injuries are usually caused by training errors and running too much, too quickly. Poorly fitting footwear, running on hard surfaces, and a lack of flexibility and muscle imbalance can also play a role.

The lower leg pain of shin splints is caused by inflammation and micro-tears in muscular attachments and tissue around the shin. A stress fracture is a tiny crack in the bone and usually occurs in the lower leg, hip or foot.

I see many runners in my primary care sports medicine practice at the University of Chicago Medicine. To make the diagnosis, I start with with a complete history from athletes about their running routine, including mileage, intensity, pace, terrain and footwear, as well as any recent changes in training regimen.

Shin splints

This condition — medial tibial stress syndrome, or MTSS — is common among new runners, runners returning to the sport after an extended break and runners who have rapidly increased their mileage and training intensity.

Symptoms: Lower leg pain while running, especially at faster speeds. Shin splints don’t usually cause pain while walking or during daily, non-running activities. The pain often goes away once running is stopped.

Treatment: I start runners with rest, ice and anti-inflammatory medication for pain. Stretching and low-impact activities that don’t cause pain, like swimming and cycling, can help maintain strength and conditioning. Sometimes, decreasing running frequency, distance and intensity by half can improve symptoms while allowing somone to keep running.

I advise patients to return to their running program slowly, increasing the load by no more than 10 percent per week. Flexibility exercises and strength training are also very important as part of the comprehensive treatment plan and to prevent recurrence.

Stress fractures

Stress fractures result from cumulative strain on the bone, without enough time for proper recovery. Eventually, the bone weakens and becomes susceptible to tiny cracks, or stress fractures.

Symptoms: Pain while running, but over time, runners also will experience pain while walking and doing other activities. If the stress injury is significant, pain may persist at rest, too. Pain is often localized in one spot, rather than a spread out over a small area, as with shin splints.

Treatment: Runners with a stress fracture have to stop running until it heals. To ensure proper healing, I often place the runner in a walking boot and may even add crutches. Anti-inflammatory medication is used for pain. After several weeks, runners can gradually return to pain-free activities, while addressing risk factors that may have contributed to the stress fracture. This includes a proper diet with enough calories as well as calcium and vitamin D supplementation to optimize bone health.

Preventing overuse injuries

Here are some ways you can prevent shin splints and stress fractures:

• Don’t do too much, too quickly. If you’re new to running, start with a run/walk regimen. Consult a physical therapist, coach or personal trainer to set up a smart running program.
• Don’t run through pain.
• Slowly ramp up your training regimen, adding 10 percent maximum (mileage, intensity) per week.
• Cross-train with a focus on strength and resistance training, especially for the core, hips and legs.
• Maintain overall flexibility with a good stretching program.
• Ice after runs if you are sore, and avoid hard surfaces when possible.
• Properly fitting running shoes are essential. Orthotics also may be helpful.
• Ensure a well-balanced diet with adequate calorie intake for your activity level and target a healthy body weight.