TIBIAL STRESS FRACTURE AND PHYSICAL THERAPY TREATMENT

A tibial stress fracture is a crack or micro-fracture in the lower shinbone. If the amount of force is too great for the Tibia to handle, a person may develop a tibial stress fracture. This causes instability in the bone, severe pain and difficulty walking without a severe limp. Long distance runners, military personnel and other activities that  “over-load” the lower extremities can cause a stress fracture over time.

Understanding the Tibia

Sometimes called the shinbone or shankbone, the Tibia is a long bone that is one of the strongest weight-bearing bones in the body. It has a hard outer shell, it is compact, and has a sponge-like inner portion or cancellous bone.   The Tibia is a living connective tissue capable of “remodeling” or repairing itself.  The Osteoblast is a bone cell that is responsible for “making” more bone. If the degradation of the bone due to stresses and forces is greater than the ability of Osteoclast to produce more bone and “remodel” it the bone will be compromised and can suffer a break.  The stress fracture is an example of this situation.

Diagnosing a Tibial Stress fracture

Healthcare professionals will conduct special tests to positively confirm the existence of the fracture site. The site will be point tender.  It might be hot to the touch and will cause the patient to limp when they are attempting to walk or run.   Regular x-rays are usually performed, but they might not be accurate in the acute phase of the injury.  The most accurate way to diagnose a stress fracture is via a MRI.

Treatment for a Tibial Stress Fracture

After the orthopaedic doctor makes the formal diagnosis via the MRI, the patient is usually referred to Physical Therapy.  The Physical Therapist implements a multifaceted treatment program, beginning by controlling the inflammation and pain.

Reducing Inflammation and Pain

The use of anti-inflammatory medications is not recommended because they can inhibit bone healing.  An active inflammation process causes the pain, and this can be best addressed with an icing program.   The use of ice on a regular basis will reduce the pain by slowing down the nerve conduction of the pain signal and reduce the heat in the tissue which acts as a catalyst to the inflammatory process.   The Physical Therapist will use a variety of modalities to enhance blood flow to the injury site and help to decrease the pain level.  Weight bearing and non-weight bearing exercises might be prescribed to accomplish the same thing.

Strengthening Musculature Around Injury

When appropriate, the Physical Therapist will increase the intensity of the exercise regimen to help to increase the strength of the musculature that surrounds the injury.  The muscles are responsible for moving the joints, but have a secondary function of absorbing some of the stress and forces  that are placed through the bone when the injured person is weight bearing.  In the absence of enough strength, the force and stress through the bone might be too great and a stress fracture might occur.

Seeing a Physical Therapist is easy and does not require a visit to a doctor.  If your insurance company requires that you have a referral for a specialist’s visit, then you will have to get it from your doctor.  If you do not need a referral, simply call your Physical Therapist’s office and make an appointment.  You will be evaluated and treated and if they assess the need for more testing they can help you with the process.

Stress fractures in the Tibia are common injuries in people that experience a constant pounding in their lower extremities.  Runners, military personnel and others that walk, march, jog or run constantly are the most susceptible for this type of injury.  If the proper training principles and regimen are performed many of these injuries can be avoided.