Joe A Shaw PA-C - 1/30/2008

Question
I have just started running. I am a very new beginner, and started out just walking, and progressed up to a run for 1 minute, walk for 3 after about 3 weeks. I started to get pains in my shins that seemed like shin splints at first, but my left shin had one spot that was much more painful, and would be sore and tender after exercising. This pain would start during running and not stop until I stopped running. It never hurts when just walking. After reading about this in medical and sports journals (I am a librarian with access to reliable information) and talking to other runners, I wonder if I have a stress fracture on that shin. About 5 years ago, I fell and landed with my shin on a tile ledge. My question is, can I treat this as a stress fracture and not see a doctor if it heals with rest? If so, how much time should I wait to start walk/running again?

Answer
Julie,
You can treat this as a stress fracture, however, if it continues another 4 wks I would get an evaluation, as it should always be ruled out in a case of lower leg pain. I have read rare cases where there may be an abnormal bone growth/benign bone tumor etc..that is causing the pain in which an xray would diagnose. I doubt hitting it yrs ago has anything to do with it?
 It probably is just shin splints ( posterior tibial tendonitis/medial tibial stress syndrome )The pain usually occurs in the lower third of the lower leg and more medial (or towards the inside of shin)
With stress fractures of the tibia you can have pain at the same areas of shin splints and higher. Xrays are usually negative initially but may show healing changes in 4 wks or so. A bone scan is best. The treatment for both is to avoid running...sometimes it can be guided by f/u xrays or bone scans as to the healing process...but from a practical standpoint you just have to gradually start training again and see how it goes for either one. Of course you need to stretch etc..you need to avoid running on hard surfaces,get the best shoes you can afford and make sure your foot and heel are striking the ground properly..ie not pronating or supinating(in which orthotic inserts can help with this)