After enduring the challenges of a cold and snowy winter, late spring and early summer is the time of year when long distance runners ramp up their training in preparation for the some of the best half and full marathons in the fall: Steamtown, Philadelphia, New York, Marine Corps in DC to name a few. But, runners beware; overtraining can lead to stress fractures.
I would like to introduce this topic with some marathon history. In 490 B.C. Athens was under attack by the Persians and was outnumbered more than two to one. The Athenians fought bravely and defeated the enemy in the town of Marathon to keep the intruders 26 miles away from their families in Athens. To keep the anxious citizens of Athens calm, leaders immediately ordered a foot soldier, Phedippides, to the capital to share the news. Phedippides ran, in full armor, for 26 miles from Marathon to Athens, delivered the message and died immediately. Now, people do the same thing of their own free will!
In the modern age, marathon and recreational runners enjoy testing their mental and physical stamina in pursuit of fitness and wellness. If not careful, many runners (and other competitive athletes) will develop pain in their shins (shin splints). Unfortunately, in many of these well-intended athletes, this problem can lead to a much more severe and advanced problem with shin splints called a stress fracture. Some very good athletes have been hindered by this problem.
A stress fracture is fatigue damage to bone with partial or complete disruption of the cortex of the bone from repetitive loading. While standard x-rays may not reveal the problem, a bone scan, and MRI will. It usually occurs in the long bones of the leg, mostly the tibia (shin) but also the femur (thigh) and foot. Occasionally, it occurs in the arm.
10-21% of all competitive athletes are at risk for stress fractures. Track, cross country and military recruits are at greatest risk. Females are twice as likely as males to have a stress fracture. Other athletes at risk are sprinters, soccer and basketball players, jumpers, ballet dancers are at risk in the leg and foot. Gymnasts are also vulnerable in the spine while rowers, baseball pitchers, golfers and tennis players can experience the fracture with much less frequency in the ribs & arm.
The problem is much more prevalent in weight bearing repetitive, loading sports in which leanness is emphasized (ballet, cheerleading) or provides an advantage (distance running, gymnastics).
Stress fractures usually begin with a manageable, poorly localized pain with or immediately after activity such as a shin splint. Over time, pain becomes more localized and tender during activity and then progresses to pain with daily activity and at rest.
Visit your doctor regularly and listen to your body.
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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org
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Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.