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Health Services

Tibial Stress Fractures/Shin Splints

Diagnosis/Definition

  • Inflammation due to repetitive stress of the broad proximal portion of any of the musculotendinous units originating from the tibia. 
  • Symptoms of overuse injury are precipitated by initiation of training, an increase in training intensity or a change in surface or equipment.  The mechanism for overuse injury is overload of forces on the muscle, tendon, or bone, which leads to an inflammatory reaction.

Initial Diagnosis and Management

  • History and physical examination.
  • Rest of the affected muscle-tendon bone unit.
  • Use of crutches, bracing or casts as needed.
  • NSAIDs may be beneficial
    • Adults - 200 to 400 milligrams (mg) every four to six hours as needed for up to 2 weeks.  Example: Ibuprofen
    • Take tablet or capsule forms of these medicines with a full glass (8 ounces) of water.
    • Do not lie down for about 15 to 30 minutes after taking the medicine. This helps to prevent irritation that may lead to trouble in swallowing.
    • To lessen stomach upset, these medicines should be taken with food or an antacid.
  • Encourage active range of motion.
  • Appropriate restrictions of activity.

Ongoing Management and Objectives

  • Rest is individualized depending upon severity.
  • Immobilization should be utilized if simple weight bearing (walking) is painful.
  • Obtain X-rays of both legs if pain occurs with simple weight bearing.
  • Obtain bone scan for chronic shin splint pain.
  • The duration of rest varies from 1-2 days for mild shin splints to several months for severe stress fractures. 
  • Ice for 10 to 15 mins with hourly reapplication.
  • Elevate leg frequently with compressive wraps.
  • Slow and sustained active stretches when no pain is present.

Indication a profile is needed

  • Any limitations that affect strength, range of movement, and efficiency of feet, legs, lower back and pelvic girdle.
  • Slightly limited mobility of joints, muscular weakness, or other musculo-skeletal defects that may prevent moderate marching, climbing, timed walking, or prolonged effect.
  • Defects or impairments that require significant restriction of use.

Specifications for the profile

  • Weeks 1-8
    • No running and jumping
    • No rucking
    • Walking to tolerance
    • Swimming recommended
  • Weeks 8-12  progress profile to bike/run at own pace and distance.

Patient/Soldier Education or Self care Information

  • See attached sheet.
  • Demonstrate deficits that exist
    • Describe/show soldier his/her limitations.
  • Explain injury and treatment methods.
    • Use diagram attached to describe injury, location and treatment.
  • Instruct and demonstrate rehab techniques.
    • Demonstrate rehab exercises as shown in attached guide.
    • Warm up before any sports activity.
    • Participate in a conditioning program to build muscle strength.
    • Do stretching exercises daily.
  • Ask the patient to demonstrate newly learned techniques and repeat any other instructions.
  • Fine tune patient technique.
  • Correct any incorrect ROM/stretching demonstrations or instructions by repeating and demonstrating information or exercise correctly.
  • Encourage questions.
    • Ask soldier if he or she has any questions.
  • Give supplements such as handouts.
  • Schedule follow up visit with primary care.
    • If pain persists or worsens.
    • The pain does not improve as expected.
    • Patient is having difficulty after three days of injury.
    • Increased pain or swelling after the first three days.
    • Patient has any questions regarding care.

Indications for referral to Specialty Care

  • To Physical Therapy: Routine referral for rehabilitation.
  • In the rare instance when there is a visible fracture line on plain radiographs – orthopedic consultation is appropriate.

Referral criteria for Return to Primary Care

  • Completed specialty care.
  • For MEB if symptoms persists for > 6 months despite above treatment.
  • MEB to be initiated by primary care and referred to Tripler Army Medical Center orthopedics MEB and peblo for completion.
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