Orthopedics - Tibial Stress Fractures/Shin Splints
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Tibial Stress Fractures/Shin
- 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
- 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.
- 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
- Appropriate restrictions
Ongoing Management and Objectives
- Rest is individualized
depending upon severity.
- Immobilization should be
utilized if simple weight bearing (walking) is painful.
- Obtain Xrays 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
- 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
- See attached sheet.
- Demonstrate deficits that
- Describe/show soldier
- Explain injury and
- Use diagram attached to
describe injury, location and treatment.
- Instruct and demonstrate
- Demonstrate rehab
exercises as shown in attached guide.
- Warm up before any
- Participate in a
conditioning program to build muscle strength.
- Do stretching exercises
- Ask the patient to
demonstrate newly learned techniques and repeat any other instructions.
- Fine tune patient
- 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
- Schedule follow up visit
with primary care.
- If pain persists or
- 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
- Completed specialty care.
- For MEB if symptoms
persists for > 6 months despite above treatment.
- MEB to be initiated by
primary care and referred to TAMC orthopedics MEB and peblo for completion.