Runners old and new experience pain and plenty of it! So, when that shooting pain in your shins just won’t go away, how do you know if it’s just shin splints or something more serious? Sometimes ignorance is bliss. Sometimes it isn’t. And I would argue that in the case of a stress fracture, ignorance is not bliss. So how do you know? How can you tell if it’s shin splints you feel or a stress fracture?
Do Shin Splints and Stress Fractures Feel Different?
No, not really. So, if shin splints and stress fractures don’t feel any different how do you know which injury it is? Both shin splints and stress fractures are painful overuse injuries with stress fractures being much more rare. Here are some differences in symptoms to help you distinguish between the two:
- Generalized pain and tenderness over an area
- May have some swelling
- Pain during activity, mild pain before/after activity
- Presents bilaterally (on both legs)
- Localized pain (can pinpoint specific trouble area)
- May have some swelling
- May have some bruising
- Severe pain before and after activity, moderate pain that increases during activity
- Usually only presents on one leg
What If I Don’t Have All The Symptoms?
Just because you don’t have all the symptoms, doesn’t mean that you can rule out any diagnosis quite yet. They signs and symptoms of an injury just direct you in a general direction; the way to determine which injury you have is through tests and treatment options.
Vibration helps determine if you have a stress fracture because it will cause the crack in the bone to vibrate (which is painful). So, borrow that music savvy friend’s tuning fork and get testing. Tap the end with two prongs on a surface to get it to vibrate (the edge of a table works great). Once it’s vibrating, hold the end with only one prong on the most tender point of your shin. A positive finding for this test is if the vibration causes a lot of pain deeper in your leg (not on the surface). I recommend performing this test multiple times – it’s easy to get a false negative. Another form of vibration that’s great for diagnosing a stress fracture is ultrasound. With the help of an operator (someone who knows what they’re doing) apply ultrasound at the lowest settings and increase the intensity if there is no pain. A positive finding will produce pain deep within the bone. You can also try to produce vibration by tapping at the point of pain.
This test requires no equipment, but is less accurate than the vibration test. Standing on the injured leg, jump repeatedly. A positive test would be increased pain and weakness to the point where you cannot fully perform the test.
Diagnose Through Treatment
If your injury does not improve with rest, ice, compression, NSAIDS, arch strengthening exercises, and non-weight bearing activities it is likely that you have a stress fracture, at which point a doctor’s visit is in order. I would like to point out though that stress fractures are pretty hard to identify and some forms of imaging only show a fracture once it begins to heal. So, making an appointment at the first sign of pain may be a waste of money. Begin with treating your shin pain first and if the pain persists, then make an appointment to figure out the root of the problem – it will be more likely that you will have definitive results.