Definition/Background of Tibial Stress Fracture:
Tibial stress fractures are caused from repetitive overuse, causing an accumulation of microtraumatic forces up the tibia. The athlete will present with point tenderness and localized pain with activity that subsides with rest. Predisposing factors include running on hard surfaces, lower limb malalignment, and hyperpronation. Muscle fatigue and weakness may decrease the ability of the surrounding muscles to absorb shock. This occurs in up to 20% of the running population (Gore).
Treatment Protocol for Tibial Stress Fractures:
Reduce weight bearing physical activity. Weight bearing exercises should be avoided for a minimum of 2-4 weeks. Swimming and cycling are recommended instead.
Biomechanical Exam: All muscle groups of the leg are checked to figure out if muscular imbalances are causing the athlete to hyperpronate or supinate. Possible causes could be weak gluteus medius, tight iliotibial tract, weak calf muscles, or a tight piriformis.
Gait/Shoes: It is important to make sure that the shoe is properly fitted for the athlete to avoid putting extra stress on the tibia, and to decrease impact, torsional, and pronatory forces.
Orthotics: If the patient is hyperpronated, he/she should wear orthotics to correct for the over-pronation and reduce impact forces.
Chiropractic Care for Tibial Stress Fractures:
Chiropractic Evaluation: Torsional and pronatory forces on the tibia can be caused from problems at the hip or the foot. Hip problems include weak external rotators (piriformis) or improper or lack of motion in the pelvis and lumbar spine. Foot problems include weak tibialis anterior and posterior, as well as structural issues and improper movement of the ankle joint.
Manipulation: Manual joint manipulation is used on any joints that are misaligned.
Therapies: Ice massage will be done to initially decrease swelling.
Active Release Technique: Soft tissue treatment to break up adhesions in the muscles that develop from repetitive stress.
Rehabilitation: To strengthen weak muscles.