Stress Fractures, Bone Bruises, and Shin Splints

There are many different types of injuries that can happen to bones in the human body. A fracture represents a complete break in which the pieces of bone completely separate. This injury may occur as a result of direct trauma to the bone, or from other factors such as advanced age or a metabolic bone disease such as osteoporosis. However, there are other bone injuries that can be just as problematic (or even more so), such as stress fractures, insufficiency fractures, bone bruises, and shin splints. Although these types of bone injuries do not represent a complete break of a bone, they can cause pain for many weeks or even many months and can interrupt all types of activities. These injuries can be difficult to diagnose and magnetic resonance imaging (MRI) is usually required to determine the source of pain and magnitude of the problem.

Most stress fractures and shin splints are associated with sports and military training. A sudden or rapid increase in training frequency, intensity and/or duration, or a change in the training surface are well-known causes of these injuries. This represents the “too much, too fast” training regimen in which errors may occur from poor technique and/or fatigue. These problems occur in patients with normal bone. In contrast, insufficiency fractures occur in bones that are abnormally weak due to a disease such as osteoporosis or other conditions that changed the normal strength and mineral content of the bone. These types of fractures, which are actually small cracks, occur with just normal loads placed on bone. It is important to diagnose and treat these injuries because, if left untreated, they may progress to a complete fracture or not completely heal.

Bone bruises usually occur from a traumatic injury and frequently accompany another major problem such as a knee ligament tear or dislocated kneecap. They can only be detected on MRI and may be painful for a long period of time. The majority of anterior cruciate ligament tears are accompanied by bone bruises and, although the bruises vary in size and severity, they may hinder the normal healing and recovery process. Bone bruises may also occur as a result of a direct blow to a bone, such as a kneecap hitting the dashboard in a car accident.

After treating patients for nearly 4 decades with stress fractures, insufficiency fractures, bone bruises, and shin splints, we decided to write this eBook to try to help individuals understand these injuries and how they should be treated. This eBook provides information on basic anatomy and function of bones, what causes bone injuries and where they occur, how they are diagnosed and treated, potential problems that may happen if they are left untreated, and tips for prevention.

About Sue Barber-Westin

Sue Barber-Westin has been a member of the Cincinnati Sportsmedicine Research and Education Foundation staff since its establishment in 1985 and serves as Director of Clinical and Applied Studies. She has co-authored over 120 articles in peer-reviewed medical journals and textbooks, focusingon the clinical outcome of various knee operative procedures and on neuromuscular indices in young athletes. Sue is the associate editor, along with editor Dr. Frank Noyes of the orthopaedic textbook, “Noyes Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes” published in 2009. In 2004, Sue and Dr. Noyes were members of the research team that won the Clinical Research Award from the Orthopaedic Research and Education Foundation, the highest clinical research honor bestowed annually in orthopaedics.