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Understanding the etiology of the posteromedial tibial stress fracture

PainSci » bibliography » Milgrom et al 2015
Tags: etiology, shin pain, pro, leg, limbs, pain problems, overuse injury, injury, running, exercise, self-treatment, treatment

Two articles on PainSci cite Milgrom 2015: 1. Is Running on Pavement Risky?2. Shin Splints Treatment, The Complete Guide

PainSci notes on Milgrom 2015:

Milgrom et al. used a strain gauge stapled to a volunteer’s tibia •cringe!• to show that the forces imposed on the shin by normal running are generally below the threshold at which we would expect them to directly cause fractures. However, they did measure more force in activities that involve greater shear strains (that is, bone resisting bending rather than longitudinal compression), especially stair jumping and vertical standing jumps. Sheer strain could explain the oblique stress fractures often seen in young adults. Thus it is runners who include a lot of jumps and stairs that are potentially at greater risk for stress fractures than just running.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Previous human in vivo tibial strain measurements from surface strain gauges during vigorous activities were found to be below the threshold value of repetitive cyclical loading at 2500 microstrain in tension necessary to reduce the fatigue life of bone, based on ex vivo studies. Therefore it has been hypothesized that an intermediate bone remodeling response might play a role in the development of tibial stress fractures. In young adults tibial stress fractures are usually oblique, suggesting that they are the result of failure under shear strain. Strains were measured using surface mounted unstacked 45° rosette strain gauges on the posterior aspect of the flat medial cortex just below the tibial midshaft, in a 48year old male subject while performing vertical jumps, staircase jumps and running up and down stadium stairs. Shear strains approaching 5000 microstrain were recorded during stair jumping and vertical standing jumps. Shear strains above 1250 microstrain were recorded during runs up and down stadium steps. Based on predictions from ex vivo studies, stair and vertical jumping tibial shear strain in the test subject was high enough to potentially produce tibial stress fracture subsequent to repetitive cyclic loading without necessarily requiring an intermediate remodeling response to microdamage.

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