1.) X-Rays are ~20% likely to show an indication of a stress fracture. Therefore, they are moderately useful for showing a positive, but are not effective in truly ruling out a stress fracture.
2.) The pain is acute (<1 inch spot on the tibia), and in an area where running related stress fractures are most common.
3.) Pain continues to be noticeable while walking - closer to a .5 on a scale of 1-10, but noticeable nonetheless.
4.) If it were MTSS, the pain would be all along the shin with no swelling - I have minor swelling in the <1 inch area where I have pain. According to aafp - "Medial tibial stress syndrome can be distinguished from tibial stress fractures by non-focal tenderness (diffuse along the mid-distal, posteromedial tibia) and a lack of edema."
So while a decent amount of evidence seems to point towards a stress fracture - I still don't know for sure. And after researching for an obsessive amount of time...I stumbled upon this:
After seeing the attachment points of the tibial tendon on that video, I took a look into my trusty training spreadsheet - and back in mid November I started to experience pain in my inner right ankle. It seemed likely that it was a mild case of tendonitis, so I wasn't overly alarmed. By early December the ankle issue had run it's course, but I was starting to experience some tenderness in my shins. It felt like a familiar pain that I had previously trained through, so thus I continued running and started taking ibuprofen and icing. This tenderness gradually increased to a legitimate pain, and I reduced my mileage from 63 to 43/42/34/30 - and then finally zero.
However, during this time I went for a sports massage on two occasions to try and take care of any tightness that might be causing stress on my shin. The first massage occurred in December, and the therapist found an extremely tough knot on the arch of my right foot. IMO - it was on the navicular bone (as referenced in the youtube clip). I used a golf ball for about a week+ and the knot was taken care of. I had the second massage a few weeks later after the shins continued to worsen, and at that time the therapist found a really painful knot deep in my right calf and worked that out. The massage provided temporary relief, but only for that day. So since the video highlights both of the navicular bone and the middle of the calf as points of attachment for the posterior tibial tendon...maybe it could be really bad tendonitis?
In the end, I still think it's a stress fracture, but I really don't know. And so the best thing I can do is to continue to cross train and wait until it feels better.
Well...not quite! During the obsessive research, I also stumbled upon this! I researched how a LIPUS (low intensity pulsed ultra sound) device works, and basically - it's a bit above my head...But the results from independent research seemed to indicate that it could significantly reduce recovery time. So in my continued effort to be my own health advocate I thought the best place to go would be....craigslist! After a bit more research I purchased the Exogen 4000+ and have added that to my recovery plan.
I'll continue pool running, swimming, taking some additional calcium, calf raises, biking, foot strengthening, and the Myrtl Routine - and hope that the bone stimulator works as well. This time off has me itching to get back to marathon training, and frankly - worrying that I'm missing important training segments as well. I hope that because I started training in early December I'll be able to maintain any gains through cross training and come back 100% healthy and ready to go...preferably sooner rather than later.
