What is the treatment for a Fredericson grade 2 stress response in the bilateral shins?

From the Guidelines

The treatment for a Fredericson grade 2 stress response in the bilateral shins involves a comprehensive approach focused on rest and gradual return to activity, with relative rest for 2-4 weeks and a structured progression of load, as recommended by recent studies 1. The goal of treatment is to reduce morbidity, mortality, and improve quality of life by preventing progression to more severe stress fractures and promoting bone healing. Key components of the treatment plan include:

• Relative rest for 2-4 weeks, avoiding high-impact activities while maintaining fitness through low-impact exercises like swimming or cycling
• Pain management with ice application and over-the-counter NSAIDs such as ibuprofen (400-600mg three times daily with food) for short-term use
• Biomechanical factors should be addressed through proper footwear with adequate shock absorption and possibly custom orthotics if indicated
• Physical therapy incorporating strengthening exercises for the lower leg muscles, particularly the tibialis anterior and posterior, as well as stretching of the calf muscles
• Gradual return to activity should follow a structured progression, with the rate of progression individualized based on risk and grade of the tibial BSI as well as the level of the athlete, as suggested by 1
• Nutrition optimization with adequate calcium (1000-1200mg daily) and vitamin D (600-800 IU daily) intake supports bone healing It is essential to monitor for symptom recurrence and adjust the treatment plan accordingly, with a focus on preventing recurrence and promoting long-term bone health, as highlighted by 1.

From the Research

Treatment for Fredericson Grade 2 Stress Response

The treatment for a Fredericson grade 2 stress response in the bilateral shins involves a combination of conservative management and modification of activities.

• The primary goal is to reduce stress on the affected area and allow the bone to heal.
• This can be achieved through relative rest, avoiding activities that exacerbate the pain, and modifying training programs to reduce impact-related forces 2.
• Imaging studies, such as magnetic resonance imaging (MRI), may be necessary to confirm the diagnosis and assess the severity of the injury 3, 4.
• Calcium and vitamin D supplementation may be beneficial in promoting bone health and reducing the risk of further stress injuries 5.
• A gradual and progressive return to activity is essential to prevent recurrence and allow the bone to adapt to increasing loads 2.

Management of Bilateral Shin Pain

In cases of bilateral shin pain, it is essential to consider the possibility of stress reactions or fractures, especially in individuals with a history of prolonged use of anti-resorptive medications such as denosumab 4.

• A thorough evaluation, including imaging studies and clinical assessment, is necessary to determine the underlying cause of the pain.
• Management may involve nonweight-bearing immobilization, physical therapy, and modification of activities to reduce stress on the affected area 6.
• A high index of suspicion is essential to avoid delayed diagnosis and optimize outcomes in cases of high-risk stress fractures 6.

Prevention of Stress Injuries

Prevention of stress injuries is crucial, especially in long-distance runners.

• This can be achieved through proper training program design, reducing impact-related forces, and increasing the strength and endurance of local musculature 2.
• Addressing malalignments and abnormal movement patterns is also essential in preventing stress injuries 2.
• Early detection and intervention are critical in preventing the progression of stress reactions to stress fractures and promoting a safe return to sport 5, 6.