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The Tibia and Running

The most frequently injured bone in runners.

Runners - a commonly injured bone (think stress fracture or stress reaction) is the tibia (shin bone). A research article recently asked an important question: does changing running equipment or running technique change the load (force) in the tibia. The tibia takes on an immense amount of load/force with running and makes up 50% of all bone stress injuries in runners.

Their key points:

Five Factors that increased load;

1) Running barefoot

2) Running in unfamiliar minimalist shoes

3) Running in motion control shoes

4) Running with an increased stride length

5) Running at an increased speed.

Avoiding these conditions when recovering from a tibial stress injury was recommended. Some takeaways from my own clinical experience are to get patients into neutral shoes. I like to consider shoes with a heel drop of </=6mm. I have people keep their easy runs very easy. We can focus on keeping a higher cadence and perhaps improving their landing pattern or if someone has a lower cadence gradually increasing it over time.

Two Factors that decreased load

1) Running on a treadmill

2) Targeted biofeedback

These are strategies that should be implemented if recovering from a tibial bone stress injury. Consider integrating runs on a treadmill. Examples of biofeedback is using visual cues such as video gait retraining or up-tempo music to improve your foot turnover or landing pattern.

Need Help?

Consider reaching out to a Physical Therapist who can help work with you on setting up a customized plan to come back from injury.


Keast M, Bonacci J, Fox A. Acute Effects of Gait Interventions on Tibial Loads During Running: A Systematic Review and Meta-analysis. Sports Med. 2022 Jun 16. doi: 10.1007/s40279-022-01703-1. Epub ahead of print. PMID: 35708887.

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