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Sims: Breaking Down The Stress Fractures In Jose Iglesias’ Shins

Jose Iglesias (Photo by Jared Wickerham/Getty Images)

Jose Iglesias (Photo by Jared Wickerham/Getty Images)

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By Abby Sims
» More Columns

Jose Iglesias, the Detroit Tigers’ 24-year-old shortstop, announced on Monday that he’ll start this season on the DL due to stress fractures in both shins.

That is a huge blow to the Tigers, as Iglesias is coming off a stellar 2013 season during which he was acquired from the Red Sox in July. He finished in second place in Rookie of the Year voting. Iglesias will be seeing a specialist on Tuesday, and we will know more about his injury afterward. However, you may be wondering how this could have occurred in both legs simultaneously.

Iglesias has been quoted as saying that he played much of last season with pain in both shins, but that the pain had recently increased in spite of daily treatment. Understanding the nature of stress fractures and the progression that often occurs from stress-reaction injuries makes the explanation fairly straightforward.

What is a stress reaction and how does it differ from a stress fracture?
Excessive and repetitive loading on weight-bearing bones can cause what some term “fatigue damage.” The milder stress reaction results in bony abnormalities that are evident with diagnostic testing (MRI, bone scans or less likely X-ray), but does not entail disruption of the cortex, the outer shell. In contrast, stress fractures progress from stage 1 to stage 3, and in each the degree of cortical cracking becomes more extensive, leading ultimately to failure. Simple X-rays often do not reveal evidence of stress injuries until healing is well underway and the calcification “lights up” the area.

Simply put, continuing to place excessive demands on already-affected bone can cause stress reactions to progress to fracture. No surprise there…

Which bones most commonly suffer stress reactions and stress fractures?
Ian Kinsler of the Texas Rangers suffered a stress fracture to his rib due to a headfirst slide last season. But more typically, it is the small bones of the feet (metatarsals) that collectively suffer the majority of stress injuries. The heel bone (calcaneus) and tibia (heavier bone of the lower leg) are also often involved. Iglesias’ fractures are undoubtedly to his tibias.

Shin Splints and their relationship to tibial stress fracture:
In the shins, the process leading to stress fractures often begins with the seemingly innocuous diagnosis of shin splints. Like most non-traumatic sports injuries, shin splints are due to overuse — placing more demand on tissue or bone than they can tolerate. This may be due to repetition, overtraining, mechanical issues related to performance or even such things as improper training — such as running on a banked surface placing consistently imbalanced stresses on the legs. Stepping up the pace of a running program or increasing the mileage beyond one’s ability to tolerate the demand can also result in shin splints.

Which athletes typically suffer stress fractures?
We tend to hear more about stress injuries in athletes whose sports require a great deal of running and jumping — like basketball or football — as well as those competing in sports that put a premium on leanness, such as long-distance running, dancing and gymnastics. Even the upper extremities can suffer stress injuries due to overuse and loading in sports that require bearing weight through the hands and arms.

Knicks fans are quite familiar with this diagnosis thanks to Rasheed Wallace and Kurt Thomas, who dealt with stress fractures in their feet during the 2013 season (as well as prior). We all know how that turned out. Age also didn’t work in their favor.

Other predisposing factors to stress fracture:
Those with hormonal irregularities or low bone density (osteopenia or osteoporosis) are at higher risk of developing stress responses. Athletes suffering from disordered eating (preponderantly women) are particularly prone, even in the heavier bone of the thigh (femur). Runners or other athletes with these conditions are also more likely than others to develop pubic bone or sacral-area (very low back) pain due to stress fractures in these bones.

Additionally, those with very flat (pronated) feet or with very high arches (cavus feet) have an increased risk of exhibiting stress responses or stress fractures in the bones of the foot. Metabolic bone diseases as well as muscle weakness or imbalances can also predispose to stress injuries. Increased incidence has also been reported due to smoking and alcohol consumption.

Iglesias is young and that should help him, but after sacrificing himself to play last season he may have to sit much of this one out.

Follow Abby Sims on Twitter @abcsims.

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