College of Massage Therapists of British Columbia (CMTBC) Practice Exam

A patient presents with right shin pain that worsens while running but is relieved at rest. What health history question best helps differentiate between shin splints and a stress fracture?

1. Is the area of pain specific or diffuse?

2. How often do you run?

3. Have you changed your footwear recently?

4. Do you have any previous injuries?

The correct answer is: Is the area of pain specific or diffuse?

The decision to identify whether the area of pain is specific or diffuse serves as a crucial factor in distinguishing between shin splints and a stress fracture. In the case of shin splints, which are also known as medial tibial stress syndrome, the pain is typically diffuse along the inner part of the shin and may not be restricted to a particular spot. This condition arises from inflammation of the muscles, tendons, and bone tissue around the tibia, especially in response to increased physical activity. In contrast, a stress fracture presents with more localized pain that is sharp and tender to touch at a specific point on the bone. The pain from a stress fracture usually persists regardless of activity level and is aggravated by activities such as running, making it significant to pinpoint where the discomfort occurs. While considerations like the frequency of running, recent changes in footwear, or previous injuries can provide additional context regarding the overall activity level and possible contributing factors to the injury, they do not directly address the distinction between the more diffuse pain of shin splints and the localized pain characteristic of a stress fracture. Thus, knowing whether the pain is specific or diffuse is key to making a more accurate assessment of the patient's condition.