Exercised Dependence and Shin Pain in a Division I Cross Country Runner: A Case Study

Abstract

The following case investigates insidious onset of shin pain in a division I female cross country runner. Though her initial evaluation revealed early onset medial tibial stress syndrome, the sequence of events that occurred immediately afterwards is what makes this case unique. As the student-athlete underwent lower extremity rehabilitation to increase her mileage, she continued to report that her pain had plateaued. Additionally, she was reporting inconsistently to her athletic trainer – one day she would present with an antalgic gait, while other days she was pain free. Her first x-ray presented a periosteal reaction of her posterior left tibia. After adhering to the treatment plan for four weeks, the student-athlete continued to report significant bouts of pain as demonstrated by the Visual Analog Scale. A follow-up x-ray then revealed a transverse fracture through the proximal tibia. As this finding left the medical staff questioning reliability in her reportings, they soon discovered that she was excessively exercising beyond the set limitations specifically set by the athletic trainer, coaches, and team physician. Her roommate admitted to the coaching staff that she recalled instances over the past few weeks of the student-athlete deliberately skipping meals, and even conducted bouts of pinging and purging. She was immediately removed from team activities and referred to our team physician who reviewed her case and relevant medical history. She was further referred to additional behavioral counseling for disordered eating, obsessive compulsive tendencies, and her idealization of weight and excessive exercise. Although true exercise addiction is rare, the comorbidity rate in patients with disordered eating is clinically relevant. The Exercise Addiction Inventory is a simple and reliable questionnaire for healthcare providers to utilize during pre-participation examinations as a way of identifying athletes who may have a pertinent previous medical history, and greater risk of developing comorbidities.