15/02/2026
IT’S NOT ALWAYS A MUSCLE STRAIN 🦴
I had an interesting case a few weeks ago in clinic that highlights the importance of accurate diagnosis, and not being misled by what the patient reports❗️
A young athlete presented with what they described as calf pain after a heavy week of basketball training, which got to the point where they had to pull out of the session due to increased pain on jumping/hopping ⛹️♂️
They weren’t overly concerned as it was feeling better with a few days rest prior to our assessment.
On presentation, it was hard to reproduce symptoms, but pain would increase on an internally rotated calf raise, on single leg hopping, and when I palpated the upper third of their ‘outer shin’ / ‘outer calf’ 🤔
It would have been easy to suspect a lateral gastrocnemius (outer calf) strain as it was bordering that region + the outer shin, however it wasn’t a typical presentation. Given the patient’s spike in training load, and tenderness at the proximal fibula (upper third of the outer shin bone), there was suspicion for a bone stress injury (BSI) ⚠️
I sent them for an MRI to rule out a BSI. Their MRI came back showing some edema and signs of a bone stress reaction at the proximal fibula 🦴
The photo below compares the same area on the injured and non-injured leg. Can you see the difference!? 🔍
About 8.6% of stress fractures happen at the fibula. It should raise the alarm bells when someone describes ‘outer calf’ or ‘outer shin’ pain as it’s not actually that common to strain your lateral gastrocnemius muscle! 🚨
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