Curtis Jones is currently out with what Jurgen Klopp called a “shinbone stress reaction” and has yet to play this season.
The issue first surfaced late in preseason and Jones’ return to the match timeline was believed to be about three weeks away. However, when he began to accelerate his return to play and participate in team practices, he experienced pain again on two consecutive days.
Subsequently, Jones went back down and while he’s not expected to need another three weeks this time, he’s obviously still missing games. In addition, the club has not given a deadline for his return.
From the outside looking in, it can seem a bit confusing and unnerving as to Jones’s rollercoaster ride of ‘he’s on his way back, he’s training, oh he’s back, we’re not sure when he’ll be back’. However, let’s take a closer look at his injury to understand why that’s the case and the key variables that may be dictating his return timeline.
What is a “tibial stress reaction”?
Tibial refers to the tibia, which is the shinbone.
A stress reaction falls under the umbrella of “bone stress injury” (BSI) and refers to a weakening in the bone, as follows:
In general, BSIs occur due to repetitive stress and overload on the bone and are more common in running and jumping sports due to the repetitive high load stress placed on the lower body.
I’ll spare you the full physiological details, but essentially when a bone can’t repair itself (“remodel”) as quickly as it’s being loaded and stressed, it can lead to bone stress injuries. A stress reaction is the first and least severe, a precursor to stress fracture and complete fracture.
Consequently, it makes sense why Jones developed this problem towards the end of pre-season when he had been involved in activities for an extended period and also why the club is being so wary of him: he needs to be proactive and cut. this in the cocoon, so that it doesn’t become a much more lasting problem; either a higher degree stress reaction, a stress fracture, or a complete fracture.
How common are they?
Tibial stress fractures are the most common fractures in the lower body, along with the metatarsals (long bones) of the feet. They are further classified based on the location of the reaction, either posteromedial (middle back) or anterior (front) of the shin.
Key factors of the timeline
The location of the tibial stress reaction is important because the posteromedial ones are considered “low risk” while the anterior ones are considered “high risk” due to the greater chances of delayed healing and progression to a fracture. Two reasons for this increased risk are potentially the increased load on the anterior tibia and the decreased blood flow (vascularization) in that region.
Consequently, whether Jones has a posteromedial or anterior tibial stress reaction is a key factor in his return schedule and how conservative or aggressive the club’s physical therapists will be.
An additional factor, as seen in the above image of the spectrum of bone stress injuries, is that there are also different degrees of reaction to stress. We don’t have that information with Jones, but based on his initial three-week offload schedule and the fact that he’s regularly evaluated as an elite athlete, I’d imagine he’s in the lower grade.
Back-to-play management
For these reasons, the high risk of re-injury seen with bone stress injuries – previous injury is the biggest predictor of future injury in this case, and how early in the season it is – it makes sense why Liverpool he is being very methodical with his return to the game process.
The risk-reward of trying to speed up the process at this point, even with limited availability in midfield, falls squarely on risk. The key, as we saw with Jones as he was ramping up, will be how that tibial stress reaction responds to increased activity.
It is really a day-to-day injury, and that is a key reason why neither the club nor Jurgen Klopp have put any kind of schedule on it. You increase the intensity of the activity, evaluate, repeat, until you are clean.
It can be a frustrating and backwards process, especially if you’re only looking at it from a fan’s perspective, but hopefully you now have more insight into the situation. Patience is a virtue!
