Shin Splints

Medically, the term shin splints refer to medial tibial stress syndrome (MTSS).

• "Shin splints" is a term generally used to describe a running-related injury causing pain in the front of the lower leg along the shin bone (tibia).
• Medically, the term shin splints refer to medial tibial stress syndrome (MTSS).
• The type of pain that causes shin splints is most often caused by athletic-related activity that the participant is not physically prepared to perform.
• Shin splints are most often caused by doing too much of a particular activity too fast.
• There are four grades of shin splints pain
• A plan for a gradual return to play should be started once the pain is reduced and muscle strength and flexibility are restored.

• Shin splints may have many different causes:
  • Overuse,
  • poor biomechanical alignment,
  • stress fractures,
  • muscle strains,
  • anterior compartment syndromes, or
  • muscle tightness.
• The most common cause of shin splints is overuse, in which the soft and the hard tissues of the body are stressed and re-stressed to the point that damage occurs in the tissues.
  • This type of damage is known as repetitive micro-trauma.
  • Factors that may contribute to this injury include running on uneven surfaces, running on surfaces that are too hard or too soft, shoes that have poor force absorption qualities, participating in running or other athletic activities requiring frequent starts and stops, and going too hard or too long during repeated exercise bouts.
  • Running, walking, bicycle riding, and even standing in place for long periods can contribute to shin splints.
• Biomechanics is the study of how living creatures move. A trip to the nearest mall to watch people move reveals that everyone moves differently. Sometimes these differences are great enough to cause an injury.
• Weakness of leg muscles, shoes with poor support, poor foot alignment, tight muscles, loose ligaments in the foot, and feet turned too far in (flat feet), or too far out may cause variances in the mechanical function that may cause shin splints.
• Whether or not these conditions are the cause of shin splints can be determined by a medical practitioner familiar with the biomechanical function of the human body.
• Shin splints may be an early warning sign of a stress fracture or anterior compartment syndromes, as well as be a secondary symptom of muscle strains or tightness.

Pain associated with shin splints most often occurs on a third of the shinbone or the tibial bone that is furthest from the knee. The following are common signs and symptoms of shin splints:

• A distinguishable lump or gap felt at that location
• A "crunchy" feeling on that spot caused by inflammation
• Four grades of pain:
  • during activity
  • before and after activity, but not affecting performance
  • before, during, and after athletic activity affecting performance
  • pain so severe that performance is impossible

When the pain begins to interfere with your activities of daily living or if you cannot perform your desired activities without pain, you should consider seeking medical attention. Other indicators that you should seek medical care are if the area begins to look deformed, becomes exquisitely tender to the touch, or is causing you to move differently.

The doctor will take a brief history to determine how the injury occurred. If necessary, a thorough physical exam will be conducted to evaluate if any other injuries are present.

• Both shins will be physically and visually examined by the medical practitioner. The lower leg will be touched and inspected to identify obvious deformities or any differences in the bones of the lower leg.
• The nerves in the leg will be tested to make sure no injury has occurred there.
• An X-ray, MRI, or bone scan of the shin may be taken to determine if there are changes in the makeup of the bone.

Self-Care at Home

When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain.

Rest will allow the tissues to heal themselves by preventing any further stress on the affected area. Ice should be applied no longer than 20 minutes. The ice may be put in a plastic bag or wrapped in a towel. Commercial ice packs are not recommended because they are usually too cold.

Compression and elevation will help prevent any swelling of the affected tissues.

There are two types of over-the-counter medication that may help with the pain and swelling of shin splints. Acetaminophen (Tylenol) will help with the pain, and a nonsteroidal anti-inflammatory such as aspirin, ibuprofen, or naproxen will help with the pain and battle the inflammatory response. Caution should be taken when using these drugs, and the dosage should not exceed the recommended dosage.

Medical Treatment

Once the severity and cause of shin splints are determined, a course of corrective and rehabilitative actions can be started.

• The use of various therapy techniques by qualified medical personnel may be recommended. Therapists may use machines and/or manual therapies to reduce pain and increase circulation to the area to promote healing.
• Maintenance of fitness levels via modification of activity may be prescribed.
  • Substitution of activities that do not aggravate shin splints: Bicycling, elliptical trainers, step machines, swimming, or ski machines eliminate impact and allow maintenance and improvement of fitness levels.
  • Employ corrective prophylactic measures.
    • Wear new shoes, or replace the insoles of your current shoes.
    • Athletic shoes lose the elastic properties of the soles through usage and age. A good rule of thumb is to replace your shoes every six months, or more often if there is heavier usage. The use of purchased insoles can increase energy absorption and add support to the foot.
    • Corrective and off-the-shelf orthotics may also improve the biomechanics of the foot.

Practice muscle strengthening and flexibility.

• Exercises may be recommended that increase the strength and stability of the affected area and correct muscles that may not be balanced.
• Exercises to increase flexibility will maintain or improve the length of a muscle. Flexibility helps to make a stronger muscle that is less likely to be injured.
• Take medication to help reduce inflammation.
• Follow up with a health care provider until symptoms have improved.

In cases where changes were seen in the initial scans or X-rays, follow-up scans or X-rays may be performed. A plan for a gradual return to play should be started once the pain is reduced and muscle strength and flexibility are restored.

Returning to participation and prevention of shin splints are limited by the same factors. Shin splints are most often caused by doing too much of a particular activity too fast. Shin splints usually occur at the beginning of a conditioning or a sports season. A sudden increase in activity may also cause shin splints during the end of a season or a conditioning program.

A good workout program begins with a physical exam by a physician, then a gradual, consistent workout period. A good example of this type of program is a running program that starts with walking for 20 minutes, followed by an increase in exercise time and the intensity of the exercise. Good surfaces and proper equipment used in your workout will lower the risk of shin splints.

Components of a good exercise program should include core strengthening, muscle strengthening, and flexibility specific to the goals of the workout program or the sport.

If pain is encountered when working out, try decreasing the intensity of the workout. If the pain persists, then you should immediately stop and seek medical advice to discover the source of the pain. Pushing through the pain often results in injury.