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Shin Splints
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The term "Shin Splints" refers to pain due to inflammation of the soft tissues of the lower leg. It does not necessarily mean a literal "splintering" of the bone. The pain associated with shin splints is a result of fatigue and trauma to the muscle's tendons where they attach themselves to the tibia. In an effort to keep the foot, ankle and lower leg stable, the muscles exert a great force on the tibia. This excessive force can result in the tendons being partially torn away from the bone. Chronic shin splints can ultimately lead to stress fractures, which are tiny, hairline breaks in the bone.
Anatomy
As you can see from the diagram to the right, there are many muscles and tendons t
hat make up the lower leg, or calf region. It's quite a complex formation of inter-weaving and over-crossing muscles and tendons.
The main components of the lower leg that are affected by the pain associated with shin splints are the: Tibia and Fibula & the Muscles. The Tibia & Fibula are the two bones in the lower leg. The tibia is situated on the medial, or inside of the lower leg. While the fibula is situated on the lateral, or outside of the lower leg. There are also a number of muscles that attach to the tibia and fibula. It's these muscles, when overworked, that pulls on the tibia and fibula and cause the pain associated with shin splints. Shin Splints image from Principles of Anatomy and Physiology
Description
Although the term "shin splints" is often used to describe a variety of lower leg problems, it usually refers specifically to a condition called Medial Tibial Stress Syndrome (MTSS), and the pain typically occurs on the inside, or medial, border of the tibia. To better understand shin splints, or MTSS, an understanding of the muscles, tendons and bones involved is required. Shin splints can also occur anteriorly, posteriorly, or laterally. Typical areas of shin splints can be seen in the diagram below.
Cause
While there are many causes of shin splints, they often occur after sudden changes in physical activity. All cases can be categorized into two main groups. Overload(training errors), and Biomechanical Inefficiencies.
Overload (or training errors): Shin splints are commonly associated with sports that require a lot of running or weight bearing activity. However, it is not necessarily the added weight or force applied to the muscles and tendons of the lower leg, but rather the impact force associated with running and weight bearing activities. In other words, it's not the running itself, but the sudden shock force of repeated landings and change of direction that causes the problem. When the muscles and tendons become fatigued and overloaded, they lose their ability to adequately absorb the damaging shock force.
Other overload causes include:
· Exercising on hard surfaces, like concrete
· Exercising on uneven ground
· Beginning an exercise program after a long lay-off period
· Increasing exercise intensity or duration too quickly
· Exercising in worn out or ill-fitting shoes
· Excessive uphill or downhill running
Bio-mechanical Inefficiencies: The major bio-mechanical inefficiency contributing to shin splints is flat feet. Flat feet lead to a second biomechanical inefficiency called over-pronation. Pronation occurs just after the heel strikes the ground. The foot flattens out, and then continues to roll inward. Over-pronation occurs when the foot and ankle continue to roll excessively inward. This excessive inward rolling causes the tibia to twist, which in-turn, over stretches the muscles of the lower leg.
Other bio-mechanical causes include:
· Poor running mechanics
· Tight, stiff muscles in the lower leg
· Running with excessive forward lean
· Running with excessive backwards lean
· Landing on the balls of your foot
· Running with your toes pointed outwards
Symptoms
The most common symptom of shin splints is pain along the medial border of the tibia. Mild swelling in the area may also occur.
Shin splint pain may:
Examination
After discussing your symptoms and sport activity, your lower leg will be examined. An accurate diagnosis is very important. Sometimes, other problems may exist that can have an impact on healing.
If you see a doctor, they may order additional imaging tests to rule out other shin problems. Several conditions can cause shin pain, including stress fractures, tendinitis, and chronic exertional compartment syndrome.
Stress Fracture: If your shin splints are not responsive to treatment, your doctor may want to make sure you do not have a stress fracture. A stress fracture is a small crack(s) in the tibia caused by stress and overuse. Imaging tests that create pictures of anatomy help to diagnose conditions. A bone scan and magnetic resonance imaging (MRI) study will often show stress fractures in the tibia.
Tendinitis: Tendons attach muscles to bones. Tendinitis occurs when tendons become inflamed. This can be painful like shin splints, especially if there is a partial tear of the involved tendon. An MRI can help diagnose tendinitis.
Chronic Exertional Compartment Syndrome: An uncommon condition called chronic exertional compartment syndrome causes symptoms like shin splints. Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. Chronic exertional compartment syndrome is brought on by exercise. Pain usually resolves soon after the activity stops.The tests used to diagnose this condition involve measuring the pressure within the leg compartments before and after exercise.
Treatment
Although shin splints may be caused by different problems, treatment is usually the same. Because shin splints are typically caused by overuse, resting your body so the underlying issue heals, and modifying your activity levels are the first steps. Here are some other things to try:
Ice: Apply ice or use ice massage to reduce pain and swelling. I prefer to use ice for 10 minutes every three to four hours for two to three days. If the pain persists, a more comprehensive approach to the problem should be initiated.
Anti-inflammatory medication: Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling. However, these drugs can have side effects, like an increased risk of bleeding and ulcers. They should be used only occasionally unless your doctor specifically says otherwise.
Arch supports: These orthotics which you put in your shoes, can be custom-made or bought off the shelf. These may help with flat feet or other foot mechanic issues. I can direct you to stores that carry specific brands that have proven effective for athletes.
Stretching Exercises: A daily routine of stretching the lower leg can help reduce pain.
Strengthening Exercises: Strengthening the muscles of the lower leg and foot can decrease pain and speed up recovery
Neoprene Calf sleeve: Helps to support the muscles and warm the leg.
Prevention
Prevention, rather than cure, should always be your first aim. Even before any sign of shin soreness appears there are a number of simple preventative measures that can be easily implemented.
Footwear: Since about half of all lower leg problems are caused by bio-mechanical inefficiencies, it makes sense to get the right advice on footwear. Your feet are the one area you should not "skimp" on. Good quality footwear will go a long way in helping to prevent many lower leg problems.
Warm-up: A thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff, which may limit blood flow to the lower legs and result in a lack of oxygen and nutrients for those muscles. Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity. Click here for a detailed explanation of how, why, and when to perform your warm up.
Flexibility: Flexible muscles are extremely important in the prevention of lower leg injuries. When muscles and tendons are flexible and loose, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. To keep your muscles and tendons flexible, it is important to undertake a structured stretching routine. Click here for beginner calf stretches.
Strengthening: Strengthening and conditioning the muscles of the lower leg will also help to prevent shin splints. There are a number of specific strengthening exercises you can do for these muscles. Please stop by to see me in the Athletic Training room to start a strengthening program.