Shin Splints 

If you workout you’ve probably heard the term “shin splints” at some point or another. How do you really know if you have shin splints or if you’re just sore or suffering from some other affliction? This condition has some very telltale signs that can serve as instant red flags that you might be doing something wrong in your workout routine. Read on to find out if you might actually be suffering from this all too common condition.

What Are Shin Splints?

Technically speaking, ‘shin splints’ is a common term used to describe “nondescript leg pain.”[1] It is very broad and doesn’t narrow the scope of injury to a great degree. Shin splints can be associated with lower leg tendinopathies, periostits, tibial stress fractures, fibular stress fractures, exertional compartment syndrome, inflammation, entrapment, muscular tear, deep vein thrombosis, or medial tibial stress syndrome. [1] This being said, if you have officially been diagnosed with ‘shin splints’ you need to seek a more official and narrower diagnosis. Medial tibial stress syndrome is one of the most common injuries that fall under the colloquial phrase ‘shin splints.’

Medial tibial stress syndrome (MTSS) is inflammation of the periosteum on the inside of the tibia (shinbone). [1] The perosteum is a thick and fibrous covering of the bone and is rich in sensory nerve endings. The large amount of nerve endings can make the periosteum extremely painful. Additionally, if MTSS is left untreated it can progress into stress reactions, and finally stress fractures.

Sports Commonly Associated with Medial Tibial Stress Syndrome:

Running is the sport most commonly associated with this form of shin splints. In fact, medial tibial stress syndrome account for nearly 15% of all running injuries.[1] However, MTSS is a chronic or overuse injury and can be associated with any weight bearing sport. Other sports that are commonly associated with MTSS or shin splints are soccer, football, basketball, hockey, or volleyball. Repetitive jumping or conditioning on inclines and declines can also flare this condition.

Causes:

Shin splints an overuse injury and is caused by an overload in training beyond that of which the body can regenerate. It is often caused by training on hard surfaces such as asphalt or gymnasium floors. It is also caused by increasing training load too quickly, shoes with poor support, or structural abnormalities.[1] Women are more likely to experience medial tibial stress syndrome than men and are more likely for it to develop into stress fractures. Stress fractures, while occurring due to a variety of factors, can be linked to disordered eating, amenorrhea, and osteoporosis (female athlete triad).

Additionally, an athlete with overly pronated feet is predisposed to medial tibial stress syndrome or shin splints. [1] Foot pronation is a condition that occurs in individuals with flat feet. When the foot is weight bearing the arch of the foot collapses and causes the ankle to shift inward. This biomechanical abnormality causes increased strain on the tibia and increases the likelihood of developing this condition. Foot pronation can be observed, tested in the navicular drop test, or even be directly measured by a professional.

Symptoms:

An individual experiencing shin splints will describe a gradual progression of pain without a specific moment of onset. The pain will cover an area along the inside of the shinbone (tibia) of greater than 5 cm.[1] If the individual has a stress fracture, the pain will be much more pin pointed. Repeated pointing of the feet or flexing of the toes will reproduce symptoms. Stretching the toes may also cause pain.[1]

The progression of MTSS generally follows a routine pattern and can be the main sign or indicator of the condition. The pain will first appear at the beginning of the workout but subside during activity and return after.1 Over time, the pain will continue to bother the athlete at the beginning, during, and after the workout. The pain may eventually even occur at rest and in most severe cases will continue during the night.

Prevention:

Prevention of shin splints is fairly simple and can be accomplished through appropriate rest and equipment. Training should progress at a comfortable and steady pace. An athlete should avoid huge training shifts and jumping into increased mileage too quickly. As a general rule of thumb, a 12% increase of training per week is the most an individual should ever attempt, however, each individual is different and should work directly with a coach or physician for more individualized training plans.

Working out on softer surfaces such as tracks, dirt, or grass can also limit the chances of developing shin splints. An athlete should be proactive about purchasing new shoes and should not allow the support of the shoe to diminish before switching to a new pair. Finally, an individual with over pronation should seek out orthotics or shoe inserts.

Treatment:

Modalities:

In addition to rest and exercise modification, modalities with antiinflammatory properties can benefit the athlete. Ice is the easiest way to decrease inflammation. The use of an ice pack or ice frozen in a Dixie cup for ice massage can work wonders for the athlete with shin splints.

Stretching:

The athlete with MTSS should stretch the muscles of the back of the lower leg.[2] This can be done using a slant board. With the toes facing up the board, allow the heel to touch the ground. This should be done with the legs bent and straight as to target different muscles. The same stretch can be accomplished with a lunge stretch or the ‘downward facing dog’ stretch.

Strengthening:

Strengthening exercises for MTSS and shin splints can be controversial because this is an overuse injury. Non-weight bearing strength exercises such as ankle pumps or ankle 4-way using plastic tubing or a therband are the best way to continue strengthening without causing more symptoms. The athlete needs to listen to his or her own body and only participate in strengthening exercises that do not reproduce symptoms.

References:

1. Starkey, Chad, and Sara D. Brown. Examination of Orthopedic & Athletic Injuries. F.A. Davis Company, 2015.

2. Higgins, Michael. Therapeutic Exercise: from Theory to Practice. F.A. Davis Company, 2011.