What is it ?
Shin splints are common among runners and individuals who participate in any activity which involves running. This overuse injury usually develops gradually over a period of weeks to months but may occur after a single, excessive bout of exercise. Individuals typically complain of pain in one of two locations: the lower inside half of the leg and, less commonly, the upper outside portion of the leg. Shin splints, also known as medial tibial stress syndrome, are an inflammation of the soft tissue surrounding the bone lining of the tibia at the origin of several leg muscles.
What causes it?
Excessive running, improper conditioning programs and overpronation (flattening of the arch) are common causes of shin splints because of the stress they cause to the medial structures of the lower leg. This stress may cause microtears and inflammation in the soft tissue (periosteum) attached to the tibia. Muscle weakness, non-supportive shoes, running hard on surfaces and overtraining can also be contributing factors. Patients will usually notice the pain when they start exercising and it decreases or goes away as they continue to exercise. They will usually tell you the pain is worse after they stop exercising or it will hit them the following morning. If strain continues in this area for an extended period of time, it is possible for microfractures (stress fractures) to form along the tibia. There typically isn’t a sudden break of the bone but usually patients will relate a gradual increase in pain until it becomes quite severe.
Pain in the shin area may be coming from the lumbar sacral spine, a muscle imbalance, uneven leg length or compartment syndrome. Typically, abnormal biomechanics, such as overpronation (excessive flattening of the foot), can cause these posterior shin splints
Running on hard surfaces and a flatfoot condition may be initiating factors as well. However, more often than not, this condition is a simple result of over-training or improper training.
How to diagnose ?
Podiatrist are very familiar with this condition and often the patients history, pattern of pain, and clinical assessment will be adequate to diagnose it. X-rays are often negative and reveal no bone changes. If you suspect a stress fracture, you should obtain a bone scan or MRI. Also keep in mind that shin splint-type pain in the leg may mimic several other problems, including tendonitis, partial muscle tear or growth plate inflammation, which may not respond to the same treatments that one may choose for shin splints..
The RIICE Treatment Plan : rest, ice, immobilization, compression and elevation.
Rest. The hallmark of treatment is “relative rest.” You want to dramatically reduce the frequency, intensity and time of activity/exercise. Usually, this means recommending anywhere between a 50 to 90 percent drop in the duration of the activity/exercise and doubling or tripling the time between workouts. You can pursue cross training or doing different types of exercise. When resuming activity after a few weeks, ensure you have a very gradual return .
Ice. This is extremely useful for reducing the inflammation following a workout. Apply ice for 10 to 15 minutes over the painful area as this will both decrease pain and increase healing time.
Immobilization. In some instances, the pain in the legs does not respond to other conventional and conservative modalities. Immobilization with a removable or walking cast/boot or a non-removable fiberglass cast maybe required. Length of time of immobilization can vary between two to six weeks.
Compression. Using compression socks prior to or following an athletic event or workout may be extremely beneficial.
Elevation. Elevate the legs above heart level. In doing so it will help reduce the flow of blood to the legs and certainly help reduce the inflammatory process. This will help reduce pain and healing time.
Tips On Other Helpful Modalities When it comes to antiinflammatory medications, oral drugs such as NSAIDs (ibuprofen, naprosyn, etc.) are very useful for reducing pain and inflammation during the acute stages. However, one should be mindful that most antiinflammatory drugs do have the potential to cause stomach irritation, ulcers or kidney problems. Therefore, limit the use of these medications to the acute phase of the injury.
Other helpful treatment therapies:
-Deep tissue massage may often prove to be a useful technique for getting rid of shin splints by smoothing out knots in muscles or tight areas within the muscle. This will help reduce pain and prevent recurrence.
-Addressing any biomechanical issues such as correcting any abnormal biomechanics is crucial. If this goes unaddressed, you will continue to experience recurrence. Arch support or custom orthotic is important for people whose overpronation/excessive flattening is the underlying cause of their shin splints.
-The choice of footwear is also important since different running shoes and cleats/turf shoes have different degrees of support and motion control. Running shoes typically lose 30 to 40 percent of the shock absorbing capabilities after 450 miles. The tread may look fine but the capacity to prevent injury is not. Uneven wear patterns from one shoe compared to the other may also be an indication of abnormal motion in one leg.
-You may also consider the use of prescription orthotics. After a short break-in period, patients should wear the orthotics full-time as they can be helpful in reducing acute symptoms of pain and inflammation. Patients can also use custom orthotics to prevent recurrent flare-up episodes from shin splints.
The primary goal of treatment is relieving pain and inflammation. One can accomplish this via a combination of rest, physical therapy, cold therapy, taping, oral medications, antiinflammatory medication, a change of shoe gear and orthotic devices. During the healing process, patients can maintain cardiovascular fitness via alternative pain-free activities such as cycling, swimming, water therapy or weight training
Dr Vanessa Hadchiti (Podiatrist)