Oh no, the dreaded “shin splint!”  It seems that almost everyone has heard of this common injury, and many of us have had to deal with it on a first hand basis.  What are shin splints?  What causes this problem?  How can it be treated and/or prevented?

What are Shin Splints?

Shin splints is a generic term used to describe the diagnosis of medial tibial stress syndrome.  This means that the muscles that attach to the medial side of the tibia (the larger lower leg bone) become inflamed, irritated, and painful.  Symptoms of medial tibial stress syndrome include pain and tenderness along the inside of the shin bone, possible swelling in this area, and pain and limitation with activities such as running and jumping.  The pain is usually dull at first, but can progress in intensity to cause the athlete to stop his or her workout.  Other conditions can mimic the pain caused by medial tibial stress syndrome, such as tibial stress fracture or compartment syndrome. These can be ruled out with specific diagnostic testing.

What Causes Shin Splints?

The root cause of this over-use and inflammatory injury can be multifactorial, and usually includes one or more of the following situations:

  1. Training Method: sudden increase in frequency or intensity of training, or change to a new type of training or sport
  2. Training Surface:  changing to hard or uneven surfaces, such as outdoor trails or streets, can cause undue stress on the muscles of the lower leg
  3. Muscle Dysfunction or Inflexibility:  biomechanical abnormalities such as poor alignment, poor strength and dymanic muscle control, or poor flexibility can cause undue stress to certain muscle groups
  4. Shoe Selection: improper footwear or footwear that is too worn down will not provide the support and cushioning necessary
  5. Improper Running Biomechanics: biomechanical issues such as excessive pronation, excessive forward lean, keeping the toes pointed too far outward, or landing too hard on the foot can also lead to increased stress.

How Can Shin Splints Be Treated or Prevented?

Shin splints typically is an overuse and inflammatory problem, so treatment should always begin with rest from the offending activity, ice, and other anti-inflammatory measures.  However, because there may be more than one factor involved in the cause of the issue, appropriate treatment must begin with an evaluation of all of the above issues.  Your local physical therapist is a perfect resource to evaluation each of these issues and give you ideas on how to address your specific problems.

Poor training technique or training surface problems need to be addressed with modification to activity.  In some cases this means changing the amount or intensity of activity, and in other cases, it may mean stopping the activity all together for a specific period of time, and then progressing back into it very gradually.  Which of these situations applies will depend on the severity of the problem, and the length of time it has been present.

Muscle dysfunction or inflexibility issues need to be addressed with stretching and strengthening exercises specific to the individual’s deficits.  Poor gastroc (calf) flexibility and weak ankle and foot intrinsitc muscles can lead to altered foot mechanics or poor dynamic function of the shock absorbing capabilities of the foot and ankle, leading to too much stress translated further up the leg. These issues may need to be addressed before the lower leg will be able to tolerate running and jumping again.

Biomechanical problems of the foot and ankle such as over pronation or poor shock absorbtion (lack of pronation) can be addressed with appropriate footwear and sometimes orthotics.  Often stretching and strengthening and sometimes even gait training techniques can also help with correcting these issues.

The bottom line is that the problem of shin splints, although extremely common, is a very treatable problem, and if properly handled, should not lead to long term interruption of the desired sport or activity.  It is very common for the cause of shin splints to be multi-factorial, so having your flexibility, strength, foot biomechanics, shoes and training program evaluated is very important to eliminate the problem as quickly as possible and prevent it from reoccurring in the future.

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