Are you a runner, active walker, hiker and during your activity suddenly found yourself experiencing pain in your lower legs? There are several types of overuse injuries that may develop in this region as a result of the repeated pounding from the aforementioned activities. One of these conditions is known as shin splints.
What are shin splints?
The term shin splints refers to a painful condition that develops along the inside (medial edge) of the shin (tibia). The usual location is along the lower half of the tibia, anywhere from a few inches above the ankle to about half-way up the shin. The repeated running cycle of pounding and push off results in muscle fatigue, which may then lead to higher forces being applied to the fascia, the attachment of fascia to bone, and finally the bone itself. Respectively, this represents a spectrum from mild to severe. On the relatively more severe end of the scale the injury may progress from stress reaction within the bone to an actual stress fracture.
What are the symptoms?
Shin splints cause pain in the front of the outer or inner leg below the knee. The pain of shin splints is characteristically located on the outer edge of the mid region of the leg next to the shinbone (tibia). An area of discomfort measuring 4-6 inches (10-15 cm) in length is frequently present. Pain is often noted at the early portion of the workout, then lessens only to reappear near the end of the training session. Shin splint discomfort is often described as dull at first. However, with continuing trauma, the pain may become so extreme as to cause the athlete to stop workouts altogether.
What causes shin splints?
A primary culprit causing shin splints is a sudden increase in distance or intensity of a workout schedule. The overall recurring theme that leads to overuse running injuries is excess training with inadequate recovery. Excess and inadequate are relative terms and must be judged against one’s usual training routine. The more that excess and inadequate deviate from the usual training routine the less time it takes for an overuse injury to develop. This increase in muscle work may be associated with inflammation of the lower leg muscles, those muscles used in lifting the foot (the motion during which the foot pivots toward the tibia). Such a situation may be aggravated by a tendency to pronate the foot (roll it excessively inward onto the arch). Similarly, a tight Achilles tendon or weak ankle muscles are also often implicated in the development of shin splints.
How is it diagnosed?
A thorough examination should be performed by your doctor or a physical therapist to assess whether your symptoms are truly shin splints or potentially another of the overuse injuries to the lower leg such as tibial stress fractures or compartment syndromes. Specialized (and costly) tests (e.g., bone scans) are generally only necessary if the diagnosis is unclear. Bone scanning in this setting is helpful to detect stress fracture of the tibia bone.
How is it treated?
The treatment for shin splints is rest. Depending upon severity it is often necessary to completely stop running for a period of time. Generally this is done until day-to-day activities are pain free. When running is resumed – and this is where many injured runners make a mistake – it must be significantly different from the routine that led to the injury. The concept of relative rest employs lengthening the interval between training as well as decreasing the volume and intensity of training. One can often substitute cross-training activities (e.g., bicycling or swimming) for running to help increase the interval between running days. There should be a graded and gradual increase in run training, keeping an eye out for the return of any shin splint symptoms.
Stretching and strengthening the calf muscles can help prevent the injury from returning. Icing and anti-inflammatory medications can help with the acute pain and subsequent inflammation. However the most important preventive strategy is not to repeat the mistakes that lead to the injury. Examine all the training variables – surface, shoes, training volume, intensity, workout type, hills, weather conditions, etc. Only with modification in these variables and a patient return to activity can success be achieved.
Contact one of our physical therapist at COAST Physical Therapy Services if you suspect that you may have shin splints or if you have any other related questions and we would be glad to help you out.