What Are Shin Splints? The term ‘shin splints’ (SS) is a commonly used term to describe pain that arises along the anterior (front), and medial (inside), portion of the tibia (shin bone) usually along the distal (end portion) 2/3’s of the lower leg. Another name associated with SS, is Medial Tibial Stress Syndrome (MTSS).
Some related conditions associated with pain in this area are sometimes confused with true SS, such as tendonitis, neuritis, and stress fractures of the tibia. The pain that occurs with ‘true’ SS is caused by inflammation associated with the attachment of two muscles to the shin bone (tibia). The soleus and flexor digitorum longus muscles attach to the tibia through their association with the periosteum, which is the tissue overlying all bones in the body. The periosteum, and/or the muscle fibers which attach to the tibia via the periosteum, become inflamed and cause pain over a given surface area of the tibia…usually a 3-5 inch span.
Symptoms of true SS include pain experienced along, or just behind the inner edge of the tibia. The pain is exacerbated by increased activity, and many times occurs only during periods of activity and resolves with rest. The pain can extend for a short distance along the tibia, or for longer distances depending upon individual anatomic and/or physiological factors. SS are common in runners, dancers, aerobic exercises including stair-steps, and military personnel. However, they can occur in individuals participating in any sport.
What Causes Shin Splints?
The number one cause of SS is related to flexibility issues; predominantly, lack of flexibility of the muscles of the lower leg. The muscles most responsible for the development of SS are the long flexors of the leg (flexor digitorum longus and flexor hallucis longus), and the calf muscles (referred to as the triceps surae-three muscles including the (1) medial head of the gastrocnemius, (2) lateral head of the gastrocnemius, and (3) soleus muscles).
Tightness (or lack of flexibility) of these muscles, results in pronatory problems of the rearfoot, and also leads to excessive pressure along the crest of the tibia. The second most common cause of SS is faulty foot mechanics. This is a relatively misunderstood and under-appreciated area of concern. There is an enormous amount of information, just a click away on the internet, regarding medical conditions and proposed treatments. Although being educated on a particular problem or condition is useful, misinformation many times leads to further frustration and problems for patients with more complex types of biomechanical problems. (For some additional information regarding biomechanical problems, see my section devoted to this particular issue.
The myriad of biomechanical problems that affect the human foot and locomotion are beyond the scope of this presentation, and individuals who suffer from chronic SS, should seek treatment by a podiatric physician with specialized training in sports medicine and biomechanics.
Another common cause of SS is Leg Length Discrepancy (LLD) where one leg is structurally longer than the other-a condition fairly common in the general population. Additional causes of SS include running on hard or uneven surfaces, excessive activity without proper stretching, progressive activity without proper training, chronic running up/down-hill, and/or inappropriate shoe gear and support.
Treatment for Shin Splints
Initial treatment(s) for the pain associated with SS, are geared towards reducing/eliminating acute inflammation of the soft tissues that arise along the crest of the tibia. Methods include: resting-or limiting activity; varying running surfaces or terrain, heat massage (prior to activity), ice massage (after activity); using compression techniques such as stockings or ace bandages; OTC anti-inflammatory medications and shoe inserts. Other treatments available through a doctor’s office include professional physical therapy modalities such as hydro-therapy, ultra-sound, and electrical-stimulation treatments; custom fabricated biomechanical functional orthotics, prescription-strength NSAIDS and/or cortico-steroid medications, various taping and strapping techniques, and occasionally immobilization by various methods.. Long-term treatment(s), (and prevention) for SS include many alternatives.
First, and foremost, stretching cannot be over-emphasized as stated above. Proper shoe gear is also imperative. In San Antonio, I recommend and refer my patients to www.rogersoler.com for professional shoe gear services. Altering running surfaces and terrain with emphasis on avoiding up/downhill grades, and uneven or hard terrain, is beneficial. Appropriate, progressive training regimen(s) are vital to prevent overuse/load factors associated with SS. Massage therapy (deep-friction) of the lower-leg muscles can many times prevent SS from developing or progressing.
SS can be(come) a very debilitating condition for many athletes. Especially runners or individuals who participate consistently on hard surfaces. Prevention of SS is the most important type of treatment for this condition. Again, the most important factors are: 1) Rigorous, consistent lower-extremity (especially the calf) muscle stretching; 2) Appropriate shoe gear and support; 3) Progressive training regimens; 4) Avoiding consistent up/down-hill or hard/uneven terrain until properly trained; and 5) seeking podiatric-medical treatment at the onset of problems.
Since the number one cause of SS is lack of flexibility, the number one treatment is routine, rigorous stretching exercises. Although proper stretching of all the lower extremity muscles is important, particular attention to the posterior muscle group (calf muscles) is imperative when dealing with SS.
Stretching is important before any exercise or activity, but it is equally (or more) important to stretch after activity. Proper stretching of the calf muscles includes holding the sustained stretch for a minimum of 10 seconds, and them relaxing the muscles for 2-3 seconds….this is referred to as a single repetition. 10-15 repetitions should be completed for each leg, and should be performed at least twice daily, irregardless of whether you perform any physical activity.
Taking the extra time after your run, or physical activity, to stretch properly will greatly improve SS and reduce the probability of developing other foot and/or legs problems related to flexibility issues.