Shin Splits – Cause, Treatment & Prevention
Shin splints (medial tibial stress syndrome) are an exercise-related pain; they occur along or just behind the inner (medial) edge of the shin (tibia). The pain usually involves a span measuring about 3-4 inches. Shin splints result from exercising the involved leg(s) - the pain recurs if you try to go back to doing the same kind of exercise before healing is complete. Studies show that medial tibial stress syndrome (MTSS) commonly affects runners, aerobic dancers and people in the military.
Shin splints are an inflammation of the thin layer of tissue that covers the bone (periosteum). The bone tissue itself is also involved as can be seen on bone scan examinations. The muscles that attach to the shinbone through the periosteum are the part of the shin that hurts. These are the soleus muscle (an ankle flexor important in pushing off the foot) and the deeper of the two toe flexors (flexor digitorum longus).
Risk Factors/Prevention
Certain factors seem to contribute to the onset of MTSS. Circumstances can result in abnormal tension at the site of the bony attachment and this tension causes microscopic tissue injury. Training such as running, walking and aerobic dancing can cause tissue damage that must heal and adapt to the increased level of tension. When training causes damage more quickly than the area can heal, a more chronic inflammatory state seems to occur. Some factors cause tension and micro damage more quickly than the area can heal and adapt. You may be more likely to get MTSS if there are abnormal stresses from:
Flatfoot or abnormally rigid arch (foot/ankle mal-alignment)
Knock knee or bow legs (knee mal-alignment)
Runners: As many as 13.2-17.3% of all running injuries are attributed to MTSS. Shin splints are among the five most common running injuries.
Aerobic dancers: 22% of dance related injuries were MTSS in one group of aerobic dancers.
Military personnel: Naval recruits observed during their first 11 to 12 weeks of training showed a 6.4% incidence of MTSS.
Circumstances that contribute to MTSS include relatively sudden changes in:
Training regimens, such as running longer distances or up hills, increasing the length of time spent aerobic dancing or increasing the number of days you exercise each week.
Surfaces, such as running on concrete rather than cinders.
Wearing shoes that have lost their shock absorbing capacity can also be a factor.
Symptoms
Symptoms include pain along or just behind the inner edge of the shin during increased activity. Centered about two-thirds of the way down from the knee, it usually measures a distance of several inches.
See your doctor for a diagnosis. Explain your complete medical history and describe how the condition started. After an examination, the doctor will recommend treatment.
Treatment Options
Treatment for shin splints involves several weeks of rest from the activity that caused it. You may substitute other forms of conditioning. The doctor may recommend that you take anti-inflammatory medications, or use cold packs and mild compressions.
Most often the pain is not so bad with just ordinary walking. After several weeks of rest, training begins at a level much lower than previously. Increase training slowly. If you start to feel the same pain, stop exercising immediately for the rest of the day. Use a cold pack and rest for a day or two. Return to training again at a lower level of intensity. Increase training even more slowly than before.
Use pain as your guide:
Severe pain is to be avoided at all cost.
Mild pain is a sign that you have reached or even passed your maximum level for the session.
Most people eventually get back to their prior level of fitness/training. – Michael