Shin Splints

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Shin splints will affect almost every runner at sometime during training. Any shin pain felt during or after training is referred to as shin splints. This “catch all phrase” can actually be one of three different conditions, each having its own cause. This article will address each of the three conditions, provide treatment ideas, and more importantly convey preventative information.

The shin, seen in cross-section, shows a unique structure. The bones and muscles are arranged into 3 distinct compartments, each containing muscle, arteries, and nerves. These compartments (Anterior, Posterior, and Deep Posterior) and can be the cause of one type of shin splint pain (Compartment Syndrome). The muscles attachment to the bone, specifically Tibia, Medial Tibial Stress Syndrome, can be another cause. While the bone (Stress Fracture) can be a cause of the shin pain. And, finally the muscles themselves can be a cause of shin pain.

Medial Tibial Stress Syndrome

This is believed to be the condition responsible for most athlete’s shin pain. This is a condition that is characterized by pain along the medial (inside) border of the tibia. The area will be painful to touch, may feel warm, and may exhibit swelling. This is an overuse condition that may have several causative factors, such as: improper footwear, muscle strength imbalance, muscle inflexibility, or improper running surface.

Pain with this injury is located along the medial (inside) border of the tibia. The pain worsens with activities, and is alleviated with rest. The prevailing theory for the origin of the pain lies with the connection of the gastrocnemius-soleus-tibialias posterior muscles connection to the tibia. It is believed that the muscles attachment becomes inflamed, causing the pain. The causative factors for this can be any of the above mentioned things. It is important to access them all to determine the cause of the pain.

• Ice before and after running,

• Posterior leg stretching,

• Arch support if shoes are improperly fit,

• Strengthening of the posterior and anterior leg muscles,

• Choose a softer running surface, and

• Cross-training on bicycle or swimming.

Stress fractures are microscopic fractures in a bone. They occur over a period of time in which unusually high stress is applied to the bone. The amount of stress needed to cause this condition varies from person to person. The same volume of training, intensity of training, and surface type will affect two people differently. In other words, one athlete may develop a stress fracture while training exactly the same as another who does not develop a stress fracture.

The signs and symptoms of a stress fracture are essentially the same as medial tibial stress syndrome. There is pain along the bone, swelling may or may not be present, pain exacerbates with training, and the athlete’s performance begins to decline. Clinical findings in stress fractures are often difficult. Plain film X-rays are often inconclusive; the fracture is too small to be seen. The physician will often order a bone-scan to rule out a stress fracture. Bone scans involve injecting the athlete with a radioactive dye that is selective for areas of greater metabolic activity. The dye is absorbed by the body in areas where it is working harder to heal an injury. The special scan then shows these areas as dark spots on the x-ray. This test is NOT conclusive for a fracture, but merely shows that the body is trying to heal an injury. The physician then differentially concludes that a stress fracture may be present and chooses a course of treatment. Repeat plain film X-rays in 4 -6 weeks may show a healing fracture, thus validating the diagnosis of a stress fracture In this case, removal from running is advised. If an athlete continues to stress the bone with a stress fracture, a complete fracture may result. That is, the stress fracture grows, causing the bone matrix to fail, resulting in a visible fracture site.

Treatment for stress fractures includes:

• Removal from running,

• Posterior leg stretching,

• Posterior and anterior leg strengthening, and

• Ice,

New research has shown that taking nonsteroidal anti-inflammatory medications (Advil®, Aleve®, or other similar prescription medications) may slow the healing of stress fractures. Physicians should not prescribe these medications if a stress fractures is suspected.

Compartment Syndrome

The three compartments of the shin are composed of bone, muscle, blood vessels, and nerves. The connective tissue around the bones and muscles produce a sealed compartment. This sealed compartment produces pain when the pressure inside becomes too great. Increased pressure is normal while exercising. The muscles become engorged with blood during use. In a non-symptomatic athlete this is not a problem, it is only a problem when the volume of blood increases to the point where it begins to compress the arteries, veins, and nerves within the compartment.

This compression is accompanied by pain, swelling (the compartment will feel like a full balloon when compressed), and tingling and numbness in the foot. This is a serious medical problem. Prolonged high pressures in the compartments can cause muscle death from ischemia (lack of blood and oxygen).

• Removal from running,

• Posterior leg stretching,

• Posterior and anterior leg strengthening (as pain permits), and

• Ice.

Athletes suffering from compartment syndrome may not benefit from conservative treatment and require surgery to correct the problem.

Rehabilitation

Posterior leg stretching should be performed with the knee straight and with the knee bent. The gastrocnemius is best stretched with the knee straight, while the soleus is stretched with the knee bent.

Strengthening exercises are the same as utilized with an ankle sprain.  The athlete should perform Theraband® exercises for inversion, eversion, plantarflexion, and dorsiflexion and calf raises, with an emphasis placed on a very slow descent, rather than an explosive ascent.  These exercises should be performed as pain allows.  Special attention should be paid to those suffering from compartment syndrome, many times these exercises may make symptoms worse.

©2000 - 2009 David Edell

Information on this site is not a substitute for physician directed care.

Please consult your personal physician for more detailed information

concerning specific injuries or illnesses.

Last Update for AthleticAdvisor.com: 10/24/2009 12:09:35 AM