Shin Splints

Shin splints refer to discomfort or nagging pain along the inner edge of the shin bone. This pain is usually concentrated on the lower leg, between the ankle and the knee. This condition is sometimes known as medial tibial stress syndrome (MTSS). Individuals who participate in moderate to heavy physical activities are at a greater risk of developing this condition. You are also predisposed to this condition if you participate in physically demanding activities like basketball, soccer, squash and tennis.

Sometimes the pain is so intense that you have to cease the activity. This is more of a cumulative stress disorder. In short, repeated stress and pounding of the muscles, joints and bones of the lower leg, reduces the ability of the body to heal and repair itself naturally. Due to this, the connective tissue covering the surface of the bone is irritated and inflamed. Since the ability of the body to repair and restore itself naturally is diminished, the inflammation and irritation becomes worse, limiting different physical activities. Dancers, runners and military personnel have also reported high cases of shin splints.

Additionally, changing your training regime too fast or adding too much, can also put you at risk. For example, due to time constraints, a runner might decide to increase the normal pace and distance, instead of doing it gradually. Due to this sudden change, the section on the lower foot receives unexpected shock, which later becomes shin splints. Some athletes preparing for high profile events are tempted to run even when suffering from the condition. However, doing so will only worsen the situation and might even cause further damage to the underlying tissues. It is advisable to take a 2-weeks break from the activity associated with the injury. Shin splints affecting the front area of the tibia are known as anterior shin splints while those occurring along the inside edge of lower leg are called posterior shin splints.

Causes of Shin Splints

As previously noted, shin splints mainly occur due to overuse. Continuous and repeated foot movements can lead to damage, at the point where the tibialis muscles connect with the tibia. When that happens, the muscles start pulling away from the bone. The bone covering and the injured muscle become inflamed. Overuse is commonly observed due to sudden changes in training. For example, if you suddenly increase the distance or speed and run on angled and hard surfaces, overuse might occur. Apart from that, if you run or engage in weight-bearing activities wearing flimsy footwear or trainers with worn out soles, overuse can also occur.

Posterior shin splints occur due to imbalances in the foot and leg. Muscle imbalances created by tight calf muscles, can lead to this condition. Moreover, imbalances in foot alignment like having flat arches, commonly known as pronation can lead to posterior shin splints. With each step, the foot flattens out. This causes stretching of the posterior tibialis muscle. This stretching causes the muscle to pull on the on its muscle attachment. Eventually, the posterior tibialis muscle attachment gets damaged. This leads to inflammation and pain in this section of the leg.

Anterior shin splints mainly affect people who are new to a certain physical activity such as playing sports or jogging. Due to the unfamiliar force, a heavy strain is placed on the anterior tibialis muscle. This causes the muscle to become irritated and inflamed. If you are not a regular runner and you decide to go on a jog, you are putting yourself at risk. Anterior tibialis muscles must work extremely hard to control the forefoot landing, with each stride. When you are running downhill, more demand is placed on this muscle, to prevent the foot from slapping down hard.

Individuals who train in shoes with poor shock absorption as well those running on the balls of their feet, also develop sheen splints later on. Shins splints are sometimes confused with a stress fracture occurring on the tibia. They seem to have the same symptoms and they are caused by almost the same factors. People, who attempt to train through shin splints, usually develop a stress fracture in their tibia.

Shin splints may also lead to serious complication known as compartment syndrome. This is a situation where pressure from swelling and muscle damage, builds up within a compartment or a section inside the body. The lower limb contains four compartments. Due to pressure buildup in the compartment, the capillaries or the small blood vessels tasked with supplying blood to the muscles are squeezed out. This occurs when there is higher pressure inside the compartments. Since the muscles don’t have blood supply, they begin aching like a muscle cramp. With continued pressure, the nerves as well as the large blood muscles are squeezed out too. Patients begin experiencing numbness, swelling and coldness in the lower foot and leg. If this pressure build up is left untreated, it causes serious tissue damage in the foot and leg. Shin splints occur mainly when the leg tendons and muscles are tired. People with rigid arches and flat feet, have a high tendency of developing this foot condition.

Symptoms of Shin Splints

If you are suffering from shin splints, you are likely to experience various symptoms, ranging from mild to severe pain. The symptoms occur depending on the extent of the damage. If you observe the following symptoms, then you might be suffering from shin splints.

  1. Weakness and numbness in the feet.
  2. Swollen lower leg which can be mild or severe.
  3. Soreness or tenderness along the inner part of your lower leg.
  4. Muscle pain.
  5. A dull ache experienced in the fore part of the lower leg.
  6. Small bumps along the edge of the tibia.

If you apply common treatments and the shin splints fail to respond, you should consult a doctor. If you are also experiencing the following systems, then you need to see a doctor immediately, before the conditions become chronic.

  1. Pain in the shins even during rest.
  2. Visibly inflamed shin.
  3. Swollen shin which tends to get worse.
  4. Shin feeling hot.
  5. Severe pain in your shin when you get involved in an accident or a high impact fall.

Diagnosis of Shin Splints

Shin splints are diagnosed using physical examination. The physician asks you questions related to your footwear or physical activities. The physician may also seek to determine whether you have recently started a new sport or an activity that requires jumping or running. The physical examination allows your doctor to determine the positions on the leg where there is pain. The doctor might also move the ankle in different directions and positions. When the physician stretches the tibialis muscles and examines the muscle attachment on the tibia, he can point out the location of the problem.

As noted earlier, shin splints are sometimes confused with stress fracture. In order to make sure that the patient is actually suffering from shin splints and not stress fracture, X-rays may be used. However, if the injury is only a week or a few days old, then it may not show up on the X-ray results. In such instances, a bone scan may be necessary. During a bone scan, tracers are injected into the blood stream, which then show up when special leg X-rays are conducted. If extra stress is observed, it may due to stress fracture, and not shin splints. Extra stress may also be caused by inflamed periosteum.

MRI scans may also be ordered by your physician, if the problem seems extensive. Since it displays both bones and tendons, it can show any abnormal swelling, which might not be possible when using X-rays. MRI scans are painless and don’t require injections or needles. If you are showing signs of a compartment syndrome, your doctor may decide to measure pressure on the swollen leg.

Treatment and Prevention of Shin Splints

This condition can be treated through surgical and non-surgical methods. When you start experiencing pain due to shin splints, doctors may advise you to refrain from any physical activity. This gives your legs enough time to rest and recover. The discomfort on your legs will reduce or disappear after a few hours or days as long as you give yourself enough rest. Podiatrists recommend a break of at least two weeks. During this time, you only engage in necessary physical activities like walking. Leisurely walks and sports should be avoided. Here are some conservative methods that can be used to cure and prevent shin splints.

Cross Training

High impact activities such as running and playing soccer can shock your system. Therefore, implement exercises with minimal jarring to your joints like rowing, swimming and cycling. Instead of running every day, mix it up with cross training. For example, you can do three runs and two cross training sessions in a week. The result will be 5 cardiovascular exercises in a week, with minimal strain to your joints, muscles and tendons.

Implement Training Gradually

Instead of going from 10 miles to 50 miles, increase your distance and speed gradually. If you have just started running, you will not suddenly cover this huge mileage every day. Just like shoes, you will require a break-in period, or a transitional phase. This will allow your body to develop the necessary support structures, in order to support the increased level of activity. in terms of building duration and intensity, work with 10% increments.

Using Custom Orthotics

If you notice that you are overpronating or heel striking, then you will have to replace the insoles of your shoes, with plastic or custom orthotics, which provide additional arch support. Custom orthotics help to prevent and treat shin splints together with other overuse injuries such as runner’s knee, plantar fasciitis, iliotibial band and Achilles tendinitis. Check for your local running store or manufacturer’s of sport shoes.

Wear a Supportive Shoe

Lightweight and minimalist shoes might be the in-thing now. However, that does not imply that you expose your feet to unnecessary conditions, just because everyone else is going lightweight. People have different feet. Some can wear lightweight trainers their entire lives, and not complain of any foot problem. Others need proper cushioning, in order to enjoy physical activities. The most important thing is to understand the alignment and configuration of your foot. Most minimalist shoes don’t come with arch support. Therefore, if you have high arches, your feet will be overpronating thus exposing you to overuse injuries. If you are suffering from shin splints, look for motion stability or control shoes. Additionally, change your training sneakers every 4 months at most. Training in worn-out shoes is one of the main causes of shin splints.

Strengthening shin and calf muscles

When you strengthen these muscles, you are increasing the body’s ability to absorb shock and reduce the strain and stress on your tibia. Most importantly, these exercises will strengthen your tibia due to the increased muscular size and strength. Therefore, the tibia will be able to carry and handle the extra weight and movement, minimizing the risk of injuries. Research indicates that female runners who have a small calf circumference, are at a greater risk of tibial stress fracture. It does not come as a surprise that athletes with poor calf strength often end up with shin splints. As much as there is no pre-set programme for strengthening your calves, daily calf raises will boosted your calf strength considerably.

Surgery

Surgery is rarely used to treat or correct shin splints. However, if the shin splints have already been complicated by compartment syndrome, surgery may be required as soon as possible. The problem should be corrected as soon as possible to prevent damage to the adjacent tissues and tendons. If diagnostic tests indicate presence of compartment syndrome or high pressures particularly in the lower leg, you will have to undergo immediate surgery. The procedure involves removing the pressure in the area with the help of small incisions on both sides of the lower leg. After surgery, you might use crutches for a few days, as you allow the wound to heal. You can resume mild activity within 14 days. Start with light jogging activities or riding stationery bikes.

Bottom Line

Whether you are suffering from weak muscles, over-striding, shaky stance or shin splints, biomechanics play a very huge role towards your gait. Before you start a new physical activity or new training regime, consult a medical expert or a sports scientist. These professionals can help you come up with a good training plan, as well as advice on the right type of footwear. This goes a long way towards preventing and treating shin splints.

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