Shin splints are a common lower leg ailment predominately found in runners. The term shin splints is used to describe pain along the shin (tibia) and is generally thought to be an overuse injury. The painful nature of this injury is a result of small tears in the leg muscles where they attach to the shin bone. The pain may begin as a dull aching or throbbing after activity. Tenderness may be present along the inside of the shin with small areas of bumps along either side of the shin bone. The aching may become more intense during activity if ignored.

There are two types: Anterior shin splints occur in the front portion of the shin bone (tibia). Posterior shin splints occur on the inside (medial) part of the leg along the tibia.

Improper stretching, warm-up or exercise technique will increase the chances of shin splints. Training too hard puts the body at risk for injury. Running or jumping on hard surfaces can jar the area. Beginning runners or walkers are the most susceptible to shin splints for a variety of reasons, but the most common is that they're using leg muscles that haven't been stressed in that way before. Another common cause of shin splints among beginners is poor choice of shoes. People who have started up again after a long layoff are also susceptible to shin splints because they often increase their mileage too quickly. Often these occur on both legs. They are seen in circumstances in which an individual is just beginning a running program, excessive downhill running, engaging in sports requiring rapid starts and stops. These conditions cause damage to the tibialis anterior muscle, resulting in pain.

Symptoms

• Pain / tenderness
• Aching / throbbing
• Swelling

Causes of injury

• Inflexibility- tightness in the calf muscles place strain on the muscles in the front part of the lower leg, which works to lift the foot upward.
• Running on hard surfaces
• Poor shoe condition, worn or improper shoes increase the stress on the front leg muscles.
• Toe running, without normal heel contact places a tremendous amount of stress on the lower leg.
• Over pronated feet / flat feet - the muscles of the foot and leg get overworked in an attempt to stabilize the pronated foot and the repeated stress can cause the muscles to tear.
• Supinated / high arch - a rigid foot that has decreased shock absorption
• A rapid increase of speed or distance
• Overuse / over training
• Muscle strength imbalance

Treatment

• Ice after running or walking
• Never exercise through pain
• Avoid hills and inclines
• Avoid running on hard surfaces
• Stretching of the calf and hamstring muscles
• Protective bracing

Persistent problems may require a visit to your Sportsmedicine physician and physical therapist who may prescribe:

• Strengthening and flexibility exercises to correct muscles imbalances
• Orthotics or shoe inserts
• Anti-inflammatory medicine
• Physical therapy treatment to reduce inflammation and pain and promote healing

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Rest is important, but it doesn't mean absolute rest unless there is pain with walking and daily activities. Otherwise, relative rest is applied. This means a decrease in both frequency and duration of symptom causing exercise, as well as increasing the time between workouts. Many individuals make the mistake of taking a few weeks off and then going right back to the same schedule; this will only cause the problem to return. During this relative rest period, it is important to work on correcting the problems that are causing the pain.

Maintaining good flexibility and strength in the lower leg is one of the most effective ways to keep shin pain from developing. Taking time to stretch and strengthen the lower legs can make running and exercising more enjoyable, less stressful, and possibly prevent shin splints or more serious complications. Good alternatives are non-impact exercises such as swimming, pool running, or cycling. These will help keep you in shape while you work to strengthen the lower leg.

Correction of any abnormal foot biomechanics is crucial because if not addressed, the problem will simply come back. A thorough evaluation of the entire legs biomechanics is needed to identify any problem areas. If problems are found, a cast can be made of the feet so individualized custom molded orthotics can be made to correct the abnormalities.

The choice of footwear is also important since different running shoes have different degrees of support and motion control. Running shoes lose 30-40% of their shock absorbing capabilities after 500 miles. The tread may look fine, but the capacity to prevent injury is not. Examination of the tread of the shoes can provide a clue to any abnormal biomechanics. Uneven wear may signal abnormal motion.

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Nirschl Orthopaedic Center for Sports Medicine & Joint Reconstruction
1715 North George Mason Drive Suite 504
Arlington, Virginia 22205
phone: 703-525-2200
fax: 703-522-2603

All information presented here copyright 1998-2008 Nirschl Orthopaedic Center for Sports Medicine & Joint Reconstruction unless otherwise stated.

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The information provided on our web pages is intended for educational and informational purposes only. It is not to be used as a substitute for medical advice. Please contact your physician, who after a full medical exam can give you advice about your specific condition. Your comments are welcome but No answers to medical questions will be given by e-mail or other correspondence.