Shin Splints

    The term shin splints is currently avoided in medical circles and the terms medial tibial stress syndrome, compartment syndrome and stress fracture are preferred. The term shinsplint has been historically used to encompass almost all problems occurring in the lower leg. These problems included both bone and soft tissue problems and those that overlapped. They were jumbled into several categories which poorly represented reality. The previous categories in use were anterior, posterior, medial and lateral. Most athletes have used the term shin splint to refer to pain occuring either in the anterior or the medial portion of the leg. This correlates well with the type of problems that are most often seen and will be utilized here. Problems that occur in the lateral aspect of the leg are usually either fibular stress fractures or peroneal tendon injuries following an inversion injury of the ankle. Posterior leg pains are frequently injuries to the posterior muscle group at the myotendinous junction of the calf muscles and achilles tendon or early achilles tendonitis.

Definition:

• Anterior shin splints occur in the front portion of the shin bone (tibia). Most of these are soft tissue injuries interface of the bone and muscle however stress fracturing can occur in this area. Anterior shin splints usually have a longer, wider more vertically oriented area of symptoms and tenderness. Most stress fractures have a discrete narrow line of tenderness. This line in many stress fractures of the tibia extends horizontally, but might take a tangential course through the tibia. With those that are horizontal there would be no tenderness found one or two centimeters above or below this discrete line of tenderness.

• Posterior shin splints occur to the rear of the leg and are frequently injuries to the posterior muscle group at the junction of the calf muscles and achilles tendon or early achilles tendonitis.

• Medial shin splints occur on the inside (medial) part of the leg along the tibia. The term medial shin splints has been replaced by medial tibial stress syndrome. Stress fractures can also occur in this area. The definitive test for stress fracture is a bone scan, but false negatives or positives occur. A physical examination can often be used to differentiate between "medial shin splints" and stress fracture. With medial shin splints, (medial tibial stress syndrome, MTSS), the tenderness extends along a considerable vertical distance of the shin (tibia). When a stress fracture is present, tenderness is usually noted that extends horizontally across the front of the tibia.

• Lateral shin splints occur on the outside part of the leg.

Symptoms:

Causes of Injury:

• Shin splints are often due to muscle imbalances, insufficient shock absorption, over or under pronation.

• Tightness in the posterior muscles, which propel the body forward, places additional strain on the muscles in the front part of the lower leg, which work to lift the foot upward and also prepare the foot to strike the running surface.

• Hard surface running, or worn or improper shoes increases the stress on the anterior leg muscles. Softer surfaces and shoe cushioning materials absorb more shock and less is transferred to the shins.

• The lower leg muscles suffer a tremendous amount of stress when a runner lands only on the balls of the feet (toe running), without the normal heel contact.

• The muscles of the foot and leg overwork in an attempt to stabilize the pronated foot and the repeated stress can cause the muscles to tear where they attach to the tibia.

• Rapid increase of speed or distance.

Short Term Treatment:

• Ice immediately after running, never before.

• Treat with the use of anti-inflammatory pain medicines. The most acceptable over-the-counter medications of this type are Ibuprofen and Naproxen Sodium and should be taken in the dosages indicated on the packaging.

• Reduce mileage and intensity for 7 to 10 days.

• Avoid hills and hard running surfaces.

• A varus wedge to support the inside of the foot and reduce the amount of pronation.

• Gentle stretching of the posterior leg and thigh muscles.

• Taping (click for instructions).

• Exercises

  • Calf Stretch: With hands on a wall, extend one leg behind and press its heel to the ground slowly. Perform 20 times with each leg.

  • Toe Taps: Place both hands against a wall. With knees slightly bent, tap your toes up and down quickly. Perform 20 times each with feet parallel, tuned out and turned in.

  • Calf Raises: With knees straight, lift heels off the ground as high as possible. Perform 20 times each with feet parallel and turned out.

  • Achilles Stretch: Place hand against a wall with feet about 1' from the wall and heels on the ground. Bend one knee as far as possible while keeping heel down. Perform 20 times with each foot.

  • Ankle Circles: With one hand on wall for balance, lift leg and circle the foot 20 times each clockwise and counterclockwise. Perform 20 times with each leg.

  • Shin Stretch:  With one hand on wall, bend one knee, place that pointed foot behind you and gently press the foot down. Perform 10 times with each foot.

Long Term Treatment:

• Strengthening and flexibility programs to correct muscle imbalance. These exercises should only be done in the absence of pain.

• Orthotic devices.

• Anti-inflammatory medications.

• Physical therapy involving ice massage, ultra-sound, electrostimuli and heat to reduce inflammation and pain.

Prevention:

Ankle mobility and flexibility has been determined to be a valuable resource for the prevention of shin splints. The following series of drills performed three times daily - morning, prior to practice and night - can assist in developing and maintaining flexibility in the ankles.

• Tucker Crunch: While seated using your hands hyperextend and rotate each foot in all directions and angles.

• Foot Rotations: Pull your toes forcefully towards the knees and then rotate them outward. Curl your toes away from your knee and force them outward, sideways and return to the original position. Repeat 10 times in each direction with each foot.

• Isometrics:

  • Pull the toes up toward the body building up force gradually and then hold for 10 seconds.

  • Curl the toes and hyperextend the foot and ankle away from the knee while keeping the leg straight gradually increasing tension. Hold for 10 seconds.

  • Turn the ankle and foot inward building up tension. Hold for 10 seconds.

  • Rotate the ankle and foot outward and upward gradually increasing tension. Hold for 10 seconds.

  • Stand between 18" and an arm's length from the wall with the feet and heels on the ground. Push the hips and chest to the wall keeping the heels flat on the ground.

   

Some information and graphics provided by the American Running and Fitness Association.