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Shin Splints: A Guide to Diagnosis and Treatment

By Harold Antwine III, M.D.

Many high school and college basketball players have the potential to develop a condition known as “shin splints” or medial tibial stress syndrome.

Another name used to describe this condition is soleus syndrome, after the muscle in the lower leg. The pain is usually localized on the inside portion of the lower leg below the knee and can travel towards the inside of the ankle.

The phrase “shin splints” was originally used as a nonspecific term referring to overuse syndromes of the lower leg. Other injuries of the lower leg that can mimic shin splints are stress fractures, which can occur from overuse of both the tibia and fibula in the lower leg.

Exercise-induced compartment syndrome is another condition a treating physician needs to be aware of. This is an increased pressure within a confined space in the lower leg, which can cause discomfort and sometimes result in surgical intervention.

Most cases of shin splints occur in running-type activities, with an incidence ranging from between 4 and 13 percent.

The primary cause of shin splints is related to stress at the periosteum of the tibia, which is a film-like covering overlying the bone and is instrumental in nutrition as well as bone remodeling in stress or acute fractures. In the early stages, the periosteum may reveal inflammatory changes, which can be treated with simple anti-inflammatory medications, as well as rest. In longer-term cases or chronic cases, the periosteum may be separated from the bone.

The muscles involved in this condition are the soleus and flexor muscles of the foot and toes. Diagnosis also can be confirmed by studies that include plain x-rays, bone scans and MRI scans.

Runners who have excessively pronated or flat feet have been shown to be predisposed to the development of these overuse syndromes.

Rest is the mainstay of treatment for shin splints. Most patients can be treated successfully by refraining from the offending activity for several days to two weeks. Depending on the degree of pain, non-impact exercise, such as swimming or biking, may be permitted to maintain stamina and endurance.

The rule of thumb, “let pain be your guide,” is a phrase frequently used with these patients. Nonsteroidal anti-inflammatory medications are used for one to two weeks to decrease pain and inflammation. Cryotherapy or ice applied to the affected area two to three times per day also may diminish inflammation. Heel cord stretching exercises are recommended in patients as well. Patients who have flat feet or excessive foot pronation can use arch supports. After the symptoms have resolved, a graduated return to running is permitted over a three to six-week period.

In this day and age with many athletes participating in multiple sports, overuse injuries, such as shin splints, are common presentations at the orthopedic surgeon’s office. With proper evaluation, diagnosis and treatment, these athletes can be back on the track, court or field in a relatively short period of time.

Shin Splints Q & A

By Cheryl Murray, P.T.

Q: What are shin splints?
A: Shin splints is the name given to pain located over the front of the lower leg that is the result of an overload on the shinbone and the connective tissue that attaches muscle to the bone. Symptoms include tenderness over the inside of the shinbone, mild-swelling and lower leg pain, which goes away after a period of rest, but returns when activity starts again.

Q: What causes shin splints?
A: They may be caused by a sudden increase in distance or intensity of a workout schedule. A tendency to overpronate, or roll the foot excessively inward onto the arch, may put one at risk for shin splints, and a tight Achilles tendon or weak ankle muscles often are implicated in their development.

Q: What is the treatment for shin splints?
A: Treatment involves resting from the activities that cause pain. Modifying your exercise routine to include low impact exercises, such as swimming, bicycling or pool running, will help maintain cardiovascular fitness.

To reduce pain and inflammation, ice should be applied for up to 20 minutes three times a day, and anti-inflammatory medications, such as Ibuprofen or Aleve can be taken.

Treatment also involves wearing proper shoes suited for your foot type. A professional gait analysis may help determine if you overpronate, which may require special footwear or orthotics.