Shin splints (or tibial periostitis or medial tibial stress syndrome) is a common injury that affects athletes who engage sports with repetitive impact or overuse the muscles of the leg (runners, dancers, basket and football players, etc), This condition is characterized by pain (usually sharp) in the lower part of the leg between the knee and the ankle. Shin splints injuries are caused by repeated trauma to the connective muscle tissue surrounding the tibia.
The 2 most common causes of shin splints are:
- The Tibialis Anterior Strain (Anterior Shin Splints) is defined as a muscle strain, tendinopathy and/or periostitis involving tibialis anterior and other anterior muscles. Patient complains of pain along anterolateral aspect of leg.
- The Posterior Shin Splints (or Medial Tibial Stress Syndrome) is defined as a muscle strain, tendinopathy and/or periostitis involving tibialis posterior or flexor digitorum longus and/or soleus. Patient presents with pain along posteromedial aspect of middle 1/3 of tibia.
However a thorough exam by a practitioner should be conducted to exclude: stress fracture, compartment syndrome, intermittent claudication.
Causes
The most common cause of shin splints is overdoing activities that constantly pound on the legs and feet. This may include sports with many stops and starts, running down hills and/or uneven surfaces, repetitive impacts. Simply training too long or too hard, especially without proper stretching, warm-up and poor shoes can cause shin splint. People with flat feet, high arches, externally rotated hip (feet that turn outward) and leg length discrepancy may be more prone to shin splints.
Muscle imbalance, including weak core muscles, can cause lower-extremity injuries, and inflexibility and tightness of the soleus, gastrocnemius and plantat muscles (such as the flexor digitorum longus) may contribute as well.
Diagnosis
A typical clinical presentation of this condition involves pain, palpable tenderness, and possibly swelling. The pain is anterolateral or posteromedial, increase during activity and initially is relieved with rest. In early diagnosis, individuals may experience pain at the beginning of a workout, which may go away by continued activity and then occur again at the end of the activity.
X-ray may be needed if patient complains of constant or night pain.
Treatment
Usually a period of 2-4 weeks rest is recommended to let the area heal, though the time varies depending on the patient and injury severity.
Acute phase
Initially should be treated with rest, ice, NSAIDs (such as Ibuprofen), ultrasound, soft tissue (unless is an acute traumatic strain) and manipulation of the joints in dysfunction. Patients should gently stretch the tight muscles and avoid high impact/distance, hills. Taping could help taking some pressure off the muscles.
Shoes should be changed and orthotics should be considered.
To maintain fitness patient can jog in shallow end of pool, swimming or cycling.
Post acute phase
Gradually resume hills, jumping, sprinting, longer distance, etc.
Deep tissue massage can be done and further stretching.
Strength (isometric and then isotonic) soleu/gastrocnemius, tibialis anterior and posterior, quadriceps, hip flexors/extensor/abductors, hamstings.
Vitamin C, E, aminoacidis could speed up the healing process.
6 weeks of treatment may be needed to reduce scarring/adhesions.
If the shin splints does not respond to conservative care, lifestyle changes may be needed or gait analysis performed.
Prevention
- Warming up and stretching calf muscles before running or jogging
- Wearing quality shoes with arch supports. Runners should purchase new shoes about every 400 miles
- Runs should be started at a slow pace and gradually increased
- Avoid/limit hard surfaces, hills, uneven surfaces
- Build up distance carefully, avoiding over-training. As a matter of fact increasing activity, intensity, and duration too quickly leads to shin splints because the tendons and muscles are unable to absorb the impact of the shock force as they become fatigued.
Hints
You can strength the muscles in the front lower leg (anterior tibialis) with resistance exercises or by walking on the heels three times daily for about 30 yards.
Neoprene shin splint support may provide firm, comfortable compression to help relieve pain and discomfort associated with shin splints.
Suspect stress fracture with constant or night pain.
Evaluate feet, leg length, shoe wear, gait pattern, dysfunction SIJ, scoliosi,knees,hips.
Check for normal pulses & changes in the skin (suspect vascular problems).
***Refer if acute compartment syndrome, DVT, intermittent claudication or tibial stress fracture.***
See your physiotherapist, chiropractor or osteopath for further information.
Dott. Emanuele Luciani
Osteopath, physiotherapist, hatha yoga teacher
Osteopath registered with the General Osteopathic Council (GOsC)
(number 8232http://www.osteopathy.org.uk/home/)
"Centro Studi Tre Fontane"
Via Luigi Perna 51, Rome
