What are Shin Splints?
Shin splints, or medial tibial stress syndrome, are the most common cause of lower-leg pain in athletes. “Shin splints” refers to a number of conditions that cause diffuse pain along the inside shin. These conditions include injury to:
-Calf muscles, such as the soleus, tibialis posterior, or flexor digitorum longus.
-The crural fascia, a thin, fibrous tissue that envelopes muscle in the lower leg.
-The periosteum, a connective tissue that covers the shin bone. Inflammation of the periosteum is called periostitis.
“Medial tibia” is the medical term for the inside of the shin. Pain is typically felt in the bottom 2/3 of the medial tibia.
Other causes of lower leg pain in athletes include tibial stress fractures, exertional compartment syndrome, and entrapment of the popliteal artery. These medical conditions are considered serious and require medical attention.
Symptoms of Shin Splints
Below are common symptoms associated with shin splints. Although mild swelling sometimes occurs, notable swelling of the lower leg, numbness, and weakness are not associated with shin splints and should prompt evaluation for other disorders.
- Dull pain. Athletes report a dull pain that affects most of the inside shin (medial tibia), particularly in the middle or lower part of the shin.
- Pain occurs during activity. Shin pain typically develops while running or doing other athletic activities, such as dancing, or shortly after these activities. As the condition progresses, pain may be noticeable even when walking.
- Tenderness. The inside of the shin may be tender and painful if pressed or squeezed.
- Tight calf muscles. Athletes may notice their calf muscles are tight.
- Decreased ankle flexibility. Just as the calf muscles may become tight, the ankle may become less flexible.
The symptoms of shin splints and tibial stress fractures can be similar. Shin splints differ from stress fractures on two ways:
Shin splints tend cause dull or diffuse pain, in contrast to stress fractures, which tend to cause sharp pain that is concentrated to one area.
Shin splints cause pain on the inside of the shin, not the front of the shin. Pain on the front of the shin, or tibia, may represent a stress fracture.
What causes Shin Splints?
A person should contract his or her doctor if he or she is experiencing severe pain or suspects a stress fracture.
Shin splints are overuse injuries, meaning they occur over time through repeated use.
Shin splints occur most often in people who:
- Intensify training: A rapid change in training, such as increasing volume or intensity, can bring on shin splint pain. Shin splints are common early in a sports season when people start or intensify training.
- Hyperpronate. Excessive pronation refers to when most or all of the body’s weight rest on the inside sole of the foot. Hyperpronation can cause increased eccentric loading of the soleus and tibialis posterior muscles in the calf, which can lead to shin splint pain.
- Have flat feet (pes planus). Like people who hyperpronate, people who have flat feet, called pes planus, tend to put more stress on the inside sole of the foot.
- Have slightly different leg lengths. A person can have slightly different leg lengths and not be aware of it. A relatively small leg length difference can cause problems in running biomechanics, leading to shin splints or other repetitive use injuries.
- Wear improper footwear. Running shoes that do not provide enough cushion and support proper foot mechanics may encourage the development of shin splints.
- Run on hard surfaces. Running on hard surfaces, such as concrete sidewalks, increases the impact on the musculoskeletal system and can lead to shin splints.
- Run on uneven surfaces. Running on uneven trails or pavement can force the body to make constant adjustments, causing strains that can lead to shin splints.
- Have bad running form. A runner who has poor form puts additional stress and strain on the musculoskeletal system, which can lead to shin splints.
A person with shin splints may have only one of these risk factors or all of them.
I think I have shin splints what do I do now?
Most people with shin splint pain never need to go to the doctor for a formal diagnosis. However, athletes may want to consult with their doctors if shin splint pain is not relieved after a couple of weeks of resting, icing, and taking over-the-counter NSAIDs, such as ibuprofen
Our Physiotherapists at Sporting Edge Physiotherapy will conduct a patient interview and physical examination and possibly also recommend medical imaging.
Patient Interview. Your Physiotherapist will ask you many questions, including questions about your training regime, what brings on pain and what relieves pain.
Physical examination. Pain along the medial tibia is most often present with running and sports, but may progress to be triggered by walking as well. Tenderness to palpation is present along the medial tibial border. Tight calf muscles and decreased ankle motion are common. Neurovascular exam is normal
Medical imaging. X-rays, bone scan, and MRI are often negative with shin splints, but they may help to differentiate shin splints from stress fractures. X-rays may demonstrate some generalized periosteal thickening. A bone scan may demonstrate some generalized uptake of the tracer substance used in these scans along a length of the medial tibia, which indicates locations where the bone’s metabolism is increased. This differs from the intense uptake seen in a medial tibial stress fracture.
The majority of patients are able to treat their shin splints with rest and other home-care methods, but some need help from Physiotherapists or other healthcare providers. Several of the treatments listed below can be done at home.
- Cut back on training. Athletes should decrease training to a point where discomfort is no more than mild. This may require taking some time off running and sports. During this time, athletes can do non-impact cross-training, such as water running, cycling or using an elliptical machine. This is usually the hardest thing we have to tell our dedicated athletes.
- Improve running form. Adjustments in running form can lessen the impact on the body, thereby decreasing the likelihood the shin splints will become chronic or more painful. For example, a running technique that lessens the risk of shin splints is to avoid footfall on the heel and move to the mid- or forefoot.
- Use shin sleeves or shin wraps. These products provide compression and support for the lower leg and may decrease shin splint pain. Shin sleeves and wraps can be ordered in clinic if needed.
- Change shoes. Switching out athletic shoes for a newer or a different pair can decrease the impact when feet hit the ground.
- Use shoe inserts. Like changing shoes, using inserts (orthotics) can help, especially for athletes with flat feet.
- Ice. Applying a cold pack for 20 minutes two or three times a day can decrease inflammation.
- NSAIDs. Over the counter NSAIDs can help relieve pain and control inflammation.
- Stretching and strengthening exercises. Helpful exercises will stretch the calves and strengthen the lower leg muscles.
- Electrical Stimulation. This type of therapy is used to treat muscle pain and spasms, and may be helpful when damage to calf muscles is the underlying cause of shin splints.
- Ultrasound. Concentrated, low ultrasonic frequencies stimulate blood flow, potentially promoting cell healing and speeding up recovery. Ultrasound therapy is different from ultrasound used for medical imaging.
- Iontophoresis. This treatment uses a mild electrical current to push a topical steroid medicine into the affected shin(s).
- Dry needling or acupuncture. Inserting ultra-thin needles into specific locations on the skin might relieve musculoskeletal pain and dysfunction, including shin splints.
- Massage. Manual therapy and soft tissue massage can improve limitations in joint motion and flexibility.
A person suffering from shin splints may employ several of these treatment techniques at once. For example, Physiotherapists at Sporting Edge Edge Physiotherapy teach our patients stretching and strengthening exercises to be done at home and use appointment time for joint mobilizations, massage, acupuncture, dry needling, ultrasound and education.