Shin splints – a pain in the leg and a pain to treat!
What are shin splints?
Shin splints or Medial Tibial Stress Syndrome is a condition defined as a dull ache or a sharp, burning pain along the inside of your shinbone. The specific location along the shinbone can vary, either at the bottom close to your ankle or higher up in the middle. Thus the distal two thirds of the shin bone. The painful area is usually about 5cm in length and could be bilateral. The area is usually very tender to palpation and some edema might be present.
The pain usually worsens with each moment of contact (walking or running or jumping) and at first the patient might only feel it at the beginning of training. As the muscles warm up, the pain might disappear during exercise and return after training when the patient cools down. In more severe cases the pain stays for the entire training period and might also prevent or inhibit training.
What causes Shin splints?
This is where it becomes difficult…
The exact cause of this condition is not fully understood and no definite cause can be explained. However it is believed that the various causes could be summed up in four words: TOO MUCH, TOO SOON.
It seems that shin splints is most likely an overuse injury. Runners often tend to suffer from shin splints. It is important to determine if they had any changes in their training such as: increased amount of training, increased speed, increased inclines, change in footwear, change in surface (hard and uneven) and change in activity. They might be overtraining their bodies resulting in an overuse injury.
Shin splints are also common in gymnasts as a result of the increased time and intensity of training, high explosive forces generated by their muscle (calves and foot muscles) and the hard surface and high impact landing from jumps.
Shin splints might also develop due to inadequate rehabilitation following another lower limb injury. This is due to an imbalance in muscle power and control and possibly favoring certain areas and putting more stress on other areas of the body.
Other possible causes for shin splints are a bad technique (running or jumping and landing) or an anatomical abnormality such as over pronated feet (flat feet) or a leg length discrepancy. The condition of the patient’s muscles and bones are another factor. Muscles that are too strong could cause micro fractures or micro tears in weak bones and tendons. Muscles that are too weak fail to absorb stress and loading and transmit it directly to weaker bones. Therefore, it is important to test muscle strength and flexibility.
How to treat Shin splints?
Since the exact cause of shin splints are somewhat of a grey area, the treatment thereof causes a dilemma as well. Previously it was believed that Rest and Ice and avoidance of the aggravating activity were the way to treat Shin splints. However, that is not always possible for competing sportsmen and –women.
A treatment plan should be developed depending on the individual, the type of sport, the level of participation and the possible cause of shin splints.
It was found that complete avoidance of activity and rest is not always favorable. A gradual and slow increase in loading is sometimes a better approach. Thus, allow the sportsman to continue with training but progress slowly and gradually. A study done on gymnasts also stated that during off-season gradual increased loading and allowing jumps and landings on the harder floor, rather than on trampolines and padded floor, helps to strengthen the bone and decreased the incidence of shin splints.
It was also found that tightness and spasms or trigger points in calve muscles causes a forceful pulling stress on the medial border of the Tibia where they attach. Thus, by keeping the calve muscles loosened and by getting rid of spasms and trigger points has shown to decrease the pain at the sight of shin splints. This could be achieved by foam rolling, deep myofascial release with massage techniques, stretching and Dry needling.
Examination of the individuals training shoes might be necessary. Insoles might improve anatomical variations like flat feet. Padded insoles might decrease the loading and impact on the bone itself. Old and worn shoes might need to be replaced to give better support to the individual’s feet and running style.
Examination of muscle imbalances, running technique, anatomical variations such as foot arches, spasms and trigger points, muscle control and proprioception.
Myofascial release of tight muscles by means of massage.
Stretching program for shortened and stiff muscles
Dry needling to release trigger points in calve muscles
Strengthening and rehabilitation after injury
Strengthening the calve muscles (eccentric) to prevent fatigue
Strengthening hip stabilizer muscles and core muscles to improve running biomechanics
Correction of muscle control deficit
Balance and proprioception training
Electrotherapy such as ultrasound, Interferential current and laser to promote healing
Training and activity modification programs might help to keep the individual training without further injury
… Don’t let shin splints become the splinter that prevents you from living your life…