Shin Splints

Shin Splints
Posted on 01/14/2022
Photo of shin

Shin Splints

Tom Bradley, MS, LAT, ATC, CES

Head Athletic Trainer, Castle View High School


Medial tibial stress syndrome (MTSS), commonly referred to as shin splints, typically can be captured in four words: too much, too soon. This is commonly seen at the beginning of sports seasons when athletes begin high intensity workouts immediately, instead of gradually increasing in intensity and duration over time. According to the American Academy of Orthopaedic Surgeons, shin splints is "pain along the inner edge of the shinbone (tibia).”                         

Shin splints make up 10 -15% of all running injuries and as much as 60% of all lower leg injuries that affect athletes. The sports affected the most are running, basketball, and gymnastics. Military personnel also suffer from shin splints.

Basic knowledge of the causes of shin splints as well as prevention and treatment strategies can help athletes avoid shin pain throughout their sports seasons.


Causes

Flat foot - Over pronation of the foot (see picture 2)

Tight Achilles

Weak soleus and tibialis posterior muscles

Weak toe flexors muscles

Worn out shoes that do not absorb the ground reaction force anymore

Repetitive high-impact exercises on hard surfaces

Increase in exercise intensity over a short period of time

http://orthoinfo.aaos.org/figures/A00173F01.jpgPic #2

Symptoms

There are 4 levels of shin splints: 

Grade 1: pain in the shin after athletic activity

Grade 2: pain in the shin before and after activity but not affecting performance

Grade 3: pain in the shin before, during, and after athletic activity and affecting performance

Grade 4: pain so severe that performance is impossible


Prevention

Wear a proper fitting athletic shoe: If you are going to play basketball, wear a pair of basketball shoes. If you are going for a run, wear running shoes. Wear the appropriate shoe for the activity that you are doing. Wearing the right shape of shoe is also important. To determine the shape of your foot, use the "wet test" method. Step out of the shower onto a surface that will show your footprint, such as a paper towel. With a flat foot, you will see an impression of your entire foot; whereas with a high arch, you will only see the ball and heel of your foot. This will help you determine if you need a shoe to support the arch of your foot.

Build up your fitness level over time: Starting out with a high intensity, long duration workout will add stress too quickly. The body needs time to adapt to the demands imposed on it. Increasing the duration, intensity, and frequency of your exercise regimen over time will help reduce the chance of shin splints.

Cross train: Rotate exercise activities between high impact exercise and low impact exercises like stationary cycling, swimming, elliptical trainer, or resistance training.


Treatment

Rest: Several days or weeks of rest from the activity that caused the pain may be necessary. Substitute cross training during your recovery, such as swimming and stationary cycling.

Ice: After activity use ice for 20 minutes at a time, 2-3 times a day as needed.

Compression:  An elastic compression bandage will help reduce swelling.

Non-steroidal anti-inflammatory medicines: Ibuprofen and Aleve help reduce pain and swelling.

Stretching of Achilles/Calf: With leg straight and with the knee bent.

Strengthening of toes flexors muscles: Towel curls or picking up marbles with the toes.

Strengthening of soleus muscle: With the knee bent and a resistance band around the toes, push down with the foot into plantarflexion (like pressing on a gas pedal).

Strengthening of tibialis posterior: With leg straight and a resistance band around the toes and resistance toward the outside of the ankle, pull the toes inward.

Orthotics: Shoe inserts can help with alignment and stability of the foot and ankle, reducing stress to the lower leg.


When to see a Dr.

Shin splints that do not improve with conservative treatment may require an examination from a physician. Ruling out stress fractures or compartment syndrome is important before resuming athletic activity. 


Resources:

Aynollah Naderi, Hans Degens & Ainollah Sakinepoor (2019) Arch-support foot-orthoses normalize dynamic in-shoe foot pressure distribution in medial tibial stress syndrome, European Journal of Sport Science, 19:2, 247-257, DOI: 10.1080/17461391.2018.1503337


Becker J, Nakajima M, Wu WFW. Factors Contributing to Medial Tibial Stress Syndrome in Runners: A Prospective Study. Medicine and Science in Sports and Exercise. 2018 Oct;50(10):2092-2100. DOI: 10.1249/mss.0000000000001674. PMID: 29787473.


Cameron Garnock, Jeremy Witchalls, Phil Newman, Predicting individual risk for medial tibial stress syndrome in navy recruits, Journal of Science and Medicine in Sport, Volume 21, Issue 6, 2018,

Pages 586-590, ISSN 1440-2440, https://doi.org/10.1016/j.jsams.2017.10.020.


Pietrzak M. (2014). Diagnosis and management of acute medial tibial stress syndrome in a 15 year old female surf life-saving competitor. International journal of sports physical therapy, 9(4), 525–539.


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