Shin splints is an umbrella term for anterior leg pain or inflammation. This refers to pain from the top of the tibia to the ankle area. Patients complain of tightness or tenderness along the tibia border. Shin splints is largely associated with “Too much, too soon”; specific activities or changes in training programs can aggravate this area.
Shin splints must be diagnosed correctly. There are three commonly presenting conditions which cause shin splints. These conditions are most often found in sports or military personnel; they can be triggered or brought on from increased activity or change in training regimes.
These 3 conditions are:
This is a very common injury among athletes, and is an overuse or repetitive stress injury. Statistics show that more women than men are affected by this syndrome. MTSS starts from inflammation of the tibialis posterior muscle, which can be worsened by continual exercise. The inflammation occurs along the muscle, tendon and lining of the bone. Repetitive stress on these muscles worsens the injury, as they do not allow the area to heal properly.
The condition can be worsened by running, jumping, soccer, basketball; especially if done on hard surfaces. This causes even more pain experienced in the lower part of the shin bone. If the pain is untreated, it can become persistent and even present in routine activities such as walking or descending stairs. The pain may then extend to the muscles and bone extending to the front of the leg.
Ways to resolve the pain:
Reduce the inflammation via the RICE method.
Reduce lower limb activities which aggravate the condition.
Switch to non-weight bearing activities to reduce inflammation.
Do gentle stretching exercises of the foot and lower leg.
If pain is not resolving and still persistent after 3 days, please consult a lower limb specialist.
Gradually increase your physical activity in duration, intensity, and frequency avoiding sudden increases. Monitor your training regime closely.
Strengthen your muscles, but always remain flexible by stretching before and after exercise.
Get footwear which give the right level of support for your feet, especially people with flat feet. Collapsing arches or pronated foot types have higher inclination to developing MTSS.
Shin splints can also refer to pain in the anterior compartment of the leg, meaning the front part of your leg. This area is especially susceptible to compartment syndrome. Anterior compartment syndrome describes numbness, tingling, pain and weakness in the leg. Exercise enhances these sensations, creating a feeling of tightness in the affected compartment. There may also be a decreased feeling of space between the toes due to nerve compression.
What causes this to happen?
The muscles are tight with scar tissue formation, due to inadequate stretching and recurrent injuries.
Excess compartment pressure reduces the blood supply to the muscles.
Ways to reduce the pain:
Obtain a correct diagnosis – see a specialist who can evaluate the underlying vascular, neurological or musculoskeletal issues causing the pain.
Reduce exercises which exacerbate the condition.
Progressively increase your activites (frequency and intensity).
Sports compression stockings may be considered.
If conservative treatments (listed above) fails, surgery should be considered.
Ways to prevent recurrence:
Ensure you stretch and warm up adequately; seek professional advice if needed.
Have sports injuries treated; scar tissue development can hinder your future performance in sports.
Make sure your sports shoes are supportive with high shock absorbancy and stability around your ankle. Arch support orthotics may be needed to reduce tibial and ankle rotations in your foot.
A stress fracture can occur from overuse in an area of weak bone. Repeated stress directly on the bone, or on a muscle attached to the bone, can cause overloading and small cracks in the affected bone.
Athletes in tennis, track, field, gymnastics and basketball are highly susceptible to stress fractures in the lower limb. Women athletes are much more susceptible to stress fractures as they have a higher tendency to have eating disorders, amenorrhea, and osteoporosis leading to decreased bone mass. Runners who need to be lightweight for competitions may be at risk of nutritional deficiencies from weight loss, and so are predisposing themselves to injury.
Orthopaedic surgeons, sports physicians and podiatrists can help diagnose and treat stress fractures. X-rays are not a necessity and fractures may not show on x-rays for several weeks, but the clinician may order one to help confirm diagnosis.
Ways to reduce the pain:
Ice the painful area daily.
Rest from activities for 6-8 weeks – it takes this long for your bone to heal.
Your physician will strongly suggest immobilization and ask you to wear a cast.
Alternative bracing and shoe inserts may be offered to help heal your injuries.
How to reduce recurrence rates:
Set incremental goals, i.e. gradually increasing your mileage on a weekly basis.
Mix and match your workouts; do some cross-training to reduce repetitive stress on your bones. Mix strength training with cardio.
Rest between work outs and competitions.
Slowly adapt to unfamiliar surfaces, e.g. running outdoors vs indoors.
Ensure you have a healthy diet, rich in calcium and vitamin D.
Do not wear old, unsupportive and worn-out running shoes. Areas of repetitive load will worsen until the bone fails and breaks. Wear supportive footwear with ample cushioning and shock absorbency.
If you experience persistent pain after sports, then please ice and rest. If resting does not resolve the pain, please seek medical attention.
Recognising the symptoms early and seeking medical help to recover means you can return to sports quickly and efficiently.
Author: Podiatrist Kerry SEAMAN
Editor: Principal Podiatrist Michael LAI