SHIN SPLINTS

WHAT ARE SHIN SPLINTS?    Shin splints are a common catch-all phrase that athletes and coaches use to describe pain in the lower leg.  Technically, that pain can be caused by a number of conditions, such as tendonitis, a stress fracture, compartment syndrome or periostitis.

What is meant most often when talking about shin splints is Medial Tibial Stress Syndrome (MTSS), a condition characterized as pain of the lower third of the tibia on the medial (inside) aspect of the lower leg.

The pain begins as a dull ache along the tibia.  It is not pinpointed to one spot (which may indicate a stress fracture) but along the border where muscle attaches to bone.

Many times discomfort is felt at the beginning of the workout, then disappears only to return after the workout is over.  As the injury progresses, the discomfort becomes more severe and lasts the entire workout.  Eventually, the pain occurs, more often when getting out of bed and during other daily activities.

MTSS is most common in runners, but is seen frequently at the beginning of a sport season during the most intense conditioning.  It is caused by repetitive running on hard surfaces or by excessive use of the dorsiflexors of the foot.

For spring sports, preseason conditioning frequently takes place inside on hard surfaces.  Many times athletes haven't been running prior to the start of conditioning and the pounding, in addition to muscle weakness, adds to the injury.

WHAT CAUSES SHIN SPLINTS?    Initiating a running program at the start of an athlete's season encourages the occurrence of shin splints.  Often athletes are out of shape and jump into a program too aggressively.  It is important to start any running or sport conditioning program at a gradual pace, allowing for adequate rest between workouts.

Overuse syndrome typically occurs when an athlete does too much to fast and continually strains the muscles of the lower leg.  A runner who increases his mileage by more than 10 percent in one week, or who runs daily without alternating activities to rest the lower legs' muscles, would be a prime candidate for shin splints.

Poor running surfaces are another common cause of MTSS.  The optimal surface for running and aerobics is one of a shock-absorbing nature, such as an all-purpose track or grassy surface.  Many school gyms still have wood floors laid directly over concrete.  In these instances, hard rubber mats can be uses on the floor surface.

Faulty biomechanics are a prime culprit in causing shin splints.  These imbalances can include body misalignment, leg length discrepancies and foot problems, such as fallen arches, flat feet or over pronation.  An orthopedic physician, athletic trainer or physical therapist can help identify the mechanical problems and may prescribe orthotics as well as strengthening and stretching exercises.

Proper footwear is important to all athletes and may also help alleviate problems.  Quality running and cross-training shoes are designed to give the best anatomical support.  It is also important to make sure shoes have not broken down or are not too old.

WHAT CAN BE DONE TO HELP EASE THE PAIN?  

RICE and Active Rest.

RICE: Rest, Ice, Compression, and Elevation is an important principle in treating Medial Tibial Stress Syndrome (MTSS) or shin splints.

Rest should be active, relieving stress on the involved areas, yet maintaining conditioning.  Complete rest from activities may give temporary relief, but they are likely to resurface with resumed activity, especially if the athlete is trying to make up for lost time.  Active rest activities include cross country ski simulation, stationary cycling, swimming or jogging in deep water.

These activities should be followed by icing the lower leg, by means of ice bags, ice massages rubbed with an ice cube, or ice bath where the injury is submerged.  The ice application should be continued until the area is numb.

Compression involves wrapping the area with an elastic bandage and can be applied with the ice when bags are used.

Once compressed, the leg should be elevated - such as lying on the floor and resting the leg up on a chair.

Stretching and Strengthening.

For athletes recovering from MTSS, the following stretches will be effective.  (Hold each for 10 seconds and repeat five times, three sets per day.)

Stand on a step with heels off the edge and lower the body so heels stretch down below the level of the step, keeping knees straight.

Stand on a step with heels off the edge.  This time, squat to bend both knees to let heels stretch down below the step.  The athlete should feel tightness - no pain - with these stretches.

Calf raises:  Stand with both knees straight, next to a table for support. Rise up on toes and hold for five seconds and repeat 20 times.  Do three sets per day.  Work up to 40 to 50 calf raises per set as long as no pain is felt.

Towel curls:  Set feet on a towel and flex the toes to gather the towel.  The heel remains anchored on the floor.

Anne Micinski, ATC and Marilyn Ross, P.T.
Mishawaka Rehabilitation Center
Mishawaka, Indiana