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Shin Splints

Shin Splints

Definition

Shin splints refer to the sharp pains that occur down the front of the lower leg. They are a common complaint, particularly among runners and other athletes.

Description

Shin splints may refer to a number of lower leg complaints and injuries. In most cases, shin splints refer to the pain that results from overload on the tissues that connect muscles to the shin bone (tibia). They also may come from the small bone of the lower leg and ankle, called the fibula. The medical term for shin splints is medial tibial stress syndrome.

Next to ankle sprains, shin splints are probably the most common complaint of injury to the lower body. Most shin splints occur in the front (anterior) portion of the tibia; some also occur in the inside of the leg along the tibia. Runners probably suffer shin splints more than other people, but they also occur in people who play basketball and tennis and those who walk long distances, particularly on treadmills.

Causes and symptoms

The most common cause of shin splints is overdoing activities that constantly pound on the legs and feet. This may include sports with many stops and starts, running down hills or other tilted surfaces, or repeated walking. Simply training too long or too hard, especially without proper stretching and warm-up, can cause shin splints. People with flat feet, high arches, or feet that turn outward may be more prone to shin splints. Shoes that are worn or don't provide proper foot support also add to the problem.

Diagnosis

The physician will check the leg for tenderness. If the pain is in a single area of the tibia and hurts to the touch, the cause may by a stress fracture. The physician may order an x ray to rule out a stress fracture, but shin splints often can be diagnosed without x rays.

Treatment

Physicians usually recommend a period of rest for people with shin splints to let the area heal. Usually, about three to four weeks is recommended, though the time varies depending on the patient and injury severity. Shin splints may be treated in phases, beginning with absolute rest and gradual return to activity. Ice and elevation of the foot may be used to help relieve pain and swelling in the first phase. If the person needs to keep in shape, stretching and water exercises that keep the foot from bearing weight may be allowed after initial treatment. As the patient returns to normal function, orthotic footwear and braces may be added to prevent re-injury.

Alternative treatment

Various massage techniques may help speed up recovery. Homeopathic physicians may recommend Rhus tox. Those using alternative remedies should ensure they are certified practitioners and should coordinate care with allopathic providers.

Prognosis

With proper rest, management, and prevention, people with shin splints can return to normal activity in a few weeks or more. However, continuing to perform the activity that caused the shin splints can lead to stress fractures of the tibia.

Prevention

Re-injury is most common in the first month after return to normal activity, and patients who have had shin splints should return to previous activities cautiously. The following can help prevent shin splints from occurring in people who run and perform stop and start physical activities:

  • Warming up and stretching calf muscles before running or jogging. A podiatrist specializing in sports medicine or other sports medicine specialist may recommend specific stretching exercises.
  • Strengthening muscles in the front lower leg (anterior tibialis) with resistance exercises or by walking on the heels three times daily for about 30 yards.
  • Wearing quality shoes with arch supports. Runners should purchase new shoes about every 400 miles. A podiatrist can design special arch supports or orthotics for people with flat feet.
  • Runs should be started at a slow pace and gradually increased.
  • Athletes can cross-train in a sport that does not impact the feet and lower legs as much, such as swimming or riding a bicycle.

Resources

PERIODICALS

Metzi, Jordan D., Joshua A. Metzi. " Shin Pain in an Adolescent Soccer Player: A Case-based Look at 'Shin Splints': Do you Care for Children Who Regularly Run or Play Sports? Then You Should Have a Basic Understanding of the Different Entities that Can Cause Shin Pain. That List Includes Tibial Stress Injuries and Exertional Compartment Syndrome." Contemporary Pediatrics (Sept. 2004):36-39.

"Shunning Shin Splints." Muscle & Fitness (Aug. 2003):38.

Smith, Ian. "World of Hurt." Men's Health (June 2003):40.

ORGANIZATIONS

American Academy of Podiatric Sports Medicine. P.O. Box 723, Rockville, MD 20853. 888-854-3338. http://www.aapsm.org.

OTHER

Shin Splints.Foot.com Web site, 2005. http://www.foot.com/info/cond_cond_shin_splints.jsp.

KEY TERMS

Podiatrist A physician who specializes in the medical care and treatment of the human foot.

Stress fracture A hairline fracture (narrow crack along the surface of a bone) that is caused by repeated stress to the bone, such as from jogging, rather than from a single heavy blow.

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Shin Splints

Shin splints

Definition

Shin splints can be defined as an inflammation of the tissues in the lower leg causing pain with exercise . The disorder is also referred to as medial tibial stress syndrome.

Description

Shin splints are an inflammation of the tendons, muscles, and periosteum most commonly seen in those who walk, jog, or run on hard, uneven surfaces. The resulting pain may indicate either anterior shin splints, with radiation down the front and lateral leg, or posterior shin splints, extending down the back and inner leg and ankle. Depending on the body tissues involved, shin splints may indicate myositis (an inflammation of the muscle), tendinitis (inflammation of the tendons), or periostitis (an inflammation of the tissue covering the bone).

Causes & symptoms

The inflammation of shin splints is caused by an imbalance of the calf and shin muscles used to mobilize the forefoot with exercise . The associated pain in the lower leg usually worsens with exercise.

Diagnosis

The identification of shin splints is often made by the affected individual's observation of the symptoms. X rays of the lower extremity may be requested to prevent a misdiagnosis when stress fractures are suspected.

Treatment

Exercise should not be resumed until it can be performed without pain. Switching from high-impact workouts to swimming or cycling will allow for healing to the inflamed areas. A gentle massage with lubricating oil will provide comfort and decrease swelling. An ice massage may also facilitate healing, using a circular movement over the affected area three to four times daily for 10-15 minutes. Some find heat more comforting and beneficial, applied via a heating pad or lamp, a hot shower, or whirlpool.

A well-balanced, high-protein diet, dietary antioxidants , and essential fatty acids may also promote healing. As the patient's activity level may be lower than usual during the initial healing phase of shin splints, adequate fluid and fiber intake is vital to promote normal bowel function.

After at least a two-week rest period, a gradual resumption of exercise is recommended. Icing the legs for 5-10 minutes before stretching and after cool-down is recommended. Crisscross taping of the anterior leg maybe be helpful for the individual with anterior shin splints, as well as raising the heel portion of the shoe approximately one-eighth of an inch. The individual with posterior shin splints should remember to hold the body erect rather than leaning forward while running, and to avoid landing directly on the toes. An extra pair of socks for warmth while running is also recommended.

Allopathic treatment

For minor discomfort associated with shin splints, over-the-counter anti-inflammatory medications such as ibuprofen or aspirin may provide relief. If these are found to be ineffective for pain relief, prescription-strength, nonsteriodal, anti-inflammatory drugs (NDAIDs) may be ordered by the physician. Physical therapy sessions and ice and/or heat application may also be helpful.

Expected results

A complete resolution of the pain associated with shin splints requires an adequate period of rest followed by a slow rehabilitation or gradual resumption of activity ranging from two weeks to two months. Resuming activities too soon may result in a prolonged healing time and recurrence of symptoms. The change in gait and posture associated with shin splint pain may result in inflammatory or arthritic changes in the local joints, i.e. the ankle, knee, hip, or back.

Prevention

Those who exercise by running or doing high-impact aerobics should be sure to wear well-fitting shoes that offer adequate lateral and arch support with cushioning for the ball and heel of the foot. Footwear should be reevaluated for adequacy of support and cushioning about every six months. Warming up before and cooling down after the activity is vital, and the shins should also be kept warm during exercise. Jogging on soft surfaces such as dirt or grass is preferred over hard or uneven surfaces.

Resources

BOOKS

Gottlieb, Bill. New Choices in Natural Healing. Emmaus, Pennsylvania: Rodale press, Inc., 1995.

Mercier, Lonnie. Practical Orthopedics. St. Louis, Missouri: Mosby-Year Book, Inc., 1995.

OTHER

Thriveonline. http://www.thriveonline.com/health/Library/sports.

Kathleen Wright

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