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Understanding Shin Splints

By Montserrat Markou, MS, L.Ac. LMT

Regular exercise is a critical component to a healthy lifestyle, but improper or excessive exercise can cause nagging injuries that can sideline an individual. People sometimes mistakenly use the term shin splints to refer to a wide array of lower leg problems such as tibialis posterior tendonitis and tibial stress fractures. The term technically refers to a specific problem that causes pain along your shinbone (tibia) with exercise. The pain is the result of an overload on the tibia and the connective tissues (periosteum) that attach the muscles to the tibia. The medical term for this condition and a commonly occurring injury for runners and other athletes is Medial Tibial Stress Syndrome (MTSS). MTSS is a specific tissue-related condition found in the shin area. Medically, the loosing of muscle in the shin area and the process needed to heal this injury causes the pain of shin splints. Physically, it is the result of too much foot-to-ground contact or the abnormalities of such contact. There are several causes and some disagreement over treatment methods. Understanding the root of the injury and the need for thorough healing should prevent shin splints from becoming a chronic injury.

MTSS is caused by miniscule separations of the calf muscle where it connects to the posteromedial tibia, or shinbone. It can also be caused by inflammation of the posterior tbialis muscle, directly below the calf muscle . Running, aerobic exercise, and excessive walking are the most common causes of MTSS. Congenital conditions such as flat-footedness and being bow-legged can also cause this injury. For the conditioned athlete such as a runner or dancer, MTSS is likely the result of a repetitive motion over a continued period of time, or increasing the intensity of exercise. For novices, it is likely the result of an over-ambitious workout. They are the most susceptible to shin splints for a variety of reasons, but the most common is that they're using leg muscles that haven't been stressed in the same way before and also exercising with worn or ill-fitting shoes. Runners who have started running after a long layoff are also susceptible to shin splints because they often increase their mileage too quickly. The most common symptom is reoccurring aching, throbbing or tenderness along the inside of the shin (though it can also radiate to the outside) about halfway down, or all along the shin from the ankle to the knee. Pain when you press on the inflamed area. Pain is most severe at the start of a run, but can go away during a run once the muscles are loosened up. Unlike a stress fracture of the shinbone, which hurts all the time. With tendonitis, pain resumes after the run.

Shin Splints
Figure 1

If an athlete is afflicted with shin splints the most common treatment is rest and refrain from excessive running or walking. While there is a myth that continued running will ease the pain of shin splints, trainer Jim Thornton explains that continued activity will not allow the loosened muscle to heal properly . According to Dr. Steven Below, The proper treatment regimen should be refraining from all leg exercise to relieve the pain. For the first week after the pain subsides, for example, substitute running with riding a bicycle or other less stressful contact exercise. Then, resume regular activity at half of the pre-injury intensity and increase the level steadily over a three to six week period. In addition, the athlete may consider new footwear or increased shoe padding to reduce the intensity of foot-to-ground contact, as well as scaling back the exercise regiment for beginners. For chronic and extreme cases, there are also surgical remedies to detach the calf muscle from the shinbone to alleviate the pain .

Because of the similar symptoms, stress fractures are often incorrectly diagnosed as shin splints, but as Dr. Below explains, MTSS is a fundamentally different injury. MTSS causes pain on the lower, inner portion of the leg whereas a stress fracture will cause pain in the upper, outer portion. Rest and recovery should heal MTSS, but not stress fractures. As a simple test, one can determine which condition they have by hopping on one foot about ten times. An individual with MTSS will be able to complete this test, but it will be too painful to complete for a sufferer of a stress fracture. A bone Scan or MRI can also determine the distinction . According to Dr. Gerald Packman, There may be a link between MTSS and stress fractures but it has not been proven . Proper diagnosis is key, as stress fractures without treatment can lead to more serious fractures. Proper care, however, should heal MTSS, as it doesn't have to sideline an athlete for an extended period of time.

Some steps to help prevent injury to the shins would be:

  • wear proper footwear, choosing a shoe that suits the sport that is practiced and if one is a runner, buying new shoes about every 400 miles.
  • Consider shoe inserts if one has flatfeet, he or she may benefit from wearing an arch support to help cushion and disperse the impact on the legs.
  • Lessen the impact, cross-training with a sport that places less impact on the shins, such as swimming, walking or riding a bicycle.
  • Start smart if starting a new athletic activity by starting slow, adding time and intensity gradually. For new runners, starting with a pace that meets the "talk test", if unable to carry on a conversation with a running buddy, then the speed is too fast.
  • Add strengthening and stability training to the workout.
    • Strengthening the lower leg muscles with calf raises and leg presses.
    • Strengthening the ankles with exercises using a resistance band or tube.
    • For stability training, trying one-leg standing.

Stronger muscles can better withstand the impact of athletic activities, and stability training may help minimize forces being transmitted up the lower leg.

Below, Steven K. "How to Manage Shin Splints." Hughston Health Alert. 2003. Hughston Sports Medicine Foundation. 4 Mar. 2006 http://www.hughston.com/hha/a_15_1_4.htm
Lawrence, Star. "First Aid Myths, Ignore these summer 'Cures'." Webmd. 2005. Emdeon Corporation. 4 Mar. 2006 http://www.webmd.com/content/Article/107/108508.htm?pagenumber=3
Packman, Gerald S. "Shin Splints." AAOS.Org. 2005. American Association of Orthopedic Surgeons. 4 Mar. 2006 http://orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=135&topcategory=Sports%20/%20Exercise
"Shin Splints." MayoClinic. 2005. Mayo Foundation for Medical Education and Research (MFMER)
Figure 1: http://www.hughston.com

Montserrat Markou, MS, L.Ac., LMT is New York State and Board Certified Acupuncturist and Massage Therapist. Preceding to her work as an Acupuncturist and Massage Therapist, Montserrat had 15 years of experience working abroad at a private language school (500+ students) where she was an important liaison between the school, the children and the parents. During this time she also organized an after school activity teaching English as a foreign language to children ages 5 to 13. Her teaching modalities included role playing, expression and concentration techniques. One of the main priorities of her practice is to help children lead a happy, healthy and fulfilling life. She is member of the Holistic Pediatric Association.

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