Causes, treatments of shin splints

The warm spring weather gives many of us a desire to get outdoors and exercise after the long winter months. If running is your preferred choice of exercise you may find yourself with some soreness through your shins as you begin this new regimen.

At some point almost all runners experience pain in the calf or shin; this condition is often referred to as shin splints or Medial Tibial Stress Syndrome (MTSS). Pain is generally described through the lower leg along the medial border of the tibia bone. When the muscles attaching to the tibia and fibula are overworked they pull on the attachment site and cause the pain associated with shin splints. The tendons of these lower leg muscles exert a great force on the tibia to keep the foot, ankle and lower leg stable. This repeated stress can result in tendons being partially torn away from the bone.

Like any other overuse injury it is important to look at the causative factors and try to avoid problems before they happen. The causes of shin splints can be categorized into two major groups: overload (or training errors) and biomechanical inefficiencies. Factors that may contribute to overload injury include

- Exercising on concrete or other hard surfaces

- Exercising on uneven ground

- Exercising with poor fitting or worn-out shoes

- Excessive uphill or downhill running

- Beginning exercise after a long lay-off period

- Increasing the intensity or duration of exercise too quickly

If shin splints have become a problem for you it is also important to look at your overall biomechanics. If we take a simplified look at the mechanics of running it can be broken down into a foot strike, loading/energy transfer phase and finally the forefoot push off. A shock force is introduced as the foot hits the ground and delivers a shockwave that travels up the leg. The musculoskeletal system must absorb this energy. If the muscles and tendons become fatigued they lose their ability to effectively absorb the damaging shock force. Flat feet is the primary biomechanical inefficiency contributing to shin splints. This can lead to a secondary biomechanical inefficiency of over-pronation. Over-pronation is a condition that occurs after the heel hits the ground, the foot flattens out, and the foot and ankle continue to roll excessively inward. Runners with high rigid arches tend to experience greater pounding shock, whereas those with flat feet tend to experience greater muscle fatigue. It may be necessary to see an orthotist or podiatrist for custom-made orthotics, especially if you have tendency for over-pronation.

In addition to insuring good footwear, a thorough and correct warm-up will help prepare the muscles and tendons for activity. Shin splints can also be prevented by maintaining flexibility and by strengthening and conditioning the lower leg muscles.

Now that we have an idea what causes shin splints many of the treatment techniques are common sense.

The first tactic should be to stop running, especially if the pain is severe. Reduce the training load and intensity, and modify your running surface as needed.

A temporary alternative form of exercise may be helpful such as swimming, pool running or cycling, making an effort to avoid weight bearing exercise.

Compression with a neoprene sleeve or wrap helps compress the muscles and permits less muscle movement.

Take a nonsteroidal anti-inflammatory for five to seven days and apply ice to the shin area to reduce inflammation.

Massaging the muscle along the inside of the shin and stretching the calf muscles is also helpful.

A return to running should be gradual as an estimated recovery period is generally two to four weeks.

Shin pain is most certainly annoying but usually is an insignificant problem that can be treated with the above stated guidelines. However, it may be helpful to seek help from a physical therapist, orthotist or podiatrist. If pain persists it is important to seek evaluation by a physician because shin splints have the potential to develop into stress fractures.