DRUG INDEX
Shin Splints Medical Author: William C. Shiel Jr., MD, FACP, FACR
What are shin splints?
Shin splints are injuries to the front of the outer leg. While the exact injury is not known, shin splints seem to result from inflammation from injury to the tendon ( posterior peroneal tendon) and adjacent tissues in the front of the outer leg.
Shin splints represent one member of a group of injuries called "overuse injuries." Shin splints occur most commonly in runners or aggressive walkers.
What are the symptoms of shin splints?
Shin splints cause pain in the front of the outer leg below the knee . The pain of shin splints is characteristically located on the outer edge of the mid region of the leg next to the shin bone ( tibia ). An area of discomfort measuring 4-6 inches (10-15 cm) in length is frequently present. Pain is often noted at the early portion of the workout, then lessens only to reappear near the end of the training session. Shin splint discomfort is often described as dull at first. However, with continuing trauma, the pain may become so extreme as to cause the athlete to stop workouts altogether.
What causes shin splints?
A primary culprit causing shin splints is a sudden increase in distance or intensity of a workout schedule. This increase in muscle work may be associated with inflammation of the lower leg muscles, those muscles used in lifting the foot (the motion during which the foot pivots toward the tibia). Such a situation may be aggravated by a tendency to pronate the foot (roll it excessively inward onto the arch).
Similarly, a tight Achilles tendon or weak ankle muscles are also often implicated in the development of shin splints.
How is the are shin splints diagnosed?
The diagnosis of shin splints is usually made during examination. It depends upon a careful review of the patient's history and a focused physical exam (an exam focused on the shins and legs).
Specialized (and costly) tests (e.g., bone scans) are generally only necessary if the diagnosis is unclear. Bone scanning in this setting is helpful to detect stress fracture of the tibia bone.
How were shin splints treated?
Previously, two different treatment management strategies were used: total rest or a "run through it" approach. The total rest was often an unacceptable option to the athlete. The "run through it" approach was even worse. It often led to worsening of the injury and of the symptoms.
Currently, a multifaceted approach of "relative rest" is successfully utilized to restore the athlete to a pain-free level of competition.
What is the multifaceted "relative rest" approach?
This multifaceted approach includes: - Workouts such as stationary bicycling or pool running - these will allow maintenance of cardiovascular fitness .
- Icing - to reduce inflammation.
- Anti-inflammatory medications (ibuprofen-Advil/Motrin; naproxen- Aleve/Naprosyn) - also a central part of rehabilitation.
- A 4-inch wide Ace bandage wrapped around the region - to also help reduce discomfort.
- Calf stretching and strengthening as well as strengthening of the ankle dorsiflexor muscle group - to address the biomechanical problems discussed above.
- Careful attention to selecting the correct running shoe based upon the foot type (flexible pronator vs. rigid supinator) - this is extremely important. In selected cases shoe inserts (orthotics) may be necessary.
- Stretching and strengthening exercises are done twice a day.
- Running - only when symptoms have generally resolved (often about 2 weeks), may running be resumed with several restrictions:
- A level and soft terrain is best.
- Distance is limited to 50% of that tolerated preinjury.
- Intensity (pace) is similarly cut by one half.
- Over a 3-6 week period, a gradual increase in distance is allowed.
- Only then can a gradual increase in pace be attempted.
Caveat!
As always, the amount of injury which occurs prior to any rehabilitation program plays a significant role in determining the time frame necessary for complete recovery. - Shin splints are a type of "overuse injury" to the legs.
- The pain is characteristic and located on the outer edge of the mid region of the leg next to the shin bone (tibia). It can be extreme and halt workouts.
- The diagnosis requires a careful focused examination.
- A multifaceted approach of "relative rest" can restore a pain- free level of activity and a return to competition.
- The "relative rest" approach includes a change in the workout, ice, rest, antiinflammation medications, stretching exercises, possible change in footwear, and gradual increase in running activities.
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