Understanding and Caring for Shin Splints and Stress Fractures
By Peter Sand, ATC/LAT
UnityPoint Health - Des Moines Des Moines Athletic Training Services
All sports have specific athletic demands, which often result in certain types of injuries associated to that specific sport. Certain training techniques and sports activities require the athlete to perform repetitive high impact activities. Specifically, running activities cause repetitive stress on an athlete's feet and lower legs. One injury that has almost become synonymous with running is shin splints.
For some athletes shin splints are an annoyance that they have to overcome while they run, but for other athletes it can be indicative of a greater injury. The term "shin splints" generally describes a wide range of lower leg injuries. On the less significant end of the injury spectrum are injuries to the muscles and tendons of the lower leg, and on the more severe end of the injury spectrum lies stress fractures. While certain lower leg injuries may not affect a runner more than discomfort during running activities, stress fractures are a serious injury that can remove the athlete from their sport for quite a bit of time.
Stress fractures occur when there is repetitive trauma that occurs to the lower leg bones. Bones normally continue to remodel their structure due to the demands placed on them. However, when the repetitive trauma occurs faster than the bones can adapt to the stress placed upon it by activity, a stress fracture can occur. The affected bones simply are not able to keep up with the demands placed on it by the individual's activity.
The pain typically associated with shin splits is located along in the inside of the tibia, or shin bone. At the beginning phases of pain, the runner will experience the worst pain at the beginning of exercise with the pain either decreasing as the activity goes on or when the individual stops performing the activity. As the injury progresses the athlete may begin having pain more frequently, the pain may occur during other physical activities, or the athlete's pain may even occur at rest. The athlete's pain may also progress from being located in a generalized area to very specific point where the pain occurs. Another sign that a stress fracture may have developed is if the athlete begins to reports a very specific origin of pain. For example, if they can specifically point to one origin of pain that is no bigger than their fingertip.
If the athlete reports that their pain has progressed as described above, an evaluation by an allied healthcare professional should be performed. Many high schools contract Certified Athletic Trainers to provide medical coverage to the school's athletes, and if that service is provided at the student athlete's school they should utilize that resource. UnityPoint Health - Des Moines Des Moines provides sports medicine coverage to many of the Des Moines area Metro schools including Johnston, Norwalk, Urbandale, Waukee, and Valley High Schools. If you are unsure if your school has a Certified Athletic Trainer available, please contact them to determine if they do. Another great resource provided by UnityPoint Health - Des Moines Des Moines for athletes and their families is a free Sports Injury Assessment Clinic for middle school, high school, and college age athletes. When attending the injury assessment clinic the athlete will be evaluated by either a Physical Therapist or Athletic trainer. Please visit http://www.iowahealth.org/free-sports-injury-assessment-clinic.aspx for more information regarding this service. When the athlete is evaluated at either the school or the sports injury clinic, the healthcare professional will be able to determine if a referral to a physician is necessary.
If a stress fracture is suspected, a referral to either the athlete's primary care physician or an orthopaedic physician will most likely occur. The physician may then order specific diagnostic imaging of the athlete's injury to determine if a stress fracture is present. One method of imaging that may be used is radiographs (X-rays). However x-rays may not detect stress fractures within the first few weeks of injury. If the injury does not improve with treatment or the athlete's pain continues to progress, additional x-rays may be taken 2-4 weeks later to determine if a stress fracture has developed. Two other diagnostic imaging devices that can be used for the diagnosis of stress fractures are bone scans and MRI's. A bone scan is the gold standard for determining if a stress fracture is present because they specifically determine bone pathology. MRI scans can also accurately diagnose stress fractures and can additionally determine other soft tissue injuries that have occurred. The physician providing care for the injury will determine the best method of diagnostic imaging based on the athlete's specific injury and associated symptoms.
The treatment for the athlete's injury will be based upon the healthcare provider's evaluation, and any imaging results that may have been performed. If a stress fracture was detected the treatment of the injury may require immobilization, use of a cast or walking boot, and use of crutches to limit weight bearing on the involved leg. The length of time the athlete will need to refrain from activity depends on the location and the severity of the injury. If the injury is not severe enough to demand complete rest from activity, the best way to treat the athlete's pain is often the application of ice and activity modification. Athletes should apply ice to the painful area for 15-20 minutes immediately following activity. Since complete rest is often unachievable for in-season athletes, other forms of relative rest can be performed. Performing relative rest may require the individual to change how they train or require them to do other cross-training activities. Athletes can benefit from cross training by performing other cardiovascular activities that have a lower impact on involved leg. These activities could include swimming, riding a stationary bicycle, or use of an elliptical training machine. Over a period of weeks if the athlete's pain decreases they would be allowed to slowly progress back to full activity. The individual should only progress their running activities as their symptoms tolerate. When resuming running activities the individual should gradually increase their running intensity, duration, and frequency over an extended period of time. A gradual increase in activities will allow the athlete's body to manage and accommodate the stresses placed on it during running. Although most athletes will dislike restricting their activity levels, this simple form of treatment can be very effective.