A frequent and debilitating complaint of many athletes is shin splints. This problem is usually seen in runners, but has been noted in athletes participating in tennis, volleyball, basketball and track. This term refers to pain along the inside of the lower leg and usually is associated with an overuse problem as in the case when an athlete has engaged in repetitive strenuous activity. The medical field tends to use shin splints as a collective term for many diagnoses which may demonstrate similar findings. Other diagnoses under this category are: Anterior or posterior tibial tendonitis, tenosynovitis, periostitis, myositis, interosseous membrane tears, stress fractures and anterior or medial compartment syndrome.
The causes of shin splints are many and may include biomechanical imbalances of the lower leg structures, excessive rotation at the hip, hyperpronation, flat arches, knock knees, bow legs, or external factors such as improper running shoes that lack correct support to the arch and poor cushioning of the heel, running on a banked surface of road or track or running on a hard surface. The theory behind this condition is that there is repetitive stress on the tendon attachment on the tibia and/or interosseous membrane that connects the two long bones in the lower leg. This produces tendonitis or inflammation of these structures. If the athlete attempts to run through the initial injury, the chronic traction then produces periostitis or bone pain that results in the symptoms of tenderness, swelling and an aching sensation along the lower shin area.
The treatment options are varied and widely disputed. The condition is very resistant to usual measures of management. The best treatment is to rest the leg and allow the inflammation to subside. Other therapeutic measures may include Aspirin, anti-inflammatories, heel cord stretches, heel pads, cast immobilization, ice massage, whirlpool, heating pad, taping and orthotics. Heat helps by increasing the blood flow to the tissue and facilitates in the healing process, whereas cold produces anesthesia and decreases muscle spasms which may be present with this condition. Cold should be the treatment of choice after a workout since it will help decrease swelling and bleeding of the tissues which are a natural effect of the workout. Taping the shin can add support with various methods utilized.
The most common technique is to tape around the arch beginning on the top and moving toward the inside to support the low arch. Taping around the shin beginning on the side opposite the pain can directly support the injured tissues. Also, examining the shoes and making changes in the footwear can assist with decreasing the impact stresses on the lower leg. Shoe design should include a firm heel counter, good arch support, flexible midsole and a soft raised heel wedge to absorb impact at heel strike. Exercises are another important factor and should concentrate on stretching the calf muscles (gastrocnemius and soleus) while strengthening the muscles on the outside of the leg (tibialis muscles).
As with all activities, it is always better to prevent an injury rather that treat it. The chances of developing shin splints can be decreased by a well rounded stretching and strengthening exercise program, good supportive shoes and attention to training habits such as keeping in shape year round, increasing running mileage slowly and not changing running surfaces. All these factors can lead to a more productive and pleasant experience for the athlete.
Tim Alberhasky, MS.,PT
*To schedule an appointment with Tim Alberhasky, call Lutheran Outpatient Therapy at 515-263-5143.