What are shin splints?
Shin splints also known as medial tibial tenoperiostitis is the medical term for exercise induced pain in the front of the lower legs. Experts don’t fully understand the nature of the injury, but believe that the condition involves injury and inflammation to the connective tissue that joins the muscles to the shin bone (the tibia), or micro stress fractures to the surface of the tibia. There are also theories that it may involve small tears in the soft tissue membrane between the tibia and fibula bones of the lower limb.
Why & when do shin splints happen?
The muscles at the back of the lower leg are collectively known as the calf muscles. A select few of the calf muscles attach to the inner shaft of the tibia bone. The connective tissue that conjoins the muscle to the surface of the bone is known as the tenoperiosteum. Quick stop and start sports such basketball, tennis and football can place a repetitive strain upon the tenoperiosteum as does a sudden, prolonged or a frequent increase in activities like running and hiking. The repetitive and increased workload through the calf muscles results in additional and forceful pressure through the tenoperiosteum causing small tears and damage to the connective tissue and small stress fractures in along the shaft of the tibia. The resulting damage causes pain and inflammation along the muscle attachment and is medically referred to as medial tenoperiostitis. Shin splints are most commonly seen in beginner runners as their calf muscles aren’t used to the amount of pressure and also beginners tend to push themselves to far too early instead of a gradually increasing the distance. Athletes also fall victim to shin splints normally after long down periods or the reintroduction to training after the decreased intensity of winter training. Other contributing factors include faulty foot biomechanics like fallen or high arches, weak ankles, over pronated feet and wearing unsupportive footwear. Being over-weight and training on hard surfaces can also increase the likelihood of developing shin splints.
What do shin splints feel like?
Shin splints begin as a dull throbbing ache, initially concentrated along the inside of the shin. The pain can often radiate up to the knee, down into the ankle and across to the outside edge of the shin. Mild cases start as stiffness and discomfort following long periods of rest, typically worse in the mornings or late at night. Physical activity will aggravate pain levels. The most intense pain levels are felt at the beginning of a run or activity, decreasing and even easing completely as the muscles warm up and loosen with continued movement. In more severe or progressed cases the pain will be felt throughout activities and possibly even at rest. Individuals may notice a mild limp when moving after prolonged periods of rest; this should lessen as the muscle warm up and loosen. The affected area will be incredibly tender to the touch and in some cases it is possible to feel small lumps on the surface of the tibia bone. Visible swelling, warmth and redness of the surrounding skin may also be noticeable. Stress fractures to the tibia feel very similar to shin splints, the main differentiating factor is that stress fractures remain painful at all times and do not ease with continued activity.
How are shin splints diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining the lower leg. They will palpate the skin and muscles along the affected shin looking for pain and tenderness and will test for tight or weakened calf muscles and will inspect your foot biomechanics. No X-rays or further investigation should be needed to confirm diagnosis, unless the doctor feels there is a possibility of an underlying stress fracture.
What treatment options are available for shin splints?
The treatment options and recovery times for shin splints will be dependent on the severity of the condition. There is conflicting advice regarding whether or not to continue running through the pain. The general consensus is that for mild cases, where the pain has recently developed and is reasonably tolerable, continuing to train through the pain for 2-3 weeks at a moderate level is acceptable. This is particularly advisable if shin splints occur early on in your training season as continuing to train may help the body to adapt. If the pain and discomfort levels are not tolerable or the pain has developed half way through the training season then it would be advisable to completely avoid running or stop start sports for at least two weeks. You can still keep active, swimming or cycling are brilliant alternative low impact sports to keep active during the rest period. If the pain levels are moderate to severe and the condition is persistent then it is strongly advised that you do not run through the pain and that you opt to rest and have the area examined to determine the underlying cause.
Applying a covered ice pack to the area during the rest period or after training may also significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. Keeping your foot elevated on a cushion or a stool whilst icing will also help limit the swelling. Your GP may prescribe you with anti-inflammatory medication to reduce and limit any swelling and analgesic medication for pain relief.
For persistent and recurrent cases of shin splints or cases that don’t recover with rest, it is recommended that you attend a podiatrist who can fully examine the biomechanics of your feet and provide you with orthotics or insoles to correct the faulty foot posture. The podiatrist will also be able to recommend specialist running shoes to help prevent the condition for recurring.
After a rest period you should ease back into training gradually, building the time and exertion level of your training. Your therapist should be able to advise you on a graded training programme. To help prevent shin splints in the long term it is important to stretch and strengthen the tendons and muscles in the lower leg, thera-band resistance exercises are very good for this. You can further avoid developing shin splints you should replace old worn-out shoes, warm up before training and choose to run on softer surfaces.