Shin Splints

What are Shin Splints?
Shin Splints are a common lower leg complaint, especially among runners and other athletes. The term shin splints is often given to any pain at the front of the lower leg. However, the typical "shin splint" symptoms occur at the front inside of the shin bone and can arise from a number of causes including most commonly Medial Tibial Stress Syndrome.

Other causes include:
 - Tibial or fibular stress fractures
 - Chronic exertional compartment syndrome
 - Muscle strains or tears (particularly of the tibialis anterior and posterior muscles)
 - Arterial or nerve entrapment
 - Deep vein thrombosis
 - Fascial herniations
 - Referred pain from the spinal lumbar region

The two common areas for  "shin splints" are:
 - Anterior shin splints, in the front portion of the tibia
 - Posterior shin splints, occurring on the inside of the leg along the tibia bone (which we will talk about)

MTSS
The pain usually develops gradually without a history of trauma, and might begin as a dull ache along the front or inside of the shin (distal 2/3 of the posterior aspect of the medial border of the tibia) after running or even walking. The pain can become more intense if not addressed, and if untreated can develop into stress fractures

Cause
The most common cause of shin splints is excessive stress on the anterior tibia and leg muscles in the location where they are attached to the shin bone (tibia). This stress is often caused by running (esp on hard surfaces or extensively on the toes), or sports that involve jumping. Other causes include wearing worn out running shoes, tight calves, over pronation (flat feet) and less commonly high arched feet which are poor shock absorbers. These factors can lead to microfractures in the tibia. There is current debate over whether or not inflammation of the periostium of the tibia (sheath surrounding the bone) from increased stress on the lower leg muscles during exercise is a cause. If this is the case, then traction forces on the periostium from the muscles of the lower leg could cause shin pain and inflammation. This has lead to the use of terms such as Medial Tibial Traction Periostitis. It important to note that other causes of shin pain may include conditions such as Compartment Syndrome as well as conditions to do with the Tibialis Anterior muscle as well as other listed above.

Treatment and Prevention
The best way to prevent shin splints (MTSS)  is to stretch and strengthen the leg muscles, wear footwear with good shock absorption, and avoid running on hard surfaces or excessive running or jumping on the ball-of-the-foot. Insoles or orthotics that offer arch support for over-pronation (usually with forefoot posting) are also important especially in runners.

Treatment for shin splints should include taking a break from the exercise or activities that aggravate the problem until the pain subsides. Icing the area immediately after running or other exercise can also be effective, along with gentle stretching before and after training. Aspirin or Ibuprofen are often used to relieve pain and reduce inflammation.

It is important not to train through the pain of shin splints. Runners should decrease mileage for about a week and avoid hills or hard surfaces. If a muscle imbalance, poor running form or flat feet are causing the problem, a long-term solution might involve a stretching and strengthening program and orthotics to support the foot and correct over-pronation. In more severe cases, ice massage, heat treatments, prolotherapy and therapeutic ultra-sound might be used.

Above all else, is the importance of proper diagnosis. This will assist in both a speedy recovery of your shin pain and help to prevent the re-occurrence of shin splints.