Shin splints result from an overuse injury of the lower legs seen most frequently in runners, hikers, marchers and occasionally in ballet dancers. Pain usually occurs in the anterior or front of the lower legs during or after the cessation of an exercise that causes repetitive impact on the lower legs.
Who is likely to develop shin splints?
The following factors can precipitate shin splints:
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Poor conditioning
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Running or walking on a hard surface
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Running or walking on an uneven surface
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Downhill running or walking
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Lack of warm up exercises
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Preexisting foot or arch problems including flat feet or tight heel cord musculature
The unconditioned runner, typically early in the season, may overexert himself or herself. Overexertion causes the gastrocnemius muscles in the calves to tighten during the push-off phase of running. This creates an antagonistic muscle imbalance with the muscles in the front of the lower leg. This imbalance causes a stress reaction that results in an inflammatory reaction on the tibia, which is the large bone in the lower leg. These reactions cause the pain that is seen in shin splints. Running on asphalt or uneven surfaces or using inappropriate running shoes can aggravate the stress reaction. Dancers who have a significant amount of running in their routines may also sustain shin splints through muscle imbalance and stress mechanisms. The experienced and well-trained athlete who increases the duration and intensity of his or her training may also precipitate shin splints.
What are the symptoms of shin splints?
Pain is the predominant symptom of shin splints. The pain may be mild to debilitating in its intensity. The discomfort is located in the lower leg(s) to the inner side of the tibia or shin. The pain usually persists for a period of time after the cessation of the exercise, and the pain will continue even though the athlete or dancer may not be weight bearing.
How are shin splints evaluated?
A careful history and physical examination by a clinician is the first step in the evaluative process. The type and location of the activity, timing in the season and style of shoes are important clues for the clinician to make a diagnosis. Inspection of the athlete’s shoes is also helpful. Tenderness over the tibia or the inner aspect of the tibia in the middle or lower third of the bone is an important finding on the physical examination. X-rays may be obtained; however, patients with shin splints usually have no abnormalities on the x-rays. The clinician may also need to rule out stress fractures involving the tibia. An x-ray is helpful, although a bone scan may also be necessary. The bone scan is the most sensitive test to diagnose a stress fracture; it should be normal in a teen with shin splints.
How are shin splints treated?
The goals of treatment are to alleviate the discomfort, nurture healing and prevent the problem from recurring. To achieve these goals, the follow steps may be recommended:
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Protection: avoid activities that precipitate shin splints including running on hard or uneven surface. Orthotics to control pronation may be useful for those adolescents who tend to pronate.
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Rest: where there is significant pain that occurs with daily activities, then cessation of running activities should occur on a temporary basis. Swimming or cycling may be continued by the athlete to maintain fitness. If the pain occurs only during or after running, then decreasing the pace and duration of athletics activities should be helpful.
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Ice: may be used for about twenty minutes after running if the teen develops pain.
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Medications: ibuprofen or another analgesic may be used for the pain and inflammation.
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Modalities: trainers may use physical therapy, range-of-motion exercises and ultrasound to treat shin splints.
How are shin splints prevented?
The teen student athlete should have good pre-seasoning training to improve lower leg muscle flexibility and strength. An exercise program that includes stretching of the Achilles tendon, isometric exercises for developing arch strength and exercises to strengthen the dorsiflexors of the feet can help achieve this. The dorsiflexors are the muscles that help one point his or her foot toward the sky.
Proper running shoes are very important. They should have good arch supports. Teens should not run in street shoes.Prior to running or dancing, it is important to warm up. A training program that includes a gradual increase in the amount of running over a six-week period may also help to prevent shin splints.
Related topics:
Athletic injuries, exercise, musculoskeletal disorders, sports, stress fractures
