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  • Northeast Wisconsin
  • April 2018
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Shin splints: A real pain in the leg

Are you part of the 4-35 percent of athletic population that suffers from pain in the lower leg (shin) when you run or jump? Are you also sick of all the conflicting advice from parents or coaches? I will touch on all of the important areas of “shin splints” and what you can do to get back to living your active lifestyle.

What are shin splints?

“Shin splints” is an umbrella term for the following: medial tibial stress syndrome, tibial stress fracture and exertional compartment syndrome. It is very important to know which type you have, because that will determine your next course of action. This is best determined by scheduling an appointment with your medical practitioner. Medial tibial stress syndrome results in pain on the inside part of your tibia or shin bone that is roughly 5 cm in length near your ankle. This is characteristic of diffuse pain to the touch or with running that resolves with rest. If this issue is not addressed, it can progress to a tibial stress fracture. Tibial stress fractures are painful in a much smaller area (point tender) compared to the wider 5 cm range of medial tibial stress syndrome and is normally on the front ridge of the shin bone. If you believe that you could possibly have a tibial stress fracture, then you need to see your doctor immediately.

As you can see, the above issues are bone related, but the last issue is a muscular and fascial issue. Exertional compartment syndrome is characteristic of pain with running usually 10 minutes into the exercise and resolved 30 minutes after exercise. This is also accompanied by cramping, burning, and numbness on the upper outside shin due to pressure from fluid being trapped in the “compartment” around the muscle. This is a serious issue that requires immediate attention by your physical therapist or doctor.

What causes shin splints?

Shin splints are caused by a muscle imbalance between the tibialis anterior (front) and tibialis posterior (back) muscles in your lower leg. One muscle becomes inhibited and weak while the other is overworked, causing a spasm in the muscle, resulting in pain. For example, if you have pain in your calf, it is due to weakness in the front muscle and vice versa. The weak muscle is the issue and one of the factors that needs to be addressed. Other issues that can cause shin splits are improper footwear, overtraining, weakness in other important hip and leg muscles, and running style.

What do you do if you are experiencing this pain?

First, allow for appropriate rest and adjust your training program accordingly. Physical therapists recommend cross training with activities like weightlifting, swimming or biking while your bone heals. If you experience more of the muscle related pain, it is important to address trigger points along the front/back side of the shin bone. This can be done by using your thumb to search up and down the front/back of the shin bone looking for tight and tender spots in the muscle. Once these spots are found, simply hold for 5-10 seconds with light to moderate pressure. Overtraining is an issue that can bring on shin splints. Increasing duration, frequency or intensity of exercise too quickly can lead to pain. Slowly work into a training program, progressing the duration and intensity in a controlled manner.

Managing Shin Splints

There are two predominant camps in the management of shin splints. One train of thought is using an orthotic or specific type of shoe to better support the foot. A good shoe store will be able to take a look at your foot and help determine your needs based on your foot mechanics. Typically, a person with flat arches should look for a motion-control shoe or one that limits pronation of the foot. The other camp believes that these over-supportive shoes or orthotics are encouraging the dysfunction in your foot, making you dependent on such items. They suggest the use of a minimal heel drop shoe and walking barefoot to strengthen the arch of your foot. In my opinion, if you are in the middle of the season, choosing a good motion controlled shoe may be your best option. A long-term solution would be strengthening the arch and becoming less reliant on orthotics or overly stable shoes.

 

Chase Hanson, PT

Chase Hanson is a physical therapist at Orthopedic & Spine Therapy’s Green Bay clinic. To schedule an appointment with Chase, call 920-432-9040.

Website: ostpt.com
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