SHIN SPLINT

Overview:

What Is Shin Splints?

The term “shin splints” refers to pain along the shin bone (tibia) — the large bone in the front of your lower leg. Shin splints are common in runners, dancers, and military recruits.

It is also known as Medial Tibial Stress Syndrome (MTSS), which is defined by the American Academy of Orthopedic Surgeons as “pain along the inner edge of the shinbone (tibia).”

The symptoms usually caused by repeated trauma to the connective muscle tissue surrounding the tibia.

A common injury affecting athletes who engage in running sports or other forms of physical activity, including running and jumping.

They are characterized by general pain in the lower region of the leg between the knee and the ankle.

Shin splints injuries are specifically located in the middle to lower thirds of the inside or medial side of the tibia, which is the larger of two bones comprising the lower leg.

Shin Splint Signs & Symptoms

The pain is described as a recurring dull ache along the inner part of the lower two-thirds of the tibia. In contrast, stress fracture pain is localized to the fracture site.

Biomechanically, over-pronation is the common cause for shins splint and action should be taken to offset the biomechanical irregularity.

Pronation occurs when the ankle bone moves downward and towards the middle to create a more stable point of contact with the ground.

In other words, the ankle rolls inwards so that more of the arch has contact with the ground. This abnormal movement causes muscles to fatigue more quickly and unable to absorb any shock from the foot hitting the ground.

Shin Splints Causes 

While the exact cause is unknown, shin splints can be attributed to the overloading of the lower leg due to biomechanical irregularities increasing stress exerted on the tibia.

A sudden increase in intensity or frequency in activity level fatigues muscles too quickly to properly help absorb shock, forcing the tibia to absorb most of that shock.

Muscle imbalance, including weak core muscles, inflexibility, and tightness of lower leg muscles, including the gastronomies, soleus, and plantar muscles (commonly the flexor digitorum muscle) can increase the possibility of shin splints.

The pain associated with shin splints is caused by a disruption of Sharpey’s fibers that connect the medial soleus fascia through the periosteum of the tibia where it inserts into the bone.

With repetitive stress, the impact forces eccentrically fatigue the soleus and create repeated tibial bending or bowing, contributing to shin splints.

Improper footwear, including worn-out shoes, can also contribute to shin splints.

Shin Splints Treatment / Diagnosis

Shin splints can be diagnosed after taking a thorough history and performing a complete physical examination.

The physical examination focuses on palpable or gentle pressure, tenderness over a 4-6 inch section on the lower, inside shin area.

The pain has been described as a dull ache to an intense pain that increases during shin splint exercise, and some individuals experience swelling in the pain area.

Clinical history focuses on an individual’s previous history with shin splints. People who have previously had shin splints are more likely to have it again.

Vascular and neurological examinations produce normal results in patients with shin splints.

Radiographic and three-phase bone scans are recommended to differentiate between shin splints and other causes of chronic leg pain. MRI scans can be used to differentiate between stress fractures and shin splints.

It is important to differentiate between different lower leg pain injuries, including shin splints, stress fractures, compartment syndrome, nerve entrapment, and popliteal artery entrapment syndrome.

These conditions often have many overlapping symptoms which make a final diagnosis difficult, and a correct diagnosis is needed to determine the most appropriate treatment.

Shin Splint Treatment:

Treatment for shin splints is not always successful because the exact cause of shin splints is still unknown. The Most Common Treatment are –

Take Rest, Ice your Shin Bone, Strengthen, and gradually returning to activity.

Initial treatment for shin splints includes rest and ice. Rest and ice work to allow the tibia to recover from sudden, high levels of stress and reduce inflammation and pain levels.

It is important to significantly reduce any pain or swelling before returning to activity.

Strengthening exercises should be performed after pain has subsided, focusing on the lower leg and hip muscles. Individuals should gradually return to activity, beginning with a short and low-intensity level.

Over multiple weeks, they can slowly work up to normal activity levels. It is important to decrease the activity level if any pain returns.

Individuals should consider running on other surfaces besides asphalt, such as grass, to decrease the amount of force the lower leg must absorb.

Orthoses and insoles help to offset biomechanical irregularities like pronation and help to support the arch of the foot.

Take anti-inflammatory painkiller like acetaminophen ( Fioricet ), Neurontin ( gabapentin ), if you need them.

The following steps are part of the multifaceted approach:

• Workouts such as stationary bicycling or pool running: These will allow maintenance of cardiovascular fitness.
• Run only when symptoms have generally resolved (often about two weeks) and with several restrictions:
• A level and soft terrain are best.
• Distance is limited to 50% of that tolerated preinjury.
• Intensity (pace) is similarly cut by one-half.
• Over a three- to six-week period, a gradual increase in distance is allowed.
• Only then can a gradual increase in pace be attempted.

Shin Splint Exercises/ Shin Splint Stretches

The stretches described here will help you prevent shin splints or recover if you’re having shin splint pain. We’ll also give you some prevention and Recovery tips from an expert.

It’s important to stretch out tight calf muscles, your gastronomies, and the soleus. These large muscles at the back of your leg run from your knee to your heel. Stretch each calf muscle separately.

Here are seven stretches to try:

Gastrocnemius calf stretch:

• Stand with your hands against a wall or on the back of a chair for support.
• Put one foot behind you. Keep your feet flat and pointed straight ahead.
• With your back heel down and back leg straight, bend the front knee until you feel a stretch in the calf of your back leg.
• Keep your back straight throughout the stretch.
• Hold the stretch for at least 30 seconds. Repeat the stretch 2 or 3 times, and aim for stretching 3 times a day.

Soleus calf stretch:

• Stand with your hands against a wall or the back of a chair for support.
• Put one foot behind you. Keep your feet flat and pointed straight ahead.
• Bend your front knee slightly. With your back heel down, bend your back knee. If it’s too hard to keep your heel down, shorten your stride.
• Hold the stretch for at least 30 seconds. Repeat the stretch 2 or 3 times, and aim for stretching 3 times a day.

Achilles tendon standing stretch:

• You can do this exercise standing on a stair step, a curb, a step stool, or a thick phone book. Be sure to hold onto a railing or something heavy for balance, with at least one hand.
• Stand with the balls of your feet on the edge of the stair step (or whatever you’ve chosen to use for this exercise).
• Slowly let one heel hang off the step until you feel a stretch at the back of your leg and the Achilles area.
• Hold the position for 30 seconds. Repeat 2 to 3 times, up to 5 times a day.

Achilles tendon seated stretch:

• Sitting on the floor, bend one knee, and put the other leg out in front of you, with your heel on the floor.
• Loop an exercise band, a towel, or a belt around the ball of your foot.
• Slowly pull your toe towards you and hold for 15 to 30 seconds. Repeat 2 to 4 times.
• You can also do this stretch sitting in a chair, with one leg extended and your heel on the floor.
• Loop the band or towel around your heel and slowly pull your toe towards you.

 Tibia Bone anterior muscle stretch:

This exercise stretches the front (anterior) of your tibia muscle.

• Sit on your feet, with your toes pointing slightly in, your hands on the floor in front of you.
• To increase the stretch, lean forward to raise yourself, resting on your toes. Hold the stretch for 15 to 30 seconds.

Strengthening the anterior Tibia Bone:

• Sit on the floor or a bench.
• Secure an exercise band around something sturdy and loop it around the top of your foot.
• With your toes facing up, flex your ankle toward you to the count of 2. Return your ankle down to the count of
• Do 10 to 20 repetitions of 2 to 3 sets daily.

 Strengthening the gastro-soleus muscles:

• Stand with your feet shoulder-width apart.
• Raise your heels to the count of 2, and lower them to the count of 4.
• Make sure you’re on the tips of your toes. Use a chair or wall for support if you need it.
• Do 10 to 20 repetitions of 2 to 3 sets daily.

To make the shin splint exercise harder, try doing it on one leg. Or point your feet in or out to exercise a different part of the muscle.

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