Shin Splints – Cause and Management

Overview 

Shin splints, or medial tibial stress syndrome, represent a frequent ailment especially among athletes who engage in running and jumping. The discomfort associated with shin splints typically manifests along the inner edge of the shinbone (tibia), where muscles attach to the bone. This condition is primarily the result of repetitive stress which overwhelms the body’s capacity to repair and strengthen the bone and surrounding tissues.

The pain occurring along the inner side of the shin bone especially after physical activity is known as shin splints. It is also known as medial tibial stress syndrome. The condition is common among runners, dancers, and military recruits. The patients usually present with a history of a sudden increase in physical activity.

The shin bone is the long bone in front of your lower leg. The shinbone or the tibia has a lot of muscles and tendons attached especially on the inner side. The periosteum is the tough tissue covering the bone. Rigorous and repetitive physical activity may lead to inflammation of the periosteum and the tendons attached to the shin bone.

X-ray of a normal knee showing the area of inflammation in shin splints.

The activity most commonly associated is running. New runners and runners changing their duration, intensity, and frequency may experience shin splints. Some of the risk factors are people having flat feet. A foot having improper arch support on the inner side of the sole is known as flat feet.

Additionally, runners wearing improper shoe wear or wearing worn-out footwear are susceptible to developing shin splints. Dancers and athletes with high impact activity are commonly affected. The patient usually complains of symptoms after the initial few days of intense activity.

Symptoms of Shin Splints

The hallmark symptom of shin splints is a throbbing or aching pain along the inner part of the lower leg, which may:

• Start as a dull ache and intensify to a sharp pain
• Be accompanied by mild swelling
• Typically worsen during exercise and alleviate during rest

The commonest symptom of shin splints is pain in the front of the leg. The pain may be associated with mild swelling. The pain of shin splints is usually mild initially and goes away on stopping the exercise. But gradually the pain may become consistent and increase in intensity.

The pain may be sharp or dull in character and is usually present both during and after the activity. The inner side of the shin bone may be tender to touch. There may be a small bump consistent with swelling which is sore to touch.

Diagnosis

The diagnosis of shin splints involves a detailed history and physical examination. A detailed history of training intensity and frequency of running is taken. Physical examination of the tender shin and feet is done. 

Foot examination may include tests to look for weakened arches on the inner side of the sole. The physician may also order other investigations such as X-ray. A bone scan or MRI may be requested if the physician suspects stress fracture.

Differential Diagnosis

A doctor’s examination is necessary to diagnose shin splints. Some other conditions may also resemble shin splints. Physician consultation is, therefore, necessary to rule out other causes of leg pain.

• Stress fractures are hairline fractures occurring due to repetitive stress/overuse. The condition is diagnosed usually with the help of imaging studies such as bone scan and MRI.
• Partial tendon tears may result in tendonitis or inflammation of the tendons. The condition may resemble shin splints.
• Very rarely, a chronic compartment syndrome may develop in the pressure within the leg muscles increases to dangerous levels.

Management

The management of shin splints is conservative which involves measures to reduce inflammation.

• Rest to the part is important as it helps the inflammation to go down.
• Icing helps to decrease the inflammation and reduces pain.
• NSAIDs such as Ibuprofen and Aleve reduce inflammation. They are used cautiously in patients prone to develop gastric ulcers and bleeding.
• Compression bandages reduce swelling and prevent additional swelling in the leg.

Prevention

Shin splint is a common condition affecting athletes and non-athletes alike. However preventive measures greatly reduce the chances of developing shin splints.

• Proper shoewear is important to prevent shin splints. People having flatfeet benefit from using shoe inserts for proper balancing of the forces when they exercise. Orthotics aid in stabilizing the ankle and distribute forces evenly.
• Leg muscles strengthening and stretching exercises help in reducing the chances of shin splints. The strengthened calf muscles are less likely to develop inflammation of the periosteum upon repetitive use.
• Change of training and modifying the exercise regimen prevents shin splints. Small increments in running distance and cross-training have been associated with a lower occurrence of leg pain.

Recovery from leg pain is gradual but mostly complete. However, it is important to return to activity only after a period of rest (generally 2 weeks). Consulting a physician regarding your training and activity adjustment is beneficial.

Alternating running with lower impact sports such as cycling and swimming may help strengthen the muscles. Consider consulting a sports physician for proper evaluation and management of shin splints.

Long-Term Outlook and Considerations

While shin splints are generally not serious, without appropriate management, they can lead to prolonged discomfort and even more severe injuries. Education on proper techniques and awareness of the signs of overuse are crucial for anyone engaged in activities with high impact on the lower legs.

Conclusion

Shin splints are a manageable and preventable condition with a comprehensive understanding of their causes, symptoms, and treatments. By incorporating proper preventative measures and seeking appropriate care when symptoms arise, individuals can maintain active and healthy lifestyles without the disruption of this painful condition.

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