Published studies have shown that shin splints account for 6-16% of all running injuries. Some researches consider shin splints to be the most common cause of leg pain among young athletes. Shin Splints also known as Medial Tibial Stress Syndrome, is an overuse or repetitive-stress injury of the shin area. The most common complain of patients is vague, diffuse pain of the lower extremity, along the middle-distal tibia associated with exertion.
Training errors appear to be the most common factors invovled in shin splints, especially as athletes attempt to do “too much, too fast” Common training errors include a recent onset of increased activity, instensity or duration. Running on hard or uneven surafaces is also a common risk factor. Individuals with previous lower extremity injuries and running more than 20 miles per week are especially predisposed to overuse injuries of the lower extremity, including Shin splints. Shin splints is most often found in runners, and also found in other ballistic sports, such as football, basketball, soccer, and dancing. Biomechanical abnormalities also play a rule including, irriated or very tight calf muslces, stress fractures of the lower leg bone and/or extremely flat feet can increase stress on the shin bone, the tibia.
During the acute phase rest is the most important treatment. Ice is also important and should be applied to the shin for approximately 15 minute intervals Physical Therapy modalities including electrical stimulation, laser therapy, acupuncutre and soft tissue therapies are also beneficial. Active Rehabilitation is also important. This may involve strengthening weak calf muscles and increasing core muscle strength and endurance.
As mentioned earlier very tight and weak calf muscles can increase the stress on the shin bone, resulting in shin splints. Literature has widely supported a daily regimen of calf stretching and eccentric calf exercises to prevent muscle fatigue. Other exercises focus on strengthening the tibialis anterior and other muscles controlling both inversion and eversion of the foot.
Patients may also benefit from strengthening core hip muscles. Developing core stability with strong abdominal, gluteal, and hip muscles can improve running mechanics and prevent lower-extremity overuse injuries. Developing muscle strength will improve endurance, but should not be done in the acute phase as they may exacerbate the injury due to increased strain on the tibia.
Summary of treatment goals for Shin Splints
|Rest and ice in the acute phase|
|Modify training program: decrease intensity, frequency, and duration|
|Use low-impact and cross-training exercises during rehabilitation period|
|Gradually return to sport with pain-free activity|
|Perform regular stretching and strengthening exercises|
|Wear proper-fitting shoes with good shock absorption|
|Change shoes every 250–500 miles|
|Consider orthotics if indicated|
|Female athletes may have special considerations|
|Treat key dysfunctions of the entire kinetic chain; use manual therapy|
|Consider other treatment options: acupuncture|
|Surgery for recalcitrant cases|
Reference: Curr Rev Musculoskelet Med. 2009 September; 2(3): 127–133.
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