Diseases

To the extent that shin splints are an overuse injury, shin splints can be prevented by gradually increasing exercise activities. Proper footwear can also help to prevent shin splints.

The diagnosis of shin splints is usually made during physical examination. It depends upon a careful review of the patient's history and a focused physical exam (on the examination of the shins and legs where local tenderness is noted). Specialized (and costly) tests (for example, bone scans) are generally only necessary if the diagnosis is unclear. Radiology tests, such as X-rays, bone scan, or MRI scan, can be helpful in this setting to detect stress fracture of the tibia bone.

Risk factors for shin splints include running and over-training on hills, inadequate footwear for athletic activity, and poor biomechanics of the design of the legs and feet.

Shin splints cause pain in the front of the outer leg below the knee. The pain of shin splints is characteristically located on the outer edge of the mid region of the leg next to the shinbone (tibia). An area of discomfort measuring 4-6 inches (10-15 cm) in length is frequently present. Pain is often noted at the early portion of the workout, then lessens, only to reappear near the end of the training session. Shin splint discomfort is often described as dull at first. However, with continuing trauma, the pain can become so extreme as to cause the athlete to stop workouts altogether.

Shin splints are injuries to the front of the outer leg. While the exact injury is not known, shin splints seem to result from inflammation due to injury of the soft tissues in the front of the outer leg. Shin splints are a member of a group of injuries called overuse injuries. Shin splints occur most commonly in runners or aggressive walkers.

A primary culprit causing shin splints is a sudden increase in distance or intensity of a workout schedule. This increase in muscle work can be associated with inflammation of the lower leg muscles, those muscles used in lifting the foot (the motion during which the foot pivots toward the tibia). Such a situation can be aggravated by a tendency to pronate the foot (roll it excessively inward onto the arch). Similarly, a tight Achilles tendon or weak ankle muscles are also often implicated in the development of shin splints.

The following steps are part of the multifaceted approach:

• Workouts such as stationary bicycling or pool running: These will allow maintenance of cardiovascular fitness.
• Application of ice packs reduces inflammation.
• Anti-inflammatory medications, such as ibuprofen (Advil/Motrin) or naproxen (Aleve/Naprosyn), are also a central part of rehabilitation.
• A 4-inch wide Ace bandage wrapped around the region or a Neoprene calf sleeve also helps to reduce discomfort.
• Calf and anterior (front of) leg stretching and strengthening address the biomechanical problems discussed above and reduce pain.
• Pay careful attention to selecting the correct running shoe based upon the foot type (flexible pronator vs. rigid supinator). This is extremely important. In selected cases, shoe inserts (orthotics) may be necessary.
• Stretching and strengthening exercises are done twice a day.
• Run only when symptoms have generally resolved (often about two weeks) and with several restrictions:
  1. A level and soft terrain is best.
  2. Distance is limited to 50% of that tolerated preinjury.
  3. Intensity (pace) is similarly cut by one-half.
  4. Over a three- to six-week period, a gradual increase in distance is allowed.
  5. Only then can a gradual increase in pace be attempted.

The extent of injury that occurs prior to any rehabilitation program plays a significant role in determining the time frame necessary for complete recovery. Generally, the outlook is excellent for full recovery, but physical therapy treatment can be necessary.

Previously, two different treatment management strategies were used: total rest or a "run through it" approach. The total rest was often an unacceptable option to the athlete. The run through it approach was even worse. It often led to worsening of the injury and of the symptoms. Currently, a multifaceted approach of relative rest is successfully utilized to restore the athlete to a pain-free level of competition.