Have you ever felt pain in any area between the knee and ankle, especially after running? If yes, this is exactly referred to as shin splints. It is termed as Medial Tibial Stress Syndrome or MTSS and is referred to pain in front lower legs or shins, especially the area along the shinbone that stretches from knee to ankle. It is a kind of medical condition occurring in the tibia’s front part in the leg. People who are often involved in strenuous or stop-start activity such as tennis, running, squash, and basketball are more vulnerable to such pain.
Types of Shin Splints
Why Do I Get Shin Splints and what are the causes?
Symptoms of Shin Splints
Common Treatment for Shin Splints
Types of Shin Splints
Medically, two types, namely: posterior or behind the leg and anterior or in front. In other words, pain in the shinbone’s inner side is called posterior or medial shin splints, while the pain in outsider side is called anterior shin splints.
In both the cases, the condition usually tends to occur due to a muscle imbalance. Anterior shin splints typically result due to an imbalance between the front muscles and calf muscles, and often upset the beginners whose bodies are yet to adjust with the activity’s stress.
If the front muscle or tibia’s anterior is fragile, it is obvious for the muscle to fatigue easily even while walking, to trigger pain. Well, this is different from stress fracture in the shinbone or in tibia. The same weakness can also force the muscle on the posterior side to work a bit harder for delivering the desired support to the foot, causing shin splints in the leg’s back. This explanation is also applicable vice-versa wherein the muscle at the shin’s rear is weak.
While posterior or medial splints are relatively more widespread, pain can be felt on both sides in case the condition is severe.
Why Do I Get Shin Splints? What Causes Shin Splints?
There is no single cause of such a pain. However, the most common cause is MTSS that occurs due to intense, frequent periods of workouts, especially when the body is not used to it. The other causes of MTSS are:
- Long-distance running and activities with lots of starts and stops, such as tennis and basketball
- Sudden increase in the distance or speed, putting much pressure on legs, especially on tough surface area, causing harm to surrounding tissues and bones
- Inflammation in the layer of connective tissue on the shin bone (periosteum) surface due to extreme pressure on shins or excessive rolling of foot while hitting the ground (over-pronation), which can be due to:
- Running downhill, with inapt shoes or worn out shoes, or on a sloping or uneven terrain
- Participating in sports requiring speed bursts
According to recent research, MTSS can occur as a stress reaction from the bone. Such a reaction can be due several factors, which are:
- Overuse of legs, such as working out too hard or beyond the acceptable level, straining joints, tendons, shin bone, and bones (most common cause)
- Increase in period of activity or intensity, especially while the tendons and muscles strive to absorb the shock force when exhausted
- Repetitive lower leg, high-impact exercises that also make gymnasts and dancers susceptible
- Rigid or flat fleet arches, which can result in slight tearing while pulling at the tendons of shin bone; the shin muscles help in retaining the arch of the foot
- Inaccurate technique such as poor form of running or rolling feet inwards
- Running shoes loosening to more than 50% of shock absorbing ability after a few hundred miles
- Diminished bone density, especially in women
- Inadequate stretching
- Excessive stress on one hip or one leg by running on difficult roads or running in one direction always
- Any anatomical abnormality
- Lack of suppleness
- Muscle weakness in the thighs or buttocks
- Previous history of MTSS
- Failure to recover completely from a previous condition of shin splints and getting back to activity
The pain can take several days or weeks to decrease after the workout or activity is at halt.
A symptom is what only the patient can feel, such as fatigue and pain, whereas a sign is visible by anyone around, such as swelling and rash. The most ordinary symptom of shin splints is felt along the tibia’s border, which is pain. Talking about the sign, mild swelling is quite common among the patients of MTSS. Other symptoms and signs are:
- Dull or sharp pain in front
- Pain felt all the time in the lower leg’s front part or inner area
- Pain and discomfort only while exercising or after the workout
- Pain on either side
- Pain in one or both legs
- Pain getting worse after workout
- Pain getting better after resting
- Pain while pushing on the shins
- Muscle pain
- Tenderness or soreness inside the lower leg
- Feet may feel numb and weak, because swollen muscles irritate the nerves
- Numbness and weakness in the feet
- Hurt in legs even if you are not exercising (this is severe case)
- Are aggravated if sore and tender spot is touched
- Red skin
Ice therapy is perhaps the most effective treatment as it is instantly relieves pain. However, you should not apply ice directly. Rather, you should apply an ice pack for almost 20 minutes at frequent intervals to relieve pain. For shin splints, the practice of PRICE: Protection, Rest, Ice, Compression (through elastic badges) and Elevation (keeping legs elevated) has proved to be effective in reliving the various symptoms.
Most people feel much relieved after trying a non-operative treatment such as stretching exercises, keeping the legs elevated, strengthening exercises, and rest, which help in the symptoms of shin splints to subside. Even anti-inflammatory medication or gel can make you get rid of pain.
To prevent recurrence, bio-mechanical analysis with a physiotherapist can be quite effective. Herein, an analysis of posture while walking and running as well as at rest is done to identify any factors causing the individual to be vulnerable to MTSS. Doing so helps in overcoming them before restoring to the strenuous activity or workout. The analysis helps in identifying the common causes such as leg length inequality, muscle imbalance, flat feet, and lowered arch during running. In case the latter is the cause, arch supporting Orthotics insoles is perhaps an ideal solution.
A licensed orthopedic consultant or physiotherapist must treat the pain in shin, as the condition can become worse due to exercise continuity. During the problem, it is best to go for non-weight bearing workout in the swimming pool for maintaining fitness while letting the condition to heal.
If the shin pain is a soft tissue problem, a compression sleeve can heal it effectively while allowing the patient to run. It works by constricting the range of shin muscle pull, which alleviates stress on the shin at the time of running. While not being a direct remedy, a compression sleeve can alleviate the symptoms for the runners.
In case a patient does not respond to the aforementioned non-surgery treatments, surgery becomes essential although it’s a rare case. It is applicable to those in whom pain is severe. Surgery is done to open the thick tissue called fascia around the muscle groups or reattach the torn muscle of the shinbone.
Nevertheless, shin splints are treatable through non-surgical remedies in most cases.