If you do extensive walking or are involved in track and field, especially on a competitive level, you’re at high risk for shin splints. It’s one of those injuries that are referred to as an overused injury.
Medial tibial stress syndrome or shin splints as it is more commonly called by orthopaedic surgeons, usually develops after physical activity, such as vigorous exercise or sports. Repetitive activity leads to inflammation of the muscles, tendons, and periosteum (the thin layer of tissue covering a bone) of the tibia, causing pain.
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 shin bone or 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, and 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 causing the athlete to stop workouts altogether.
• Flat feet or high arches
• Sudden increase in training or new vigorous impact training
• Military training
Certain factors seem to contribute to shin splints. The condition commonly affects runners, aerobic dancers, and people in the protective services. Splints often develop after sudden changes in physical activity, such as running longer distances or on hills, or increasing the number of days you exercise each week. However, being flat footed, can contribute to increased stress on the lower leg muscles during exercise.
The increase in muscle work generally 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.
How are Shin Splints Diagnosed?
The diagnosis is usually made during an examination. It depends upon a careful review of the patient’s history and a focused physical exam (on inspection of the shins and legs where local tenderness is noted).
Specialised 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 magnetic resonance imaging (MRI) scans, can be helpful in this setting to detect stress fracture of the tibia bone.
Nonsurgical treatment for shin splints includes several weeks of rest from the activity that caused it. Other forms of conditioning can be substituted. It may be recommended that you take anti-inflammatory medications, or use ice packs and mild compression to feel better. Stretching exercises can also help but should be given by a doctor or therapist not your own type.
In most people, the pain is not so bad with ordinary walking. After several weeks of rest, low-level training may begin. Be sure to warm up and stretch thoroughly before you exercise. Increase training slowly. If you start to feel the same pain, stop exercising immediately. Use a cold pack and rest for a day or two. Return to training again at a lower level of intensity. Increase training even more slowly than before.
Very few people need surgery for shin splints. Surgery has been done in very severe cases of shin splints that do not respond to nonsurgical treatment. It is not clear how effective surgery is; however, an accurate diagnosis is very important. Sometimes, other problems may exist, which will have an impact on healing.
Other Causes of Shin Pain
When shin splints are not responsive to treatment, your doctor may want to make sure you do not have a stress fracture. A bone scan and MRI can often show if a fracture is present. The diagnostic tests, causes of shin splints, and treatment regimens all bear a similarity and relationship to stress fractures. It is possible that there is a relationship between shin splints and stress fracture, but this has not been clearly identified.
Tendonitis can be present, especially if there is a partial tear of the involved tendon. A MRI can also help the doctor diagnose the presence of tendonitis.
Chronic exertional compartment syndrome
An uncommon condition called chronic exertional compartment syndrome involves swelling of muscle with exertion. This happens within the muscle’s usually tight compartment in the leg which is non-yielding. Swelling can raise pressure within the compartment to levels so high that blood will not flow into the muscle. This causes severe pain and is best treated surgically. The tests that are used to diagnose chronic exertional compartment syndrome are highly specialized and not easily available. They involve measuring the pressure within the leg compartments immediately after exercise.
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