Shin Splints

Shin splints are injuries to the front of the outer leg caused by overuse and typically happen to runners or aggressive walkers. Shin splint pain can be extreme enough to prevent you from working out. Rest is usually the best treatment for shin splints, and you can also ice the injury and take over-the-counter (OTC) pain medicine to relieve pain.

• Shin splints are a type of "overuse injury" to the legs.
• The pain is characteristic and located on the outer edge of the mid-region of the leg next to the shinbone (tibia). It can be extreme and halt workouts.
• The diagnosis requires a careful focused examination.
• A multifaceted approach of "relative rest" can restore a pain-free level of activity and a return to competition.
• The relative rest approach includes a change in the workout, ice, rest, anti-inflammatory medications, stretching exercises, possible change in footwear, and a gradual increase in running activities.
• Footwear that provides proper support to your feet can also help to prevent shin splints.
• Generally, the outlook is excellent for full recovery, but physical therapy treatment can be necessary.

• 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.
• Working out harder than usual or training too hard or too fast instead of working up to a training level gradually is the most common cause of shin splints
• Workout shoes that don't have enough support may also be one of the causes of shin splints.
• Running or walking on a different surface than you are used to. For example, a person may get shin splints when they switch from running on a trail to concrete or asphalt.

• 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 in 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.

• 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 scans, or MRI scans, can be helpful in this setting to detect stress fracture of the tibia bone.

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 approach was even worse. It often led to the worsening of the injury and the symptoms.

Currently, a multifaceted approach of relative rest is successfully utilized to restore the athlete to a pain-free level of competition.

Most common stretches to relieve shin splints pain:

• Foam Rolling: An individual may kneel on the roller, then gently roll two inches down the front of the shin, then again roll one inch up. This may be repeated all the way from the lower knee to the ankle. Total-leg rolling session one to three times per week is usually recommended
• Shin Stretch: An individual may sit on feet with the top of the foot and legs flat against the floor (best done on a mat). Slowly lean back to increase the stretch supporting the upper body with arms.
• Toe Pull Back: A person may sit with legs together, straight out in front of the body. Use a slow controlled motion to pull the toes back towards the torso. If they do this exercise properly, a person may feel the front of the shin tighten.
• Toe Raise: Balance with heels on the edge of a step, then pull the toes upwards and in towards the shins. They might know if they are doing this exercise right when they feel the front of the leg tighten.
• Heel Walking: Balance on the heels barefoot and walk around in circles or a figure eight for a set period of time. Start small with only 15-20 seconds then build up to a minute or more.

The following steps are part of the multifaceted approach:

• Workouts such as stationary bicycling or pool running: Will allow maintenance of cardiovascular fitness.
• The 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 are best.
  2. Distance is limited to 50% of that tolerated pre-injury.
  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.

Prevention tips for shin splints: 

• To the extent that shin splints are an overuse injury, shin splints can be prevented by gradually increasing exercise activities.
• Footwear that provides proper support to your feet can also help to prevent shin splints.
• Cross-train in sports such as swimming or cycling, which have a lower impact on the shins, to balance out the workout. 
• Add strength training to workouts to develop the muscles that can prevent shin splints.
• Don’t overdo it. Runners, and athletes in general, have a habit of pushing through pain, but this could just cause more injury and keep them down for longer periods. 
• Poor foot mechanics and weak muscles tend to contribute to shin splints. To prevent it these people will need physiotherapy or wear custom orthotics.

• 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.