Shin splints are muscle injuries that develop gradually in one or both lower legs. The pain is usually described as an “aching soreness” that progresses and is particularly noticeable when walking or running. This is an overuse condition that develops secondary to repetitive strain at the muscle insertion – either in the very active athlete or in a patient who has started or increased a new walking or jogging routine. The involved leg is tender to touch along the muscle insertions in the middle or lower third of the lower leg. The primary factor in shin splints is weak muscles/tendons and poor biomechanics. This dysfunction leads to damage of the soft tissue that connect the tendon to the bone.

There are two major types of shin splints which are differentiated by location and involved muscles. 1) Anterolateral. These shin splints affect primarily the front and outside aspect of the leg. Muscles affected are often placed under increased demand when there is excessive running on hard or downhill surfaces, an imbalance in the muscles or when the shoe has lost its shock-absorbing qualities. In addition to biomechanical support and a better heel pad, good forefoot cushioning is also recommended. 2) Posteromedial. When there is excessive pronation (flat feet), the muscles that try to stabilize the ankle become overstrained and cause shin splints. These are the muscles along the back of the calf and along inside aspect of the lower leg. Arch support and a pronation wedge under the heel are needed to reduce the stress on these muscles. Shock absorption is helpful, but supporting the foot and ankle biomechanics is most important.

Muscle testing of the ankle reveals mild to moderate weakness of the involved muscles and may cause increased pain. There are normally no neurological changes and no significant asymmetry in muscle mass. Evaluation of lower extremity biomechanics is an important part of care, since shock-absorbing orthotic support is often necessary. Factors that predispose to shin splint development include: excessive pronation, high arches, leg-length discrepancy and muscle imbalance.

The treatment of shin splints usually involves temporarily limiting or stopping the offensive activity.  The standard self-treatment protocol is R.I.C.E (rest, ice, compression, and elevation) or M.I.C.E (movement -pain free range of motion such as light stretching, ice, compression, and elevation). The most effective therapy for shin splints involves the use of Graston Therapy, ice, rehab exercises, stretching, and kinesio-taping. Manipulation of the low back, pelvis, knee, ankle, and foot joints can also be helpful.  The athlete can also use a compression sock or have the shin taped for running.  A change in shoes may be helpful.

There are specific exercises that can be done to help prevent shin splints and includes strengthening of specific muscles. Running on softer surfaces lessens the impact on the leg and in turn decreases your vulnerability to shin splints.  If you run on uneven surfaces, as in trail running, make sure you build mileage slowly so your body has time to adapt to this type of stress.  Always be sure you get an adequate warm-up before your running event, especially if your sport involves sprinting

When you start feeling the pain of shin splints the condition has more than likely been going on for a significant amount of time.  If you seek treatment immediately after you start feeling the pain the condition should significantly improve in 1-2 weeks.  If the condition is chronic it could take months to resolve.  Treatment should continue after the resolution of pain to reduce scar tissue/adhesions.  If you are being treated for shin splints and are not seeing improvement consider one of the other possible causes for shin pain. Be sure that all of the factors listed above have been addressed. The best prevention strategies include a gradual increase in intensity and duration of exercise, wearing the appropriate shoes for your foot type, and proper stretching and foam rolling after exercise.



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