Shin Splints Stink!

Since the start of the new year is also the time many people dust off their running shoes and start hitting the pavement (or belt if your a mole runner***) in start of training for their spring races, I thought I'd write a little something about shin splints. Also, I know someone who thinks she might have shin splints! Ouch.

Shin splints is a term used to describe pain in the front of the lower leg. But the term shin splints is just that. A phrase to describe a symptom. It is not a diagnosis.

What exactly are shin splints then?

Tibial Stress Injury particularly Medial Tibial Stress Syndrome (MTSS). MTSS is the most common, but not the only, diagnosis for anterior shin pain. According to John T.Hester, DPM,MSPT, researchers believed it was microtrauma to the lining of the bone, but there is a growing body of evidence that suggests it is a bone stress reaction caused by chronic repetitive loads that induce tibial bending forces (1)

What you feel. Pain is felt in the lower half to 2/3 of the shin along the middle to inside of the tibia. It may be a dull ache felt upon starting activity which goes away, only to return hours later after the activity has subsided. The pain may progress to where it felt during the entire activity and performance is diminished. Further progression causes pain even with inactivity. There may also be pain or tenderness to the touch and swelling in the surrounding area.

What you can do. Stop running and cross train (2). Swim or pool run, bike, elliptical, lift weights (don't jump around, though). Keep it low impact or modify the activity. Depending on the severity, for instance, you may be able to box or kick box with proper modifications. You may be able to go down hill skiing. Ask your doctor or use pain as your guide...that is "if it hurts, don't do it".

What else you can do. Ice the area after activity. Usually 10-20 minutes is the recommended time to ice. If you use an ice cup, it takes about 5 minutes. To make an ice cup fill a paper cup with water and freeze. When you need to ice the leg, take out the cup, peel the top portion of the cup off, using the remaining cup to hold on to the ice chunk, rub the affected area in a circular motion for about 5 minutes.

You can do more. Take an anti-inflammatory. I'm not a doctor and do I really need to say check with your doctor before taking any medications because I'm not a doctor?

What else you ask? Here's a few more things to do. Replace your running shoes if it's been more than 250-300 miles (2). Run on soft surfaces- think high school track. Remember this, too. Grass is softer then (but it's also uneven, so be careful) pavement, pavement is softer then concrete. Run on even surfaces. Watch for the crown in the road and bumpy surfaces.

Yep, there's more. Get the right running shoe and maybe some custom orthotics. Over pronators are more likely to suffer from MTSS then people with moderate to high arches. When the foot lands, it flattens out too much, causing stress and strain on the muscles, tendons, ligaments and bone.

Something else. Strengthen the area. Also, work on endurance, balance and flexibility of the lower leg.

Check this out, too. According to Hester's article(1) "... do not overlook hormonal and nutritional factors. The female athlete triad (amenorrhea, disordered eating and osteoporosis) has been linked to decreased bone marrow density and increased risk for bone stress injuries." Even if you do not have disordered eating habits you still may be lacking in protein and calcium. Seek the advice of a nutritionist.

By the way if it's not MTSS is could be one of the following, but you should ask your doctor to be sure, since I am not a doctor and can't diagnose you.

• Tibialis anterior tendinitis. Inflammation of the tendon of the muscle that attaches to the foot, crosses the ankle, runs ups the front of the shin and attaches at the top of the lower leg (tibia).
• Compartment syndrome. The lower leg has 3 compartments. Each compartment is like a tube of connective tissue. Within that tube is a group of muscles,nerves, arteries and veins. In compartment syndrome one of the tendons or muscles becomes inflamed and causes swelling. Because of the compartment, there is no place for the swelling to go and pressure is placed on the nerves and blood vessels. This causes pain and perhaps symptoms like pins and needles.
• Stress fracture. A hairline fracture in the tibia.

Refrences:

1.Hester, John T. Conquering Medial Tibial Stress Syndrome. PodiatryToday.com/article/5031

2.Whorton, Jim and Phil. Get Over It:Shin Pain. Runnersworld.com/article/0,7120,s6-241-286-289-12604-0,00.

***a mole runner is a name I just came up with to describe someone who only runs on the treadmill and never sees the light of day until race day. What an awful way to spend your entire training regimen!