Shin Splints

Overview of shin splints

The global estimates of the World Health Organization (WHO) suggest that nearly 50% of the current world population suffers from musculoskeletal disorders. A large percentage of these diseases result from sports injuries and general overuse injuries. Professional athletes, sportspersons, gym goers and aerobic dancers are the main vulnerable groups of these categories of musculoskeletal disorders. “Shin splints” is perhaps the most widespread sports-related injury. It accounts for about 10.7% injuries in male athletes and about 16.8% injuries in female athletes. In the long term, it not only affects performance but also has adverse effects on the general health of a person.

What are shin splints?

Shin splints or “Medial Tibial Stress Syndrome” is a ballistic sports injury in which inflammation and damage of the shin bone (lower leg bone) occur.

The pain is mainly felt at the inner edge of the shin bone (tibia). Shin splints mainly arise from rigorous sports activities on a regular basis that damages the muscles, tendons, and ligaments present in the lower leg.

Two sets of muscles actively contribute to shin splints. These are the anterior tibialis muscle (present at the front of the shin) and the posterior tibialis muscle (present at the back of the shin). The inflammation and soreness mainly occur at the frontal portion of the shin or on the inner side of the lower leg. Female athletes are more likely to suffer from shin splints than the male athletes of the same age.

Under what conditions do shin splints occur?

Shin splints occur under the three main conditions-

• Stress fracture: A hairline fracture occurs in either the tibia or the fibula.
• Medial stress syndrome: Inflammation of the muscles that attach to the inner side of the tibia occurs.
• Compartment syndrome: Pain and inflammation in the anterior compartment muscles occur.

What causes shin splints?

Shin splints occur due to a number of factors. The important ones are listed below-

• Overuse injury of the muscles and bone tissues (periosteum)
• Structural defects like having a flat foot (pes planus), very high arches (pes cavas) or very tight Achilles tendon
• Over-pronation (drawing the foot inwards beyond a limit) during any sports activity
• Overload on the outer leg due to improper leg movement
• Differences in leg lengths
• Poor stability of the ankles
• Muscle weakness
• A muscular imbalance between the calf muscles and the anterior shin muscles
• Poor muscle flexibility
• Wear and tear of muscle fibers due to excessive stress and traction force at the muscle-bone interface
• A porosity of bones due to loss of minerals (due to aging)
• Having diseases like arthritis, snapping hip syndrome or foot problems
• Hormonal fluctuations during pregnancy, menopause or menstruation
• Past injuries or surgeries
• An abrupt increase in the intensity of muscular activities
• Defective footwear
• Running or training on extremely hard, uneven and rough surfaces (Eg: Concrete)
• Faulty training techniques
• Excessive sprinting or running on inclined planes

What are the symptoms of shin splints?

The following symptoms make shin splints easily identifiable-

• Pain, inflammation, and swelling in the frontal part of the lower leg
• Soreness, warmth, and tenderness of the shinbone
• Pain on the exterior portion of the lower leg (due to fractures of the tubula)
• Pain and soreness along the lateral length of the shinbone (in medial tibial stress syndrome)
• Muscular pain (due to compartment syndrome)
• Weakness, numbness, and coldness of the foot (due to the irritation of the nerves and blood vessels)
• Increase in muscular resistance and stiffness during movements
• Localised bruising and swelling
• Redness and tenderness on the inner part of the shin
• Formation of lumps on the lower leg (occasional)
• Limited motion of the legs

Grades of pain in shin splints

Patients suffering from shin splints suffer from the following grades of pain-

• Grade I: Pain usually occurs after some activities. The common locations are the calf and the shin.
• Grade II: Pain does not occur during an activity. Pre-activity or post-activity pain occurs, but it does not impact the performance.
• Grade III: In this case, degradation of performance occurs due to pain occurring before, during and after activities.
• Grade IV: Severe pain occurs that prevents the person from taking part in any activity or training.

What are the different types of shin splints?

Shin splints can be classified into a few types based on the part of the lower leg affected and the intensity of pain. The first classification is discussed below-

• Anterior shin splints: Here, pain usually occurs at the frontal part of the shin. The pain worsens when the person tries to lift his/her toe, keeping the heel in a steady position.
• Posterior shin splints: In this condition, the pain occurs medially on the inner edge of the shin bone.

Another classification of shin injuries is given below-

• Medial tibial stress syndrome: It is usually asymmetric injury syndrome, that is, if the pain starts in one leg, the other leg also gets affected shortly after. The pain usually occurs on the inner sides of the shin and runs along the lateral length of the lower leg.
• Anterior tibialis tendonitis: Pain occurs in the anterior tibialis muscles and is felt at the outer edge of the shin bone. Inflammation of the tendons occurs. The symptoms worsen on repetitive motion and overuse stress.
• Tibial stress fracture: The pain is concentrated at a particular point and occurs directly on the shin bone. It is usually absent when the person is not performing any physical activity.

Diagnosis

The following diagnostic techniques are recommended for the shin splints patients-

• X-ray
• Bone scan (CT scan or MRI)
• Ultrasound scan
• Digital radiography

Treatment & Prevention

There are mainly two options to look into if you are seeking treatment for shin splints. These are :

• Home remedies: Firstly, take a break from all physical activities and allow your body to rest.  Limit the amount of physical exertion.  One should keep the affected leg elevated and use ice-packs to heal the swelling.  OTC painkillers can be taken to obtain relief from the pain. Wearing elastic compression bandages will also help.  Use a foam roller to gently massage the shin area.
• Surgery: Though it is rare, surgical intervention might be required in certain cases if the pain is severe and persists for months. The surgery performed in such cases is known as a fasciotomy as it involves making incisions around the fascia tissues.

Prevention of shin splints can be done by:

• Instead of getting into an intensive physical workout suddenly, one should start slow and gradually build up the speed and stamina.
• Add few sessions of cross-training instead of being limited to only running or jogging.
• Follow the correct gait while standing and running to prevent such injuries.
• Wear good quality supportive footwear that provides adequate support to the calf muscles.
• Seek immediate medical attention when you experience any type of pain along calf muscles.

References