Shin splints, a common ailment among athletes and active individuals, refer to the pain and discomfort experienced along the shinbone (tibia). This condition, medically known as Medial Tibial Stress Syndrome, often affects those who engage in vigorous physical activities, particularly running and jumping sports.
Pushing through and trying to ignore the pain caused by medial tibial stress syndrome (MTSS) can have quite harmful consequences as it risks increasing the severity of the condition, prolonging recovery time and potentially leading to being out of action for the rest of the sporting season.
To avoid extended time off sport and minimising the chance of more serious injury it is important to be assessed by a Physiotherapist so that your injury can be accurately diagnosed and treated appropriately to safely guide your recovery back to sport.
Understanding MTSS is crucial for effective management and prevention. This article will explore the common causes, symptoms, and treatment options for shin splints — providing insights into how to manage this condition for a pain-free experience.
Shin Splints Uncovered: Causes and Symptoms
‘Shin splints’ is an umbrella term used to describe pain over the large bone in the lower leg. Typically pain presents in one of two areas, either being over the front of the shin or on the lower side of the inside of the leg. However, pain may also be present along the entirety of the shin bone from the ankle to the knee.
They are often the result of excessive stress on the shinbone and the tissues attaching the shinbone to the muscles surrounding it. The pain associated with them typically manifests along the inner edge of the shinbone, where muscles attach to the bone. This section will delve into the intricacies of how they develop, their common symptoms, and the underlying causes.
How do you get MTSS?
Shin splints typically develop from repetitive stress on the shinbone and the connective tissues that attach muscles to the bone (1). This condition is often seen in athletes who engage in high-impact sports, such as running, basketball, and soccer.
Factors contributing to MTSS include overuse, improper training techniques, inadequate footwear, and running on hard surfaces. The pain usually begins as a dull ache along the inner part of the lower leg and can escalate to sharp, intense pain if left untreated. This results in inflammation around the bone.
If this inflammation continues to progress with ongoing repetitive strain being placed on the muscles, tendons and bone this results in damage to these structures. Early on in the condition the pain may only be present at the start of a workout or towards the end of a session and settle with rest breaks.
As the condition progresses pain will eventually remain for the entirety of a session and if serious enough may be present with just walking and be tender to touch. It is at this point where the condition may have progressed far enough to have caused an actual fracture in the bone itself and may require specialist involvement.
How do shin splints result in fractures?
Medial tibial stress syndrome can lead to fractures if the stress on the shinbone continues without proper rest and treatment. The repetitive strain causes micro-tears in the bone, which can develop into stress fractures if the activity causing the strain continues. (2)
Understanding the progression from splints to stress fractures is crucial for timely intervention and prevention of more severe injuries. Bone stress injuries occur as a result of overuse and repetitive strain to the area. Each time we exercise, our bones are placed under strain and suffer a degree of breakdown.
Usually, our bodies are able to balance out this breakdown by repairing and remodelling the structure resulting in the maintenance of a healthy bone. When this balance is offset by placing continued strain on the bone, the breakdown of tissue occurs at a rate greater than our body’s repair process.
In summary, this process occurs along a continuum that begins with a stress reaction, which can progress to a stress fracture as damage to the bone continues to accumulate which can then ultimately lead to a complete bone fracture.
How is a diagnosis made for injury to the bone?
Diagnosing a bone injury, such as a stress fracture resulting from splints, typically involves a combination of patient history, physical examination, and imaging tests. Doctors may initially perform an X-ray, although it might not always detect early MTSS or stress reactions.
An MRI or bone scan is more effective in identifying subtle changes in the bone and can confirm a diagnosis of medial tibial stress syndrome or a stress fracture. Early diagnosis is key to preventing further damage and starting appropriate treatment. (3)
How do they present clinically?
Clinically, shin splints present as exercise-induced pain along the inner side of the shinbone. The pain typically starts as a dull ache and can progress to a sharp, intense pain during physical activity.
They are particularly common in athletes involved in running and jumping sports, but can also occur in individuals who have recently intensified or changed their workout routines. Accurate clinical assessment is vital for distinguishing MTSS from other conditions such as compartment syndrome or stress fractures. (4)
Spotting Shin Splints: Risk Factors
Understanding the risk factors is essential in both prevention and early detection. This condition is not limited to athletes; anyone who suddenly increases their physical activity level could be at risk.
Key risk factors include:
- Sudden increases or spikes in training intensity and duration
- Failure to adequately rest in between training sessions
- Flat feet and arches
- Tight or weak calves
- Poor running technique
- Inappropriate footwear
- Running on concrete or uneven surfaces
Effective Treatments for MTSS
The treatment involves a multifaceted approach, focusing on relieving pain, reducing inflammation, and addressing the underlying causes. This can range from rest and ice to more specific physical therapy techniques. The goal is to allow the shinbone and associated muscles and tendons to heal and to prevent the recurrence of the injury.
Effective treatment includes:
- Rest: Allowing time for the affected muscles and bones to heal is crucial.
- Ice: Applying ice to the shin can help reduce pain and inflammation.
- Pain Relief Medication: Over-the-counter pain relievers can be used to alleviate discomfort. (5)
- Physical Therapy: A physiotherapist can recommend exercises to strengthen the lower leg muscles and improve flexibility.
- Proper Footwear: Switching to shoes that offer better support and cushioning can help.
- Activity Modification: Reducing the intensity or frequency of high-impact activities until the shin heals is essential.
In more severe cases, or if the pain persists, a healthcare professional may recommend additional treatments or investigate other potential causes of the pain.
Preventing Shin Splints: Tips and Techniques
The best approach to managing MTSS is to prevent them from occurring in the first place. This involves understanding your body’s limits, gradually building up exercise intensity, and paying attention to pain signals. Prevention tips include:
- Gradual Increase in Exercise Intensity: Avoid sudden spikes in workout intensity or duration. Gradually increase your exercise load to give your body time to adapt.
- Proper Warm-Up and Cool-Down Routines: Engaging in proper warm-up exercises before and cool-down exercises after physical activities can help prepare your muscles and reduce the risk of injury.
- Appropriate Footwear: Wear shoes that are suited to your activity and provide adequate support and cushioning. Replace them regularly to ensure they maintain their supportive properties.
- Cross-Training: Incorporate low-impact activities like swimming or cycling into your routine to give your shins a break from high-impact stresses.
- Strengthening and Flexibility Exercises: Regularly perform exercises to strengthen the muscles of the lower leg and improve overall flexibility.’
By incorporating these preventative strategies into your routine, you can significantly reduce the risk of developing shin splints, ensuring a more enjoyable and sustainable exercise regimen. (6)
Consulting a Professional: Shin Splints Guidance
Consulting a professional when experiencing symptoms of medial tibial stress syndrome is crucial for a multitude of reasons. Firstly, a healthcare professional is equipped to accurately diagnose the cause of your pain. It’s important to determine whether the discomfort is indeed due to shin splints or another condition.
Moreover, professionals are adept at crafting personalized treatment plans that are specifically tailored to the severity and particularities of your condition. This bespoke approach ensures that the treatment you receive is most effective for your unique situation.
If you think you might be currently suffering from MTSS don’t keep trying to ignore and push through the pain. Take care of yourself and book in to see one of the physiotherapists here at Coast Sport to help guide and support you through your recovery back to sport.
References
- Healthdirect Australia. Healthdirect.gov.au
- Cleveland Clinic” Cleveland Clinic
- Mayo Clinic. Diagnosis and Treatment.” Mayo Clinic
- American Academy of Orthopaedic Surgeons. “Symptoms.” OrthoInfo
- Mayo Clinic. “Treatment.” Mayo Clinic
- American Academy of Orthopaedic Surgeons.”Prevention.” OrthoInfo
Helping the Central Coast Feel Well, Move Well and Perform Well!