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Injury Related Topics

Shin Splints - What are they?

by

Andrew T. Spence MED, ATC, CSCS
Bassett Healthcare Sports Medicine

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Figure 1. The anterior view of the lower leg

Imagine this scenario: The winter season is in full swing, you are playing basketball, running track, or playing volleyball and all of a sudden you start getting pain in your shins. You may ask how does this happen? Every year you get the same pain in the beginning of your season or possibly during it. Shin pain is very common in athletes and they occur in just about any sport. The condition is commonly known as shin splints. The term addresses many conditions associated with the lower leg. Typically, traditional shin splints are an inflammation of the posterior tibialis. This muscle runs along the medial or inside aspect of the lower leg right next to the tibia or shin bone. When it becomes inflamed, it will yield pain specifically on and around that area and can extend down to the ankle.

How do shin splints happen? Shin splints are usually an overuse injury that occurs over time. What that means is as the muscle contracts it becomes inflamed. And as the athlete begins to train he or she is repeatedly contracting the muscles in the lower leg including the posterior tibialis. Over time this can cause shin splints. As the condition progresses, pain will intensify and stay with the athlete for a longer period of time. Normally with posterior tibialis tendonitis, the athlete will have pain at the beginning of practice, but will subside as the practice or game continues. As the condition worsens so to will the pain. In this case, the pain will continue through and after the practice or game. When this occurs, the athlete may develop a stress fracture in the tibia that will likely cause the athlete to be sidelined for upwards of six weeks.

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Figure 2. The posterior tibialis muscle runs along the tibia on the inside of the lower leg. Pain will often be felt along the line drawn with shin splints.

This doesn't happen only to an athlete who just started training. It can happen to those who just finished their season. Oftentimes, an athlete who just finished a fall season will complain of shin splints at the beginning of the winter season. This can happen for a couple of reasons. Sometimes the training surface plays a role. A soccer athlete who has been training on grass all season now enters a gym type floor. This surface, combined with different shoes used in training, places additional forces on the muscles of the lower leg. As a result, the posterior tibialis once again may become overstrained. Another cause of shin splints for the athlete who is already in shape involves the demand of the sport. Let's say you are playing basketball now and were playing field hockey in the fall. The demand of these two sports may place additional stress or strain on the lower leg. If we look at basketball, there is a lot more sprinting and change of directions with greater intensity. In field hockey, the athlete tends to run a little longer during certain times of the game or practice. This change in sport demand could place different stresses on the lower leg that could result in shin splints.

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Figure 3. One of many exercises in shin splint rehabilitation.

Now that we have some basic information on posterior tibialis tendonitis, what can be done? Typically, icing the injury is a treatment of choice. But ice will only go so far. Ice will help with the pain and inflammation, but what really needs to be done is to rehabilitate the injury. By consistently performing exercises of the lower leg and foot, it will help with obtaining and maintaining strength in these muscles. Additionally, it is important to begin a season with the appropriate level of conditioning. Make sure you are training ahead of time for your sport. The training should not only involve cardiovascular training, but should involve specific elements of the sport, such as sprinting, changing directions, jumping, etc. The specific elements are the functional aspects of the sport that will help you to adapt to the game a little easier than if not done. If the above advice is not working, it is important to see an orthopedist, especially if the condition worsens. This could be the beginning of the breakdown of the tibia, which could lead to a stress fracture. At this stage the orthopedist may recommend the athlete get fitted for orthotics. Orthotics are inserts that are placed in the shoes of the athlete. The purpose of these is to help support the foot and reduce the amount of stress that is placed on the tibialis posterior. Orthotics can be custom-made or prefabricated by a certified orthotist.

As you have just learned, shin splints are very common and can be very problematic for an athlete. The best defense is to assure good conditioning prior to the beginning of the season and if you develop shin pain, early rehabilitation with lots of ice. Don't let shin splints ruin your season. Prevent them before they start. With a little planning and training, you can help to avoid this painful condition.

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