Shin Splints (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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What causes shin splints?
A primary culprit causing shin splints is a sudden increase in distance or intensity of a workout schedule. This increase in muscle work can be associated with inflammation of the lower leg muscles, those muscles used in lifting the foot (the motion during which the foot pivots toward the tibia). Such a situation can be aggravated by a tendency to pronate the foot (roll it excessively inward onto the arch).
Similarly, a tight Achilles tendon or weak ankle muscles are also often implicated in the development of shin splints.
How are shin splints diagnosed?
The diagnosis of shin splints is usually made during physical examination. It depends upon a careful review of the patient's history and a focused physical exam (on the examination of the shins and legs where local tenderness is noted).
Specialized (and costly) tests (for example, bone scans) are generally only necessary if the diagnosis is unclear. Radiology tests, such as X-rays, bone scan, or MRI scan, can be helpful in this setting to detect stress fracture of the tibia bone.
What is the treatment for shin splints?
Previously, two different treatment management strategies were used: total rest or a "run through it" approach. The total rest was often an unacceptable option to the athlete. The run through it approach was even worse. It often led to worsening of the injury and of the symptoms.
Currently, a multifaceted approach of relative rest is successfully utilized to restore the athlete to a pain-free level of competition.
What is the multifaceted relative rest approach?
The following steps are part of the multifaceted approach:
- Workouts such as stationary bicycling or pool running: These will allow maintenance of cardiovascular fitness.
- Application of ice packs reduces inflammation.
- Anti-inflammatory medications, such as ibuprofen (Advil/Motrin) or naproxen (Aleve/Naprosyn), are also a central part of rehabilitation.
- A 4-inch wide Ace bandage wrapped around the region or a Neoprene calf sleeve also helps to reduce discomfort.
- Calf and anterior (front of) leg stretching and strengthening address the biomechanical problems discussed above and reduce pain.
- Pay careful attention to selecting the correct running shoe based upon the foot type (flexible pronator vs. rigid supinator). This is extremely important. In selected cases, shoe inserts (orthotics) may be necessary.
- Stretching and strengthening exercises are done twice a day.
- Run only when symptoms have generally resolved (often about two weeks) and with several restrictions:
- A level and soft terrain is best.
- Distance is limited to 50% of that tolerated preinjury.
- Intensity (pace) is similarly cut by one-half.
- Over a three- to six-week period, a gradual increase in distance is allowed.
- Only then can a gradual increase in pace be attempted.
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