Shin Splints account for ~16% of injuries among runners

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Tuesday, 03 November 2015 825 Views 0 Comments
Shin Splints account for ~16% of injuries among runners

By Shailja Kaushik

Research studies indicate that shin splints account for 6-16% of injuries among runners[i] and it is also the most common cause of disabling leg pain in young competitive athletes[ii].

What are shin splints?

Shin splints are defined as the inflammation of the front part of the lower leg that causes mild to extreme pain. According to the book Standard Nomenclature of Athletic Injuries, published in 1966 by the American Medical Association (AMA) Committee of the Medical Aspect of Sports, Subcommittee on Classification of Sports Injuries, shin splints are defined as, ‘Pain and discomfort in the leg from repetitive running on hard surface or forcible excessive use of the foot flexors. The diagnosis should be limited to musculoskeletal inflammation, excluding stress fractures or ischemic disorders.’[iii]

Generally speaking, shin splints start as a dull and aching pain during a physical activity. If the pain is ignored and the physical activity is continued at the same pace, then it gradually worsens, forcing the person to stop the exercise or workout altogether.

Causes

Shin splints usually occur as a result of a strenuous activity that puts excessive pressure or impact on the muscles of the lower leg. This pressure or impact causes injury to the connective tissues that attach the muscles to the bone. The excessive pressure or impact may be a result of the following:

  • Sudden increase in the distance and speed while running
  • Running on hard surfaces
  • Running on uneven terrain such as hills
  • Having flat feet or high arches
  • Weak ankle muscles
  • Wearing poorly fitted shoes that do not give proper support to your feet
  • Inadequate warm up
  • Stress fractures
  • Irritation of the muscles
  • Mal alignment of the legs.

Symptoms

In the book Essentials of Physical Medicine and Rehabilitation, the symptoms of shin splints are said to be bilateral i.e. they appear when a person exercises and subside on resting.[iv] At first, the pain may disappear with continued physical activity but it may reappear after extended periods of activity. In severe cases of shin splints, the person may experience chronic pain even during normal walks, daily chores and even at rest.

Some common symptoms of shin splints are as follows:

  • Pain in the lower leg
  • Mild swelling in the lower leg
  • Tenderness or soreness along the outer edge of the lower leg
  • Feeling of numbness in the feet.

Prevention

The following prevention strategies are made in the research paper, The prevention of shin splints in sports: a systematic review of literature published in the monthly journal of Medicine and Science in Sports and Exercise[v]:

  • Prior screening for anatomical risks such as hyperpronation
  • Warm up exercises
  • Stretching
  • A nutritious and adequate diet
  • Good running technique
  • Conditioning training to promote balanced muscle development
  • Avoiding over-stressing
  • Wearing appropriate shoes
  • Use of shock-absorbent orthoses
  • Adaptation to physical factors such as heat or wet surfaces, as a result of rain
  • Rehabilitation for previous injuries
  • Minimizing running on hard surfaces
  • Maintaining healthy weight.

Treatment

The treatment for shin splints involves four simple strategies – reduction of pain and inflammation, identification of training and biomechanical problems (if any), restoration of muscles to their original condition, and gradual adaptation to the training or workout.

In the book Prevention and Treatment of Sports Injuries (Pinnacle Technology, 2011), author Rajeev Kumar, highlights the following treatment procedures:

  1. Rest. As soon as you experience the pain, you must stop the physical activity and take rest to allow the injury to heal and inflammation to subside. Usually, 2-6 weeks of rest is suggested. After rest, gradually return to training and avoid errors or excesses that may provoke the condition. During rest, you should maintain cardiovascular fitness through other activities such as swimming or cycling.
  2. Cryotherapy or Ice Compression can be applied in the early stages to reduce the pain and inflammation. It is usually done before and after exercise for a period of 20 minutes.
  3. Stretching and strengthening of the leg muscles also helps to cope with the fatigue of muscles and bones. It also increases the shock absorption capacity of muscles.
  4. Use of orthotic devices is recommended to support the abnormal leg muscles or to correct any other biomechanical defect.
  5. Non-steroid Anti-inflammatory Drugs (NSAIDs) may be prescribed by doctors to decrease inflammation and relieve pain.
  6. Surgery is advised, if conservative methods of treatment fails.

If the pain persists, doctors recommend an X-ray to rule out any stress fracture. Medication should be taken only when prescribed by the doctor. In most cases of shin splints, conservative treatment will help overcome to condition. In extreme cases surgical methods are introduced to alleviate the symptoms.[vi]

References 

[i]  Krissoff, W.B. and Ferris, W.D. Runners Injuries. Physician SportsMed. 1979.
[ii]  Jackson, D. W and Matz, S. O. Prevention of Running Injuries. Journal of Musculoskeletal Medicine.  1986.
[iii] Mark, F. Reinking. Exercise Related Leg Pain (ERLP): A Review of the Literature. North American Journal of Sports Physical Therapy
[iv] Walter R. Frontera; Julie K. Silver; Rizzo D. Thomas. Essentials of Physical Medicine and Rehabilitation. Elsevier Health Sciences. 2014.
[v] Stephen B. Thacker; Julie Gilchrist; Donna F. Stroup, and C. Dexter Kimsey. The prevention of shin splints in sports: a systematic review of literature. Medicine and Science in Sports and Exercise. 2002.
[vi] Galbraith RM, Lavalee ME (2009). ‘Medial Tibial Stress Syndrome: Conservative Treatment Options’, Current Reviews in Musculoskeletal Medicine

(Dr. Rohan Habbu is an Orthopedic Hand, Nerve & upper Extremity Surgeon. He has done Fellowship in Arthroscopy & Sports Surgery and is an avid runner. To know more, reach out to him on rohanhabbu@gmail.com or +91 982017 13941)

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