DESCRIPTION

Pain along the leg bone or shin is frequently described as shin splints. This pain is most commonly found along the inside of the lower leg. Technically, shin splints are a condition called periostitis (inflammation of the lining of the bone). This inflammation is created by overuse of the muscles of the lower leg. This can occur with either the anterior tibialis muscle on the front of the leg or more commonly the posterior tibialis on the posterior/medial part of the lower leg. Due to the repetitive contractions of the leg muscles during activity a stress is placed on the lining of the bones where the muscles originate. This eventually develops into the inflammation of the periosteum (bone lining). This condition is almost always associated with a change in activity level and many overuse type activities, such as running and other forms of exercise, will over stress the attachments of the muscles leading to the development of shin splints. This condition is very common with athletes at the start of a season as they begin the rigors of conditioning for their sport. Since the shin splint pain is caused by overuse of the posterior tibial muscle it is worsened by having an over-pronated foot. The posterior tibialis works extra hard in people with flat feet as it is the muscle that lowers the foot to the ground and the foot travels a greater distance into pronation to get to the ground when you are flat footed. This overloads the posterior tibialis and can result in a greater likelihood of developing shin splints. Other factors which influence the development of shin splints include tightness in the posterior muscles, hard surface running, striking only on the balls of the feet (toe running) without the normal heel contact, rapid increase of speed or distance, or very frequently running in worn broken down or improper shoes. Shin splints usually begin as a dull aching pain in the front or inside of the lower leg after prolonged walking, running, or jumping. If left untreated, the pain becomes sharp and intense with all weight-bearing activities. Rest generally relieves the pain. If an athlete continues to “push” themselves while having this pain there is a possibility they will develop a stress fracture of the tibia.

TREATMENT

The best treatment for shin splints is prevention! Once the periosteum is inflamed the condition is very difficult to get rid of, particularly during an athletic season. Gradually increasing the speed and mileage at the start of a season is essential. Staying in shape pre-season helps greatly. Having the proper shoe for your foot type is absolutely essential. Runners often have the impression that they need more cushioning when they have shin splints but the opposite is true. Typically more cushioned shoes cause the foot to pronate further and actually increase the workload on the posterior tibialis muscle. Stability shoes or motion control shoes with features to reduce pronation are the “first line of defense” and can significantly cut down on development of shin splints. If you do develop shin splints you may need to completely rest and avoid overuse of the involved muscle until the inflammation is gone and then gradually resume activity. Custom molded foot orthotics can be made to reduce the over-pronation and are quite helpful in most cases. Physical Therapy modalities to reduce the inflammation will speed up the healing and help the pain. Ice, ice, ice. Stretching your posterior leg muscles (hamstrings, gastrocs, soleus) and massage may be helpful. You may benefit from use of anti-inflammatory medicines (aspirin, naproxen, or ibuprofen, not acetomenophen, to reduce inflammation and relieve pain). Avoid hills and hard running surfaces.