Background & Etiology
Shin splints is a term used to describe pain along the front of the leg. This is an overuse injury, caused by the pounding of the feet on the ground. The downward pressure of the leg puts stress on the tibia and surrounding muscles (soleus, flexor digitorum longus, and deep crural fascia muscles,) which can then become inflamed causing pain.
Many athletes will try to push through the pain, but continuing to exercise when experiencing an inflammation can worsen pain, and can lead to extreme conditions where stress fractures of the tibia occur.
Shin splints are an overuse injury, common causes of this condition include:
- Medial Tibial Stress Syndrome (MTSS)
- Sudden increase in the frequency of athletic training
- Inadequate footwear
- Changing the surface on which an individual runs or trains to a harder substance like wood, concrete or even the naturally hard ground
- Underlying conditions of the leg including tendinitis, tibial perisostitis or compartment syndrome
- Biomechanical problems, like flat feet
- Pain along the front of the lower leg
- Inflammation or swelling of the lower leg
- Pain that does not subside when the leg is no longer in use
If an individual suspects they have Shin Splints, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that would include rest and immobilization, ice, physical therapy and non-steroidal medications to reduce inflammation.
If symptoms persist, treatment by your physician may be necessary. In severe cases surgical intervention may be needed to correct any mechanical or underlying causes of the shin splints.
Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Shin Splints include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage and joint mobilization by a physical therapist to regain mobility and range of motion of the leg.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the leg and effected muscle.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity, and improve movement technique and mechanics (for example, running or kicking activities) in daily use of the involved lower extremity.
- Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the leg and muscles.
- Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
Procedures that your physician may recommend and perform in addition to physical therapy that include:
- REST and ICE
- The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
- Steroidal injections to reduce inflammation
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
- Surgery to correct underlying pathology or the cause of the muscle inflammation
Prognosis
Most people recover full function following a course of conservative care that includes physical therapy, medication and/or injections. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of Shin Splints.
