 |
 |
 |
 |
 |
The term “shin splints” is commonly used to describe leg pain or aches, but it specifically refers to
pain along the inner border of the tibia—the large bone of the leg. It usually occurs in novice or
poorly-conditioned runners, and the main treatment is rest. The exact cause of shin splints is
somewhat controversial because there are several different reasons for the pain to occur:
OVERUSE SYNDROME
Overuse of a muscle refers to stress or sprain of a muscle from too much exercise. The overuse
syndrome can also be caused by wearing inadequate shoes or by running on hard or sloped
surfaces. The basic postural problem producing this is pronation of the foot. Pronation is a medical
term which means outward tilting of the foot. People with flat feet or dropped arches have pronated
feet. Stretching the foot outward places increased pull on the muscles that run along the inner
border of the ankle and under the arch. These muscles originate along the inner side of the tibia.
The major muscle--the posterior tibial muscle--helps hold up the arch. As a result of pounding on the
arch and, thus, constant tugging on the muscle, the muscle belly is stretched and even torn away
from the bone. Pain and inflammation result.
The pain may initially occur after running. Persistent running with the injury will only aggravate it and
produce pain during activity and later with normal walking.
Treatment consists of rest and application of ice to the leg. Telling a serious runner to rest is about
as undesirable as suggesting that he purchase a bicycle, but, like it or not, rest is most important for
healing to occur. The period of rest may vary, but usually two to three weeks are required.
Once a runner has recovered, attempts are made to prevent future injuries. Firm, well-constructed
shoes with arch supports are recommended. The arch support helps tilt the foot inward and corrects
the pronation. If the standard supports in the shoes are not sufficient—and they may not be for
excessively pronated feet—custom-made inserts or orthotics should be obtained. I usually
recommend first trying less expensive standard inserts which can be purchased in any running store.
Changes in running environment from hard to softer surfaces, such as a track, and away from
uneven ground, will also help.
Also, I see many patients who have one leg that is around a ½ inch shorter than the other. It is a
minor discrepancy and frequently, we do not know why this occurred. However, it can cause
problems with the back, knees, or ankles. And it can also cause shin splints. The treatment is
simple—a shoe lift or insert for the shorter leg.
TIBIAL STRESS FRACTURE
Another cause of leg pain is a stress fracture of the tibia. This is a small crack or hairline fracture of
the bone. It occurs from the pressure of constant pounding. Localized pain results. The fracture
may not become evident on x-rays for several weeks and sometimes a bone scan is necessary to
make the diagnosis. The treatment is absolute rest from running until the fracture heals. A cast is
sometimes required, but in some instances, protection with crutches is sufficient.
COMPARTMENT SYNDROME
A third –and rare reason -- for shin splints is a “compartment syndrome.” Muscles are covered under
the skin by a tissue called fascia. An analogy is the encasement of a sausage. Muscles enlarge
when they are exercised, and in the leg, muscle expansion produces increased pressure in the
compartment. The muscles become too tight under the skin and swelling results. The nerves and
blood vessels adjacent to the muscles also become crowded and pinched, producing discomfort.
Treatment consists of rest and ankle exercises, but in severe cases, surgery may be necessary to slit
the fascial covering of the compartment and relieve pressure on the muscles. The surgery is fairly
simple and usually effective.
To conclude, proper conditioning is important because shin splints frequently occur during training or
in individuals who are unfit. Thus, increases in exercise and activities should be gradual. Proper
shoes and orthotics may prevent overuse syndromes, but they will have little effect on stress
fractures or compartment syndrome. And, finally, the importance of rest cannot be overemphasized.
pain along the inner border of the tibia—the large bone of the leg. It usually occurs in novice or
poorly-conditioned runners, and the main treatment is rest. The exact cause of shin splints is
somewhat controversial because there are several different reasons for the pain to occur:
OVERUSE SYNDROME
Overuse of a muscle refers to stress or sprain of a muscle from too much exercise. The overuse
syndrome can also be caused by wearing inadequate shoes or by running on hard or sloped
surfaces. The basic postural problem producing this is pronation of the foot. Pronation is a medical
term which means outward tilting of the foot. People with flat feet or dropped arches have pronated
feet. Stretching the foot outward places increased pull on the muscles that run along the inner
border of the ankle and under the arch. These muscles originate along the inner side of the tibia.
The major muscle--the posterior tibial muscle--helps hold up the arch. As a result of pounding on the
arch and, thus, constant tugging on the muscle, the muscle belly is stretched and even torn away
from the bone. Pain and inflammation result.
The pain may initially occur after running. Persistent running with the injury will only aggravate it and
produce pain during activity and later with normal walking.
Treatment consists of rest and application of ice to the leg. Telling a serious runner to rest is about
as undesirable as suggesting that he purchase a bicycle, but, like it or not, rest is most important for
healing to occur. The period of rest may vary, but usually two to three weeks are required.
Once a runner has recovered, attempts are made to prevent future injuries. Firm, well-constructed
shoes with arch supports are recommended. The arch support helps tilt the foot inward and corrects
the pronation. If the standard supports in the shoes are not sufficient—and they may not be for
excessively pronated feet—custom-made inserts or orthotics should be obtained. I usually
recommend first trying less expensive standard inserts which can be purchased in any running store.
Changes in running environment from hard to softer surfaces, such as a track, and away from
uneven ground, will also help.
Also, I see many patients who have one leg that is around a ½ inch shorter than the other. It is a
minor discrepancy and frequently, we do not know why this occurred. However, it can cause
problems with the back, knees, or ankles. And it can also cause shin splints. The treatment is
simple—a shoe lift or insert for the shorter leg.
TIBIAL STRESS FRACTURE
Another cause of leg pain is a stress fracture of the tibia. This is a small crack or hairline fracture of
the bone. It occurs from the pressure of constant pounding. Localized pain results. The fracture
may not become evident on x-rays for several weeks and sometimes a bone scan is necessary to
make the diagnosis. The treatment is absolute rest from running until the fracture heals. A cast is
sometimes required, but in some instances, protection with crutches is sufficient.
COMPARTMENT SYNDROME
A third –and rare reason -- for shin splints is a “compartment syndrome.” Muscles are covered under
the skin by a tissue called fascia. An analogy is the encasement of a sausage. Muscles enlarge
when they are exercised, and in the leg, muscle expansion produces increased pressure in the
compartment. The muscles become too tight under the skin and swelling results. The nerves and
blood vessels adjacent to the muscles also become crowded and pinched, producing discomfort.
Treatment consists of rest and ankle exercises, but in severe cases, surgery may be necessary to slit
the fascial covering of the compartment and relieve pressure on the muscles. The surgery is fairly
simple and usually effective.
To conclude, proper conditioning is important because shin splints frequently occur during training or
in individuals who are unfit. Thus, increases in exercise and activities should be gradual. Proper
shoes and orthotics may prevent overuse syndromes, but they will have little effect on stress
fractures or compartment syndrome. And, finally, the importance of rest cannot be overemphasized.
SHIN SPLINTS By Edward Staub, M.D. |
| The following medical articles are intended only for general patient information and education. They are not necessarily specific to any one patient's needs and, therefore, should not be construed as formal medical advice or treatment. Obviously, if you have a similar medical problem, you should consult a physician and not rely on these articles in lieu of treatment. If you reside in Dr. Staub's area, he will be delighted to accept you as a patient, but his ultimate opinion and recommendations will be based on his personal examination of you. |
| Edward Staub, M.D. drstaub.com |
Orthopaedic Surgeon, Sports Medicine, Knee, Hip, Shoulder, Ankle, Spine