Shin Splints Treatment

The basic shin splints treatment is no different to most other soft tissue injuries. Previously, two different shin splints treatment 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. Most shin pain, although annoying, is minor and can be treated with the guidelines that follow. However, if the pain persists or recurs, see a doctor. Shin splints may develop into a stress fracture-a tiny chip or crack in the bone. Stress fractures won't go away on their own and, without treatment, may become serious. For proper understanding of shin splints treatment, we must know-

What are Shin Splints ?

Shin splints is a nonspecific term typically used to describe exertional leg pain. Although common in runners, this condition probably is overdiagnosed. The connective sheath attached to the muscles and bone of the lower leg become irritated, resulting in a razor-sharp pain in the lower leg along the inside of the tibia or shin bone. Pain can be felt anywhere from just below the knee down to the ankle. It usually develops after physical activity, such as vigorous exercise or sports. Repetitive activity leads to inflammation of the muscles, tendons, and periosteum (thin layer of tissue covering a bone) of the tibia, causing pain. The bone tissue itself is also involved. The condition is also referred as

• Medial Tibial Stress Syndrome (MTSS)
• Medial Tibial Traction Periostitis
• Medial Tibial Periostitis

Relevant Anatomy

The leg bones (tibia and fibula) serve as the origin for the extrinsic muscles of the foot and ankle. The muscles of the leg are surrounded and divided by the crural fascia. The resulting compartments (anterior, lateral, superficial, posterior and deep posterior) are unyielding with regard to volume and are prone to develop increased pressure. The anterior compartment contains the extensor muscles, including theanterior tibial, the extensor digitorum longus, and the extensor hallucis longus muscles. The posterior medial tibia serves as the origin for the posterior tibial muscle, the flexor digitorum longus muscle, the soleus muscle, and the deep crural fascia.

Etiology

Anterior shin splint are related to dysfunction of the anterior leg compartment or its contiguous structures. Medial tibial stress syndrome is the clinical entity that most likely represents medial shin splints. The exercise induced pain associated with medial tibial stress syndrome tends to involve the distal two thirds of the leg. The etiology of anterior shin splints is not completely understood; overuse or chronic injury of the anterior compartment muscles, fascia, and bony and periosteal attachments is most commonly implicated. The most common cause of medial tibial stress syndrome is a traction periostitis of the soleus or flexor digitorum longusmuscle origins.

Possible causes include:

• Flatfeet (pronated) or abnormally rigid arches.
• A sudden increase in running speed.
• A sudden change from soft to hard running surfaces.
• Running in worn down shoes.
• Tight Achilles and calf muscles.
• An inexperienced runner just beginning to run.
• Running on uneven terrain.
• Excessive uphill running.
• Poor running mechanics which include excessive forward lean, excessive weight on the ball of the foot, running with toes pointed outward, landing too far back on the heels causing the foot to flap down, and overpronation.

Symptoms

It cause pain in the front of the outer leg below the knee. The pain is characteristically located on the outer edge of the mid region of the leg next to the shin bone (tibia). An area of discomfort measuring 4-6 inches (10-15 cm) in length is frequently present. Pain is often noted at the early portion of the workout, then lessens only to reappear near the end of the training session. Shin splint discomfort is often described as dull at first. However, with continuing trauma, the pain can become so extreme as to cause the athlete to stop workouts altogether.

Diagnosis

A diagnosis of shin splints is suggested by a history of exercise induced pain at the distal two thirds of the leg. The pain is localized to the anterior compartment in anterior shin splints and to the distal two thirds of the posterior medial tibial border in medial tibial stress syndrome. There is exercise induced leg pain which is relieved by decreased activity. The condition is never associated with vascular or neurologic symptoms or findings.

On examination, patients with medial tibial stress syndrome will often be tender over this same part of the tibia. Patients may or may not have a small amount of detectible swelling over this part of the tibia. Some specific maneuvers, especially resisted plantar flexion (pushing down of the foot against resistance), typically causes an increase of symptoms.

In order to determine the underlying cause of the MTSS your physician may order anx-ray or a bone scan. The x-ray can detect fractures, and occasionally detect long-standing stress fractures. The bone scan will detect areas of high bone turnover; these ‘hot’ areas indicate possible stress fractures or other bone problems. Early and correct diagnosis helps in prompt shin splints treatment.

Differential Diagnosis

• Tibial stress fracture- Exertional pain at tibia; point tender tibia; pain with three-point stress; abnormal radiograph, fusiform uptake on bone scan, abnormal CT or MRI.
• Fibular stress fracture- Exertional pain at fibula; pronation or valgus alignment; point-tender fibula; abnormal radiograph, bone scan, CT or MRI.
• Acute compartment syndrome- Leg pain secondary to trauma, tender compartments, pain with passive movements, decreased sensations, elevated compartment pressure, paresthesias.
• Chronic exertional compartment syndrome- Exertional leg pain, no acute trauma, tender compartments, decreased sensation after exertion, elevated post exertion compartment pressures, paresthesias.
• Congenital anomaly- Exertional leg pain, no acute trauma, anomalous muscle such as accessory soleus, symptoms similar to chronic exertional compartment syndrome, accessory muscle identified on MRI.
• Tumor- Night pain, abnormal radiograph, bone scan, CT or MRI.

Shin Splints Treatment

Acute exertional pain associated with MTSS is treated with RICE regimen until symptoms subside. Increasing rest intervals and duration are also beneficial to both types of shin splints. Running is prohibited until the patient is pain free.

Anterior shin splints treatment with aggressive warm up and stretching, with particular attention to the gastrosoleus-Achilles tendon complex. Anterior symptoms may also respond to decreased shoe weight and level running surfaces.

Medial tibial stress syndrome is treated in similar fashion with anti pronation taping and orthotics and running on a non banked, firm surface. Stretching and flexibility is emphasized throughout rehabilitation program.

Surgery is never indicated for anterior shin splints treatment. For recalcitrant medial tibial stress syndrome, deep posterior compartment fasciotomy and release of the soleus musle origin off the posterior medial tibial cortex have been suggested.

0-3 Days: Acute stage shin splints treatment

• Relative rest, ice massage and whirlpool.
• Ultrasound therapy if no bony involvement.
• Isometrics.
• Seated towel scrunches.
• Cycling
• Water activities (deep water running).
• Gastrocnemius and soleus stretching.
• Massage

Day 4-Week 6: Subacute stage shin splints treatment

This stage begins with resolution of weight bearing pain and ends with resolution of activity related pain.

• Modalities to decrease inflammation are continued.
• Emphasis remains on increasing flexibility.
• Theraband exercises.
• Towel scrunches progressed from seated to standing position.
• Balance training are begun with progression of difficulty.
• Aerobic fitness is maintained with cross training activities such as slideboard, water running and cycling.

Week 7: Return to Sport stage shin splints treatment

• Running started once pain has resolved.
• Warm up and stretching.
• Patients are to initially avoid running on uneven surfaces.
• Attention is first directed to reestablishing distance, followed by speed.
• Antipronation orthotics for patient with MTSS or low dye taping.

Return from Shin Splints Treatment to sports physical therapy

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