Shin Splint
Definition:
Shin splints occur when the muscles and bones in the lower part of the leg pull and tug at their insertion on the shin bone (the tibia) and it becomes inflamed (irritated and swollen) and painful. It commonly affects runners (13.6% to 20%) and other athletes who engage in strenuous weight-bearing exercises, such as jumpers. It is an early stress injury in the progression of tibial stress fractures and manifests as exercise-induced discomfort over the anterior tibia. Doctors sometimes call shin splints medial tibial stress syndrome, which is a more accurate name.
Shin splints are a very common overuse injury. With rest and ice, most people recover from shin splints without any long-term health problems. However, if left untreated, shin splints do have the potential to develop into a tibial stress fracture.
Types of shin splints:
- Medial tibial stress syndrome: The most frequent kind of shin splint, it involves discomfort along the lowest two-thirds of the inside border of the shinbone. An inflammation of the muscles, tendons, and bone tissue around the shinbone is known as medial tibial stress syndrome. Where the muscle connects the shinbone, is where the strain is coming from. Running makes it worse, and stopping within hours makes it better.
- Stress fracture: A stress fracture is painful in one specific place in the shinbone. The pain is worse when you stand up or exercise, and it takes a while to improve afterward. It is caused by muscle pulling on the shinbone, eventually causing the bone to crack.
- Other conditions such as tendonitis and compartment syndrome can also cause symptoms like shin splints.
Pathophysiology:
The pathophysiologic process of shin splints is related to unrepaired micro traumas occurring to the distal part of the tibia, but this hasn’t been proven yet. We have two theories:
- According to bone scintigraphy results showing a broad linear band of elevated uptake throughout the medial tibial periosteum, the discomfort is related to periosteal inflammation caused by severe pressure on the tibialis posterior or soleus. However, a case-controlled ultrasonography investigation comparing athletes with and without medial tibial stress syndrome in terms of periosteal and tendinous edema revealed no differences between the two groups.
- Bony overload injury, with microdamage and focused remodeling as a consequence. This notion received only inconclusive support from a research that examined tibia biopsy samples taken from the sore region in six athletes with medial tibial stress syndrome. Only three specimens had linear microcracks, and there was no related repair response.
Other causes of shin splints:
Shin splints are caused by overuse of lower leg muscles and bone tissue. This can be due to:
- a sudden increase in the amount or intensity of exercise
- the ankle joint rolling inwards too far as the running foot hits the ground (over-pronation) — this is more common in people with fallen arches or flat feet
- tightness of calf muscles
- running on sloping, uneven or hard surfaces
- using unsupportive footwear
Osteoporosis and smoking also make shin splints more likely.
Symptoms of shin splints:
The main symptom is pain in the front of the lower leg and in the muscles on either side of the shin bone. The pain is there both during exercise and at rest.
How is shin splint diagnosed?
There are many key points that will lead to diagnosis shin splints, which are:
- History:
- Pain increasing in activity and is basically located on the medial tibial border in the middle and lower third
- Pain persists for hours or days after cessation of activity
- Pain decreases with running (early stage)
- Differentiate from exertional compartment syndrome, for which pain increases with running
- Earlier onset of pain with more frequent training (later stages)
- Physical examination:
- Intensive tenderness of the involved medial tibial border, more than 5 cm
- Pes planus
- Tight Achilles tendon
- A “one-leg hop test” is a functional test, that can be used to distinguish between medial tibial stress syndrome and a stress fracture: a patient with medial tibial stress syndrome can hop at least 10 times on the affected leg where a patient with a stress fracture cannot hop without severe pain. The sensitivity of the hop test for diagnosing medial tibial stress fracture when pain and tenderness were present was 100%, the specificity 45%, the positive predictive value 74%, and the negative predictive value 100%
- Provocative test: pain on resisted plantar flexion.
- Imaging: X-Ray, bone scan, MRI, or CT scan.
Management:
The treatment of shin splint is conservative and focuses on rest and changing one’s activities to involve less frequent, load-bearing exercise. There are no set guidelines for how long to rest in order to get rid of symptoms, and it will probably vary depending on the person.
Physical therapy management:
- Acute phase:
2 to 6 weeks of rest and medication are needed to improve the symptoms and to safely come back to activity. Medication usually consists of NSAIDs and Acetaminophen. A number of physical therapy techniques can be used during the acute period, although their efficacy has not been shown. Examples include ultrasound, soft tissue mobilization, and electrical stimulation. A corticoid injection is not advised since it can make you feel worse. For the reason that the healthy tissue is also treated. A corticoid injection is used to lessen the discomfort, but only when rest is also taken. Prolonged rest is not recommended for athletes.
- Subacute phase:
-The aim of the treatment in this stage is to modify and adjust training intensity, frequency, and running distances by decreasing it by 50%. Avoiding hills and uneven surfaces is usually recommended during this phase.
-The patient can engage in low-impact and cross-training activities throughout the recovery process (like running on a hydro-gym machine). As long as they are pain-free, athletes can gradually increase their training volume and intensity after a few weeks. They can also incorporate hill running and other exercises that are specialized to their sport.
– A stretching and strengthening program (eccentric) for the calf, hips, and core. Developing core stability with strong abdominal, gluteal, and hip muscles can improve running mechanics and prevent lower-extremity overuse injuries
– Training in proprioceptive balance is essential for neuromuscular education. A one-legged stand or balancing board can be used for this. Enhancing proprioception can assist the body respond to irregularities in the running surface, boost the effectiveness of the muscles that stabilize joints and posture, and help avoid re-injury.
-Good shoe choice is essential and the client should be aware of its importance.
-Manual therapy can be used and to control and modify postural problems that could prevent the recurrence of the problem.
