What are shin splints?

The phrase "shin splint" is a generic term used to describe pain in the lower leg, either on the medial (inside) or lateral (outside) side of the shin bone. Technically, that pain can be caused by a number of conditions, such as tendonitis, a stress fracture, or periostitis (inflammation of the membrane covering the bone). Considering that the placement, causes, and treatment of these injuries are often the same, the term "shin splint" became a simple way to label the injury.

Shin splints almost always occur in sports involving running or jumping, such as jogging, dancing, gymnastics, etc. Contrary to popular belief, they do not always represent a “stress fracture” of the shin bone (tibia), although stress fractures can be one of the reasons for lower leg pain.    


What are the symptoms?

The pain begins as a dull ache along the tibia (lower leg).  It is not pinpointed to one spot (which may indicate a stress fracture) but along the border where muscle attaches to bone.

Many times discomfort is felt at the beginning of the workout, then disappears only to return after the workout is over.  As the injury progresses, the discomfort becomes more severe and lasts the entire workout.  Eventually the pain occurs more often, when getting out of bed and during other daily activities.


What causes shin splints?

• Change in the activity/exercise you are doing: Often people have a lot of enthusiasm when they start an exercise program and jump in too aggressively.  It is important to start any running or conditioning program at a gradual pace, allowing for adequate rest between workouts.
• Change in the intensity of the workout (i.e. longer distance, longer workout times): Overuse syndrome typically occurs when someone does too much too fast and continually strains the muscles of the lower leg.  For example, a runner who increases his mileage by more than 10 percent in one week, or who runs daily without alternating activities to rest the lower legs' muscles, would be a prime candidate for shin splints.
• The shoes you are wearing: Proper footwear can help alleviate problems.  Quality running and cross-training shoes are designed to give the best anatomical support.  It is important to make sure shoes have not broken down and are not too old. A lthough the soles and tops may appear fine, running shoes begin to lose their ability to control the rotation of your foot and absorb shock after 400-500 miles.
• The surface on which you exercise : Poor running surfaces are another common cause of shin splints.  The optimal surface for running and aerobics is one of a shock-absorbing nature, such as an all-purpose track or grassy surface. 
• Type of exercise you do: Running sprints on a track, running uphill, jumping, and repetitive impact exercises can all cause shin splints.
• You particular body type or "anatomy": Such factors as fallen arches (flat feet), knocked or internally rotated knees, very high arches and over rotation of the foot are all prime culprits in causing shin splints.  An orthopedic physician, athletic trainer or physical therapist can help identify mechanical problems and may prescribe orthotics as well as strengthening and stretching exercises.

What can be done to ease the pain of shin splints?*

• Active Rest. This is the first mode of treatment for all types of shin splints, no matter what the cause. "Active Rest" does not mean you must stop running or stop exercising. Rest should be active, relieving stress on the involved areas, yet maintaining conditioning.  Complete rest from activities may give temporary relief, but injuries are likely to resurface with resumed activity, especially if you are trying to make up for lost time.  Active rest activities include the elliptical trainer, stationary cycling, and swimming. Any sport not requiring the usual muscles of running or pushing off, and that doesn't require repetitive impact to the lower extremity, is fine. “Water running” is a very good way to rehab these injuries. Use a flotation device and run in the deep end of a pool. You can move to the shallow end, running on the bottom, as your pain begins to improve.
  
  
• Most people (with overuse injuries) make the mistake of quitting entirely for many weeks and then attempting the same distances that got them into trouble the first time. Remember, the human body is truly remarkable in its ability to adapt, BUT it prefers to adapt to gradual changes over time. Eventually with slow steady progress, your muscles, tendons and other soft tissues will adapt to the stresses you are asking of it.

• Ice. It can be very helpful during the acute phases of your pain. This is especially true of those shin splints with redness, localized tenderness or swelling. Use an ice massage, holding the cube in a washcloth and rubbing the swollen, sore area for 10 to 15 minutes. You can also make a special ice massage applicator by filling a small Dixie cup with water, freezing it, then tearing away the top 1/2" or so of the cup, giving you a place to hold the cube (the remaining bottom of the cup) and a nice, round, regular surface of ice to apply the massage. Frozen peas or corn (in a bag) can be useful for more general ice/cooling applications. Remember not to exceed 10 to 15 minutes each time, and always wrap any applied ice in a towel or washcloth (especially true of the gel-ice you can get at the store), as it is easy to cause burns and frostbite with overly vigorous application. You can repeat icing every few hours as needed.

• Stretching and strengthening the calf muscles. This can help prevent the injury or treat it once shin splints have developed. Here are some stretches you can do to target this area (hold each stretch for 10-15 seconds, repeating 2-3 times):
  

• Soleus stretch: Stand tall with one leg in front of the other, either unassisted with hands resting on the forward leg or pressing against a wall at shoulder height. Ease your back leg further away from the front leg, bend the back leg, and press the heel firmly into the floor. Keep your hips facing forward and the rear leg and spine in a straight line. You will feel the stretch in the lower one third of the rear leg. Repeat for the other leg.

• Gastrocnemius stretch: Stand tall with one leg in front of the other, either unassisted with hands resting on the forward leg or pressing against a wall at shoulder height. Ease your back leg further away from the front leg, keeping it straight (not locked) and press the heel firmly into the floor. Keep your hips facing forward and the rear leg and spine in a straight line. You will feel the stretch in the calf of the rear leg. Repeat for the other leg.

• Hamstring stretch: Standing, put one foot in front of the other, toes pointed up. With hands in the small of your back, bend the opposite knee and hip (not the lower back) until you feel the hamstrings stretch. The upper body comes forward at the hip. Head, neck and back stay in line. Repeat with the other leg.
  

*REMEMBER : These are general guidelines for self treatment of shin splints. The problem is that your body is unable to cope with the stress of exercise that you are placing on it. Be patient; it will take time, sometimes weeks or months, for the problem to resolve. Do not try to continue training through the pain, but stop when your body tells you to. If you are not improving with this home treatment, if you worsen significantly, or if the pain becomes a continuous discomfort (even at rest), return to be rechecked by your medical provider.

	Aerobic Exercise Strength Exercise Stretching Anaerobic Exercise Warm Up, Cool Down Exercise Intensity Body Composition

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