Shin Splints

By DR. DAVID R. SCHMIDT

San Antonio Spurs, NBA

Shin splints is a general term for any pain that exists between the knee and the ankle. The classic cause of shin splints is periostitis, an inflammation of the layer of tissue over the shin bone to which the muscle attaches. The constant pull of the muscle on the periostium causes the muscle to become inflamed.

Shin splints or shin pain can also be caused by tendinitis, or can be the result of a stress reaction or stress fracture. In addition, there can be compartment syndrome, where the leg muscle gets swollen and too big for the compartment encasing the muscle.

Usually, shin splints are a pure overuse syndrome, but it is important to remember that overuse is determined relative to each individual’s fitness level. Abrupt changes in an athlete’s baseline activity level are the primary causes of shin splints.

Training errors are also responsible for shin splints. When adding new exercises to a training schedule, athletes may continue expending the same amount of effort. If the new exercises use the lower leg in a different way, shin splints may occur.

For example, an athlete may have been running 30 miles a week for the last two months. When he adds sprints or hill training to his regimen, he suffers shin splints. During training, a change in athletic footwear can also cause pain in the lower leg.

SYMPTOMS

The classic symptom is the familiar pain along the inside of the tibia (shin bone about halfway down the leg. The lower leg muscles feel tender and burn with the sensation that the muscles have separated from the bone.

The recreational athlete needs to take care not to confuse shin splints with stress fractures. If there is persistent pain that worsens with weight-bearing activity, a doctor should be consulted.

TREATMENT

A doctor can differentiate between shin splints and stress fractures by feeling the tibia where the bone is right under the skin. If there is a lot of tenderness in the bone itself, but not along the back edge of the muscle, it may be a stress fracture. Shin splints are usually in the back, where the muscle is near the edge of the bone.

An x-ray will usually be performed with the understanding that stress fractures may not show up for the first two or three weeks. After resting the leg for a few days, if exercise causes the pain to return, athletes may consider having a bone scan. The bone scan is a nuclear-medicine study that is more sensitive in detecting early stress fractures.

PREVENTION

The biggest mistake people make is training errors. They want to get fit, so they go out and run three miles a day and they feel good. The next week they want to run four miles a day and the week after that they want to go five miles a day. That is too rapid an increase. A good rule of thumb is to increase your activity time by no more than 10 to 15 percent per week. If you are running 20 minutes a day, the next week go to 22 minutes, not 30.

If a minor leg pain develops, try some activity modification or cross-training. Get on the bike, a cross-country skiing machine, or an eccentric walker. If the pain persists with activity modification, try some non-steroidal anti-inflammatory medication such as ibuprofen. If symptoms persist, icing after activities is very important as well.

Probably the best treatment is prevention and rest. Make sure to do a comprehensive lower-extremity stretching program before and after activity. Bob Anderson's book, Stretching, is a great resource for illustrating different stretches for different activities.

The information, including opinions and recommendations, contained in the Web site is for general educational purposes only. Such information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. No one should act upon any information on this Web site without first seeking medical advice from a qualified medical physician with whom they have a confidential doctor/patient relationship.

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