In a list of what’s in and what’s out in medical terminology, the term “Shin Splints” is out and medial tibial stress syndrome and stress fracture are in. In the past the term shin splints encompassed a variety of problems associated with the lower leg. These problems could be of muscular, bone, or a combination of both in origin. When people say they are having shin splints they are most likely referring to a pain that occurs along the anterior or medial part of the lower leg. This is now referred to as medial tibial stress syndrome (MTSS).
The people who are at the greatest risk for developing MTSS are beginning runners. These runners have not acclimated themselves to the stresses that are involved with running. They also may not be performing an adequate amount of stretching prior to their exercising. Other things that may increase their risk is being overweight, over training, and poor selection of shoe gear.
The usual mechanical factors that may lead to MTSS are an imbalance between the posterior and anterior muscle groups. The posterior muscles may be both too tight and too strong. The effect of the tight musculature has an impact on the gait cycle at two points. The first time that the posterior muscles have an impact on the anterior muscle group is just before and after heel contact. At this point the anterior muscles are trying to act as a decelerator of the foot and the posterior muscles are overpowering causing the anterior muscles to become overworked. The second point that the anterior muscles are overpowered is when the foot is leaving the ground at toe off. The anterior muscles are trying to lift the foot off the ground and allow the toes to clear the ground as the foot swings forward. It is these stresses that cause a repetitive inflammation in the muscle or at the attachment of the muscle to the bone. It is after this prolonged stress that a stress reaction or stress fracture may be seen radiographically on the bone.
Other factors that may cause MTSS are continual running on a hard surface, and a biomechanical abnormality in the foot such as excessive pronation.
The initial treatment for MTSS, prior to seeing a Physician, one should first decrease the amount of training. They should not run if pain occurs or if there is pain present after running. The goal is to find a distance that can be run, that does not produce any pain. Alternative exercise may also be used. Exercises like swimming, biking, or pool running can be used to maintain their fitness levels. An athlete should also perform stretching exercises before and after running. These stretches should put a gentle tension on the posterior muscles. The shoe gear should also be evaluated. The shoes should not have too many miles on them. The shoes should have adequate shock absorption as well as control the foot’s motion. Most of all, running on hard surfaces should be avoided. Icing immediately after exercise should also be done to control the inflammation present.
In the medical office the Physician will repeat some of the procedures that have been done. A thorough biomechanical evaluation should be performed with and evaluation of training schedule, training surface, and shoe gear being used. A physical will also most likely take x-rays to evaluate the bone structures. A bone scan may be used to evaluate for the possibility of a stress fracture.
Following the evaluation anti-inflammatory medications may be prescribed. The use of physical therapy modalities could also be beneficial. Custom molded foot orthotics would also be beneficial in controlling motion and absorbing shock.
In conclusion “Shin Splints” or MTSS are a common problem that many runners face. It is a problem that can be controlled and managed conservatively for most suffering from MTSS.