What Are Shin Splints?
The condition known as shin splints is referred to in formal medical jargon as MTSS, standing for medial tibial stress syndrome. Shin splints basically consist of stress fractures in the middle part of the tibia, one of the bones located in the lower leg (the tibia is the bone containing the area commonly referred to as the shin). Since the tibia is the bone that bears our weight when standing, it is susceptible to such stress fractures.
Shin splints causes patients who suffer from it a great deal of pain. This pain is the result of muscle irritation. The muscles surrounding the tibia are over stressed in cases when impact of the foot against a hard surface causes the arch of the foot to fall. Muscles and tendons both will be stretched beyond the comfort zone when this happens.
Any of the muscles surrounding the tibia may be involved in this pain, including the soleus, flexor digitorum longus, and deep crural fascia.
Symptoms of Shin Splints or MTSS
The primary symptom associated with shin splints is pain in the shin area, or the front of the lower leg. This pain is usually a dull ache rather than a violent tearing or ripping sensation. In some people, the pain occurs only while they are engaged in vigorous exercise, while others feel it continuously or only after exercise has ceased for a time.
Other symptoms may be present in addition to pain. These can include:
- inflammation, as when the area around the shin is painful to the touch
- weakness in the feet caused by swollen muscles compressing and / or irritating the nerves
- numbness in the feet caused by the same
The pain present in shin splints is often located in the front of the lower leg and seems to be generalized in location to the patient. However, sometimes patients can isolate the pain as occurring only along the sides of the shin bone (one side at times, but sometimes both). For some patients, the pain appears to be centered in the muscles in this area.
What Causes Shin Splints or MTSS
Shin splints have a variety of causes including all of the following:
- exercising without wearing appropriate footwear
- stress fractures
- compartment syndrome
- excessive high impact exercise (particularly when carried out with poor technique)
- anatomical problems including flat feet (pes planus) and pronation
- long periods of standing (particularly in high heeled shoes)
In addition, some factors are believed to contribute to the development of shin splints even though they are not directly linked causes of the condition. These factors include specific deficiencies of vitamins or minerals, as well as dehydration on the part of those engaged in heavy exercise. It also appears that shin splints are a more common occurrence in females than in males. It is not known, however, if there is a chromosomal or hormonal link to this correlation; the correlation may simply be due to the fact that women have smaller muscles on average than men, and hence the tissue becomes more easily over-stressed.
Tendinitis refers to tendon injuries accompanied by inflammation. Periostitis, on the other hand, refers to the inflammation of the layer of connective tissue, periosteum, surrounding bones, and is typically a chronic condition characterized by pain, tenderness, and swelling. A stress fracture is an incomplete fracture caused by repeated application of stress to a bone. Compartment syndrome is the death of tissue due to lack of oxygen as nerves, muscle tissue, and blood vessels are compressed inside a compartment (closed space) inside the body. It commonly occurs in the lower leg, as with shin splints, but can also occur in the forearm; compartment syndrome sometimes presents itself as a chronic condition. All of these conditions can lead to a patient suffering from the related condition of shin splints.
Diagnosis Options for Shin Splints or MTSS
Before treatment options can be considered, shin splints must be formally diagnosed. Diagnosis techniques can range from the simple to the complex depending on the exact situation involved. In some cases, a patient history along with a physical examination including the use of radiology (X-rays) to rule out stress fractures is sufficient to diagnose shin splints. Note that if stress fractures or compartment syndrome are also diagnosed, treatment will be significantly more serious than if shin splints are present without these other underlying conditions.
Some physicians prefer to use MRI (magnetic resonance imaging) to assist in the diagnosis of shin splints, but studies into this use of MRI return mixed messages. In some patients, MRI results appear to be normal when soft tissue injuries are present, but other studies have shown that stress injuries of the tibia, such as shin splints, are particularly well detected when using MRI scans. X-ray computed tomography, particularly the high resolution variety can also be of use when diagnosing shin splints; this technique commonly goes by the more typical appellation of “CT scan.”
Treatment Options for Shin Splints or MTSS
Once diagnosis has been confirmed, a physician will treat any underlying condition that may also have been detected. A stress fracture, for example, will require that the patient allow the limb to rest so that the bone can heal itself. Assuming that a stress fracture or other underlying condition such as compartment syndrome is not present, the initial treatment of shin splints will probably center on reducing the pain and inflammation of the soft tissues surrounding the tibia. Treatment options that fall into this category include:
- non-steroidal anti-inflammatory drugs
- changes in exercise routine
- specialty foot wear
- shoe inserts such as orthotics
A less commonly offered alternative to treat shin splints involves the use of low-energy extracorporeal shockwave therapy. This is a relatively new technique in the treatment of shin splints, but promising results for it have been reported recently in the American Journal of Sports Medicine.
Rest as a Treatment
Rest is a common approach to healing shin splints; regardless of the other treatment options recommended, patients will probably be advised to allow themselves to rest in conjunction with other therapies. Rest may be prescribed to last as little as two weeks or as long as a term of several months, depending on the severity of the shin splints themselves.
Using Ice as a Treatment
Ice used as a treatment therapy for MTSS or shin splints is used primarily as a way to reduce swelling and inflammation. As such, it is to be applied at intervals as per the physician’s instructions, but typically several times per day. Patients using ice therapies must be careful not to overdo them, as too much time spent in ice therapy can actually damage muscle tissue further. One would think that the pain of ice applied for too long would deter this, but some gung-ho ice enthusiasts have demonstrated that overuse of the therapy can be a real concern.
A typical schedule for ice application is to apply coldness to the affected skin area for 20 to 30 minutes, and then allow the skin and muscles three to four hours of recovery time before repeating the process. Two or three days of this treatment may be sufficient to significantly reduce pain, but a longer time span may be needed for some patients.
Sometimes in place of actual ice or ice packs, substitute products are used. These typically consist of gel packs that can be frozen and then applied to the affected areas. Because even when in a frozen state the gel can “mold” to the shape or contour of the leg, these gel packs may be more effective than the traditional water-based ice.
However, other substitutes for ice have serious drawbacks. Some of the literature will tell you that a cheap alternative for gel ice packs is simply to use a bag of frozen vegetables such as peas, which can also mold to some extent to the contour of the leg. This alternative is not recommended because as the frozen vegetables thaw, they release organic material. If the bag of vegetables leaks at all (as is common with the type of cheap plastic used to encase such vegetables), then organic liquid will be released onto the injured area. This can lead to nasty infections if any broken skin is present. It is best, therefore, to stick to ice or sterile (non-organic) gel packs rather than resort to the money-saving measure of treating with bags of frozen vegetables.
Non-steroidal Anti-inflammatory Drug Treatment Therapies
These drugs form an entire pharmacological class and are usually referred to by the abbreviation NSAIDs; sometimes they are also called analgesics. What NSAIDs have in common is that low doses of them have the effect of reducing pain and fever, while higher doses of them can reduce the incidence of inflammation in muscle tissue and tendons.
As non-steroidal drugs, they contain no steroid agents. This is an important distinction since steroids are known to also reduce inflammation, but are associated with serious side effects. NSAIDs are also known to be non habit forming (in other words, they are not narcotic). Since a great many pain-killing medicines, morphine among them, are highly addictive, this means that NSAIDs provide physicians with an option that is relatively safe compared to the other choices they have when prescribing anti-inflammatory analgesics (painkillers that reduce inflammation).
Common NSAIDS include all of the following medicines:
Another advantage these medications have, from the point of view of the patient, is that they are all available without a prescription and are furthermore available in generic formulations. This makes NSAIDS widely available and relatively inexpensive, particularly when compared to prescription only medications that are still under exclusive patent.
Because generics are available, these NSAIDs are marketed under a large variety of names. Aspirin may be labelled as such, or may go by the brand name Excedrin. Ibuprofen is also marketed as Motrin, and Naproxen may be sold under the brand name Aleve. When purchasing NSAIDs, look for the name and milligram dosage of the active ingredient in order to identify which name brand medications are using the same underlying chemical. In most cases, the best purchasing bargain is to choose the store brand of the NSAID. Walmart, for example, has a store brand known as Equate. Look for boxes marked Equate and then check the active ingredient to find an equivalent product for the more expensive nationally advertised name brand of a particular NSAID.
Because NSAIDs are available even without a prescription, they are possibly more likely to be abused than other painkilling drugs. Even though they are not habit forming, they are not without risks of their own. NSAIDs carry with them the risk of side effects including ulcers and increased risk of bleeding since they have the effect of thinning the blood. Therefore, limit your use of NSAIDs to the occasional unless you are under the care of a physician who has given you other instructions with regard to their use.
Physical Treatments for Shin Splints
Physiotherapy is also known as physical therapy and is commonly abbreviated as PT in the medical field. PT treatment in the case of shin splints will frequently include the use of range of motion exercises and stretching, as well as techniques to strengthen the muscles surrounding the shins.
Other physical treatments for shin splints or MTSS include the use of orthotics. These can be bought off the shelf and inserted into shoes to help with fallen arches or flat feet; in some cases orthotics can be custom made.