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The Cause, and Solution to Shin Splints

Published: 13th May 2018. Last updated: 21th July 2019.

Shaun Ward MSc ANutr

Staff Writer


Introduction

Individuals who perform any activity that puts a repetitive strain on their legs are likely to develop, at some point in time, lower leg pain.

This is generally known as shin splints, or medically termed as medial tibial stress syndrome.

Pain from shin splints is often described as a burning, aching, or awareness that something in the lower leg just does not feel right.

This is not to be confused with joint pain which is usually limited in the lower leg to the knee or ankle.

Shin splints also differs from muscle cramps because the pain is not necessary incapacitating or regular outside of exercise, but always seems to occur at some point during activity.

Often it starts as a dull ache that sharpens with each workout, but this ache may recede for short periods throughout an activity. Eventually, however, the pain increases in frequency and intensity until it persists throughout the activity and can even last for hours or days afterward.

This issue is fairly common among athletes and very physically active individuals, with an incidence rate of between 5-35% [1].

What Causes Shin Splints?

The initial hypothesized cause of shin splints was proposed by the American Medical Association in 1966, who speculated that shin splints was caused by “repetitive activity on hard surfaces, or due to forceful, excessive use of foot flexors.. which causes musculoskeletal inflammation” [2].

However, since this time many other plausible and detailed causes of shin splints have been put forward:

  • Caused by bone resorption that outpaces bone formation of the tibial cortex [3].
  • Reflects periosteal inflammation or irritation that is the result of numerous minuscule stress fractures.
  • The pain and changes stem from tears or irritation of Sharpey’s fibers between the soleus and the tibia.
  • Inflammation of the posterior peroneal tendon is the etiology of the pain [4].
  • During the remodeling process in which osteoblasts lay down new, stronger bone, this can put the bone at acute risk of injury.
  • Gradual flattening of the longitudinal arch of the foot, increased plantar flexion in the upper ankle joint, and a restriction of internal hip rotation [5].

Clearly the jury is still out on what is the precise cause of shin splints from a biomechanical and physiological standpoint, and future research is still needed for clarification.

However, what is already obvious is that shin splints is mainly an overuse injury from repetitive microtrauma that may occur during periods of increased training load - such as increased training intensity and/or duration.

The Main Treatments For Shin Splints

Below we've listed the primary ways you can relieve yourself of shin splints:

Good, Old-Fashioned Rest

The best and primary treatment for shin splints is exactly the same as most injuries. Rest!

Once shin splints have started to occur, they typically last anywhere from 3 days to 6 weeks. The exact recovery time is highly dependent on the extent of the injury, the timeframe the injury has been present, and the type of activity that caused the injury to begin with.

Physios tend to recommend refraining from high-impact activities such as running until the individual can walk 1 mile pain-free.

When this can be done, the person can resume their prior activities.

However, it is key to still be sensible in this situation despite the symptoms of injury having faded. It is advised to start with just 50% of the pre-injury activity level, and gradually increase training load by ~10% per week.

If for any reason the pain recurs, the individual should decrease exercise intensity to a level where pain is no longer felt and wait another week before attempting to increase it again.

During this time of recovery, athletes can cross-train with cycling, swimming, or other low-impact sports.

Physio Work

Alongside getting the required amount of rest, it may be possible to speed up the recovery process by working with a physiotherapist.

Some studies have shown that specialized physios can relieve pain and restore exercise tolerance with treatment methods based around the fascial distortion model [6].

The stated duration of treatment according to the fascial distortion model is significantly shorter than other types of therapy [7].

The fascial distortion model is:

  • A detailed physical assessment which leads to a specific diagnosis of the injury.
  • Physical therapy using targeted manual techniques. These are mainly based around strong local pressure on “trigger points” using the fingertip of the thumb until the pain has resided.

Other physiotherapy treatment options may include ultrasound, phonophoresis, and local friction, although none of these methods have proved that successful [8].

Pain Relief

If the pain from shin splints gets too much to handle, try either of the following:

  • Apply an ice pack to the painful region for 20 minutes at a time
  • Consult a doctor about taking non-steroidal anti-inflammatory drugs to reduce symptoms of pain.

Keep in mind, neither of these methods will speed the healing process, but are merely additional ways to help deal with the pain while it is present [9].

Future Prevention

Like with any injury, although the first line of thought is how to treat it, a better long-term plan is to make sure it does not happen again in future.

There may not be fail-safe methods to avoiding shin splints, but several practices can definitely help:

  • Wear appropriate, shock-absorbing footwear such as running shoes, and replace them every 300 miles.
  • Train on a surface designed for your sport. For example, runners should run on padded dirt or a similar material whenever possible. Concrete and grass are too hard and too soft, respectively, for the human leg mechanics to handle long-term.
  • If you have a limb-length discrepancy of 2cm+, consider a shoe lift.
  • If your shoes show evidence of hyperpronation, a shoe insert might be helpful. Insoles can be used to provide biomechanical arch support [10].
  • Proper technique is also essential, so a session with a coach or physical trainer can provide suggestions that will improve performance and prevent injury.
  • Follow a proper diet including the recommended daily allowance of all vitamins and minerals, but especially calcium for bone health.

Conclusion

Shin splints is often described as a burning or aching throughout the entirety of the lower leg region and is primarily caused from repetitive microtraumas during periods of increased training load.

The best way to treat shin splints is to let the body rest for a week, and potentially longer if needed.

To accelerate the recovery process, it is also an option to work with a qualified physiotherapist who can perform some specific physical therapy work on the area in need.

To prevent shin splints from occurring in future, make sure to wear the correct footwear and to run with proper technique on appropriate surfaces.

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