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The lay term "shin splints" shin_splints_v2.jpgrefers to generalized pain along or just behind the shinbone (tibia) — the large bone in the front of your lower leg. Medically known as "medial tibial stress syndrome", shin splints occur during physical activity and result from too much force (overstress) or inappropriate sports training being placed on your shinbone and connective tissues that attach your muscles to the bone.

Shin splints are very common... they are the cause of 13% of all running injuries. Runners might get them after ramping up their workout intensity, or changing the surface they run on -- like shifting from a dirt path to asphalt. Shin splints are also common in dancers and in activities with sudden stops and starts, such as basketball, soccer or tennis.

Shin splints are very common... they are the cause of 13% of all running injuries. Runners might get them after ramping up their workout intensity, or changing the surface they run on -- like shifting from a dirt path to asphalt. Shin splints are also common in dancers and in activities with sudden stops and starts, such as basketball, soccer or tennis.

Evaluation of lower extremity biomechanics is an important part of care, since shock-absorbing customized orthotic support along with therapeutic modalities such as low-level laser and proper stretching/strengthening exercises is often necessary. Most cases of shin splints are easily treated and managed with conservative chiropractic care.

What to Look For

Shin splints are muscle injuries that develop insidiously in one or both lower legs. The pain is usually described as an "aching soreness" that has been getting worse and is particularly noticeable when walking. This is an overuse condition that develops secondary to repetitive strain at the muscle insertion - either in the very active athlete or in a patient who has started or increased a new walking or jogging routine. Therefore, a careful history of recent weight-bearing exercise habits is vital.

The involved leg is tender to palpation along the muscle insertions in the middle or lower third of the tibia, along primarily either the anterolateral or the posteromedial aspect. Manual testing finds mild to moderate weakness of the involved muscles, and the isometric testing often causes increased pain of the muscle. There are normally no sensory or reflex changes, and no significant asymmetry in muscle mass.

Common Causes

There are two major types of shin splints which are differentiated by location and involved muscles. The underlying biomechanical abnormalities (and therefore the type of orthotic support needed) are also quite different:

1. Anterolateral. The shin splint that affects primarily the anterior and lateral aspect of the leg involves the tibialis anterior, extensor hallucis longus and extensor digitorum longus muscles. Since these muscles decelerate the foot and absorb the shock stress at heel strike, they are placed under increased demand when there is excessive running on hard or downhill surfaces or when the shoe has lost its shock-absorbing qualities. In addition to biomechanical support and a better heel pad, good forefoot cushioning is also recommended for the anterolateral type of shin splint.

2. Posteromedial. When there is excessive pronation, the muscles that try to stabilize the ankle become overstrained and cause shin splints. These are the muscles along the posterior and medial aspect of the lower leg, including the tibialis posterior, flexor hallucis longus, and flexor digitorum longus muscles. Occasionally the soleus muscle is implicated. Arch support and a medial pronation wedge under the calcaneus are needed to reduce the stress on these muscles. Shock absorption is helpful, but supporting the foot and ankle biomechanics is most important.

As shin splints are caused by excessive force (overload) on the shinbone and the connective tissues that attach your muscles to the bone, the overload is often caused by specific athletic activities, such as:

  • Running downhill
  • Running on a slanted or tilted surface
  • Running in worn-out footwear
  • Engaging in sports with frequent starts and stops, such as basketball and tennis
  • Shin splints can also be caused by training errors, such as engaging in a running program with the "terrible toos" — running too hard, too fast or for too long.

Risk Factors

You're more at risk of shin splints if:

  • You're a runner, especially just beginning a running program
  • You have flat feet or rigid arches, causing your feet to roll inward when running
  • You increase the intensity of your workouts by doing more high-impact activities
  • You play sports on hard surfaces, with sudden stops and starts
  • You're in military training
  • Excessive foot pronation (pes planus)
  • Excessive foot supination (pes cavus)
  • Tarsal coalition
  • Leg-length discrepancy (physical and functional),and
  • Muscle imbalance.

Symptoms

If you have shin splints, you may notice:

  • Tenderness, soreness or pain along the inner part of your lower leg
  • Mild swelling in your lower leg
  • At first, the pain may stop when you stop running or exercising. Eventually, however, the pain may be continuous.

When to see a doctor - Consult your health care provider if rest and ice don't ease your shin pain.

Seek prompt care if:

  • Severe pain in your shin following a fall or accident
  • Your shin is hot and inflamed
  • Swelling and pain in your shin seems to be getting worse
  • Shin pain persists during rest.

Tests and Diagnosis

Shin splints are usually diagnosed based on your medical history and a physical exam. In some cases, an X-ray or other imaging studies can help identify other possible causes for your pain, such as a stress fracture — tiny cracks in a bone often caused by overuse.

Injury Management

  • The first step is to stop the causative activity and substitute non-stressful exercises. A switch to swimming or cycling can maintain aerobic endurance.
  • Specific chiropractic adjustments of all pelvic, lumbosacral, and foot/ankle joint dysfunctions are necessary. The most common foot problems are a dropped navicular or a posterior calcaneus.
  • Inflammation in the area of muscle injury should be dealt with conservatively, using frequent cryotherapy and electrotherapy such as low-level laser therapy (LLLT) if necessary.
  • Gentle stretching, massage and even transverse friction treatment may speed the healing response in the involved muscle tissues.
  • Dynamic (isotonic) exercises are necessary to strengthen the weakened support muscles (tibialis anterior and/or posterior) and help prevent future recurrences. An excellent program for strengthening the involved muscles uses elastic tubing with a series of ankle exercises.
  • As the patient returns to weight-bearing exercise, methods to decrease lower leg stress should be reviewed. These include: better-fitting and more supportive shoes, softer running surfaces, smoother gait and running style, better warm-ups/cool-downs, and even increased dietary calcium intake.
  • Stabilizing, custom-made orthotics are necessary for many athletes to support the arches and reduce pronation, as well as decrease the stress of heel-strike on the foot and leg. A built-in (intrinsic or extrinsic) heel lift may be necessary for even mild amounts of anatomic or functional leg-length discrepancy. The orthotics should provide shock absorption, which offers the "most promising outcomes." Anterolateral shin splints may respond more quickly to an orthotic appliance that provides additional forefoot cushioning.

At Home Treatments

In most cases, you can also treat shin splints with simple self-care steps:

  • Rest. Avoid activities that cause pain, swelling or discomfort — but don't give up all physical activity. While you're healing, try low-impact exercises, such as swimming, bicycling or water running. If your shin pain causes you to limp, consider using crutches until you can walk normally without pain.
  • Ice the affected area. Apply ice packs to the affected shin for 15 to 20 minutes at a time, four to eight times a day for several days. To protect your skin, wrap the ice packs in a thin towel.
  • Reduce swelling. Elevate the affected shin above the level of your heart, especially at night. It may also help to compress the area with an elastic bandage or compression sleeve. Loosen the wrap if the pain increases, the area becomes n umb or swelling occurs below the wrapped area.
  • Wear proper shoes. Your doctor may recommend a shoe that's especially suited for your foot type, your stride and your particular sport.
  • Consider arch supports in the form of customized prescriptive orthotics. Orthotics can help cushion and disperse stress on your shin-bones. Avoid off-the-shelf arch supports as they lack customization and durability. More durable orthotic appliance supports can be custom-made from either a plaster or foam impression casting of your feet.
  • Resume your usual activities gradually. If your shin isn't completely healed, returning to your usual activities may only cause continued pain.

Prevention

To help prevent shin splints:

  • Choose the right shoes. Wear footwear that suits your sport. If you're a runner, replace your shoes about every 350 to 500 miles.
  • Consider customized prescriptive orthotic arch supports. Orthotics can help prevent the pain of shin splints, especially if you have flat arches.
  • Lessen the impact. Cross-train with a sport that places less impact on your shins, such as swimming, walking or biking. Remember to start new activities slowly. Increase time and intensity gradually.
  • Add strength training to your workout. To strengthen your calf muscles, try toe raises. Stand up. Slowly rise up on your toes, then slowly lower your heels to the floor. Repeat 10 times. When this becomes easy, do the exercise holding progressively heavier weights. Leg presses and other exercises for your lower legs can be helpful, too.

Back to Full Activity

A patient who reports pain in the lower leg following exercise or similar activity is often experiencing shin splints. Differentiation between anteromedial and posterolateral helps to determine the patient's treatment and orthotic support needs. Conservative care, including isotonic exercises and flexible, custom-made orthotics for biomechanical imbalances will allow a rapid return to full activities. To prevent recurrences, athletes should be educated to replace their shoes before they are obviously broken down, and to avoid abrupt changes in training.

When patients with shin splints are treated at Advanced Healthcare by Dr. Pisarek, they also have the opportunity to have their posture and gait analyzed. Often, small changes in biomechanical function can significantly... reduce pain, inflammation, swelling; promote proper and complete healing/recovery; and, improve athletic "peak" performance.

Contact Dr. Pisarek today for an assessment of your shin splints
and let him get you started on your road to recovery!

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I have been a patient of Dr. Pisarek for a few years now. Every morning I have to say "thank you Dr. P.!". Your care and your treatment renew my energy... no more pains in my lower back, knee and foot. With your help I lost 20 pounds and I am keeping it off. I am really grateful to you and your wife Hilda for taking care of me. My retirement got a new meaning, thanks to you.

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