A Look at Shin Splints
Shin splints are to the world of jogging as the runny nose is to the common cold. There is, however, considerable confusion as to what causes, aggravates, and/or relieves this annoying problem. For not only are we rather non-specific in our treatment, but just as varied in our understanding of the cause. One common denominator of shin splints that most authorities agree on is that they hurt. Let's take a closer look at some of the current ideas, which are popular regarding the cause, effect, and treatment of this frequent running affliction.
Shin splints are generally regarded as lower leg pains along the inner and/or frontal to outer aspects of the leg. They are most often progressive in character, meaning that they usually become worse as the activity continues. The runner most often does not recall an injury at the onset of the condition, but does note the worsening character of the problem. To answer or describe what shin splints actually are, is a much more difficult task. Currently, most authorities agree that this annoying and debilitating problem is one or more of the following:
1. A tendonitis, or inflammation of a tendon, which is the band, which connects a muscle to the bone.
2. A myositis, or inflammation of the bulk of the muscle itself.
3. A periostitis, or irritation with inflammation involving the covering of the bone.
4. A possible stress fracture and/or micro-tear in the bone segment itself.
Although, on occasion, I have found stress fractures amongst my running patients, I lean toward the muscle and inflamed bone covering as the more likely explanation. Perhaps, shin splints are a gradation type of phenomenon, whereby the condition, as it worsens, begins to affect other parts. For instance, it may well start as a tendonitis, progress into a full-blown periostitis, and eventuate as an actual fractured bone. To a large extent, the success of our treatment depends upon the focus of our attention and apparent understanding of the problem.
In discussing the cause of shin splints in terms of the proposed list above, I tend to favor number two as the most probable. Because of the obvious imbalance in muscular strength between the front and back of the leg, certain muscles are forced to overwork, overstrain, and are made more accessible to injury. We know that the muscles behind our legs are much stronger than our frontal musculature. Runners, by virtue of the activity itself, continue to build up these behind-the-leg muscles, but very seldom pay adequate attention to the frontal group.
A second, and quite frequent, cause of shin splints appears to be excessive pronation. One can better understand the motion of pronation if he pictures an in-rolling or collapsing of the arch and heel with the foot taking on a flattened appearance. This type of foot position creates an excessive strain on the involved leg musculature and disabling shin type pains often result.
In treating a runner with shin splints, I first attempt to determine the involvement as well as the probable cause. Then, a treatment plan is designed for that particular patient to reduce the aggravating factors while, at all possible, maintaining his or her activity involvement. The list below includes many of the approaches from which a successful plan is often selected:
1. Elevation of the involved part
2. Rest with an associated decrease in the running level
3. The application of ice to the injured part
4. A change in running surface to a softer type and one without hills or inclines
5. A type of anti-inflammatory medication to decrease swelling within the leg
6. An exercise program to re-establish an improved balance between the muscle groups of the leg
7. Supportive orthotics or devices to guide and supplement foot and leg function to decrease muscle strain
Thus, the term shin splints, is a title given to a broad category of lower limb problems. Persistent pain and disability are definite warning signals, and to continue running while ignoring their presence, is both foolish and potentially damaging. Such a problem should be brought to the attention of a sports medicine podiatrist or orthopedist. Perhaps, in the near future, we will be able to more adequately discuss the nature and character of this common malady.