Understanding Shin Splints

Introduction

Shin splints, also known as medial tibial stress syndrome (MTSS), is a common condition characterised by pain along the inner aspect of the shin bone (tibia). This condition predominantly affects individuals who engage in high-impact activities.

What causes shin splints?

Shin splints are typically caused by repetitive stress or strain on the tibia and surrounding soft tissues. The exact cause involves a combination of biomechanical, structural, and training factors.

Biomechanical Factors

Research has highlighted the role of biomechanical abnormalities in the development of shin splints. Overpronation, (where the foot rolls inward excessively during running or walking), is a significant risk factor as this leads to increased stress on the tibia and associated muscles.

Structural Factors

The anatomy of an individual can predispose them to shin splints. Those with flat feet or high arches are at a higher risk. Flat feet increase the likelihood of overpronation, while high arches can lead to increased shock transmission through the tibia.

Training Factors

Rapid increases in training intensity, duration, or frequency without adequate conditioning are common causes of shin splints. Inadequate footwear and running on hard surfaces also contribute to the development of this condition.

Diagnosis

Diagnosing shin splints involves a combination of clinical evaluation and imaging techniques. Clinicians typically rely on patient history and physical examination. Patients often report a dull, aching pain along the inner tibia that worsens with activity and improves with rest. Additionally, tenderness along the medial tibia is a hallmark sign. A thorough assessment should rule out other potential causes of shin pain, such as stress fractures or compartment syndrome.
While diagnosis is primarily clinical, imaging can be useful in ambiguous cases. Magnetic Resonance Imaging (MRI) is the best tool for detecting early signs of MTSS. Additionally, MRI helps distinguish shin splints from stress fractures.


Management

The management of shin splints focuses on alleviating pain, addressing underlying causes, and preventing recurrence.

Rest and Activity Modification

The cornerstone of shin splint treatment is rest. Reducing or modifying activities that exacerbate pain is crucial. Complete rest may be necessary in severe cases, but in most instances, a reduction in intensity and duration of activity suffices. Gradual return to activity is recommended, with an emphasis on low-impact exercises initially.

Physiotherapy

Physiotherapy plays a significant role in the rehabilitation of shin splints. Current research suggests that a tailored rehabilitation program, in conjunction with manual therapy and education around load management can significantly reduce pain and improve function in individuals with MTSS.

Footwear and Orthotics

Proper footwear is critical in managing shin splints. Shoes should provide adequate support and cushioning. For individuals with biomechanical abnormalities such as overpronation, custom orthotics may be beneficial.

Cryotherapy and anti-inflammatories

Applying ice to the affected area can help reduce pain and inflammation. Anti-inflammatory medications may also be prescribed for short periods to relieve pain for suitable individuals.

Shockwave Therapy (SWT)

Emerging evidence suggests that SWT may be effective in treating chronic cases of shin splints. SWT is a treatment modality offered here at the clinic.


Prevention

Preventing shin splints involves addressing the risk factors and adopting appropriate training practices.

Training programs should incorporate gradual increases in intensity, duration, and frequency. Sudden changes should be avoided to allow the body to adapt to increased physical demands.

Wearing appropriate footwear that provides sufficient support and cushioning is essential. Regularly replacing worn-out shoes can also prevent the development of shin splints.

Regular strengthening exercises for the lower limb, particularly of the calf muscles, can enhance support around the shin, reducing the risk of shin splints.

Shin splints are a prevalent condition among active individuals. Understanding the factors that lead to the development and progression of shin splints is important for effective management and to facilitate better outcomes. Accurate diagnosis can only be made by a trained clinician and thorough clinical evaluation. By adhering to the evidence-based recommendations, individuals can effectively manage their shin splints and to optimise participation in physical activities.

 

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