Shin splints can be a tough diagnosis to confirm, and often can be made by excluding the other common causes for lower leg pain in athletes such as stress fractures.
As more of us of get outside to run in Central Park or along the streets of Manhattan for the remainder of the summer, shin splints will probably affect at least some of us this year. The term “shin splints” refers to pain and tenderness along the front and inner side of the bone in the lower leg, the tibia. Shin splints are frequently encountered in athletes and can cause significant pain that limits the ability to compete. The official medical term used to describe shin splints is “medial tibial stress syndrome” (MTSS).
The exact cause of shin splints remains unknown. It has been attributed to inflammation of the muscles, tendons, and lining of the bone (“periosteum”) in this location that causes pain after repetitive activities. Sometimes the bone is involved as well in more severe cases. Athletes that perform repetitive, vigorous physical activities are unfortunately at higher risk for developing shin splints. Track and field athletes, particularly sprinters and jumpers, are at high risk. Vigorous dancers and military cadets (who are often training with running or marching drills) are vulnerable as well. Flat feet or very rigid arches of the foot may also increase the risk of shin splints in athletes.
Shin splints can be a tough diagnosis to confirm, and often can be made by excluding the other common causes for lower leg pain in athletes such as stress fractures. Athletes will complain about pain along the front and inside aspect of the lower leg during or after physical activity, such as running or jumping. A bone scan may demonstrate increased tracer uptake in the muscle or bone lining (“periosteum”) of the lower leg. MRI may similarly demonstrate some inflammation and fluid in this location. More importantly, however, the MRI will help to exclude a stress fracture or adjacent muscle/tendon injury in these athletes.
The mainstay of treatment for shin splints in athletes is rest and avoidance of activities that cause the pain. This provides time for the inflammation to resolve and for the recovery of the injured tissues. Rest is often accompanied by the initiation of anti-inflammatory medications and cryotherapy to alleviate symptoms and reduce inflammation. After a period of rest and with complete resolution of pain, a gradual resolution of activities can begin. This should commence at a low-level and avoid prolonged, vigorous running or jumping sports. Consulting your doctor can be helpful to design a rehabilitation program that strengthens the muscles of the lower extremity.
