SHIN SPLINTS
This term is used to describe pain along the shin (tibia) and is commonly
seen as an overuse injury in runners. It usually develops gradually over a
period of weeks to months, but may occur after a single excessive bout of
exercise. Runners typically complain of pain in one of two locations (see
diagram 1)
The pain is usually noticeable when exercise starts, then decreases or goes
away as exercise continues. It is worse after exercise stops or the following
morning.
CAUSES -- Training errors and abnormal biomechanics
Both forms of shin splints can occur from doing too much exercise without
appropriate rest. All properly designed exercise programs dictate a slow,
progressive increase in volume and intensity over a long period of time. A
sudden jump in volume, overloads your ability to heal during rest, and injury
may result. It is important to realize that it is not exercise that makes you
stronger, but REST. Exercise breaks the muscles down, and during rest they
become stronger.
FIGURE 2 (below) shows how a workout routine that builds too fast can exceed
the healing that normally occurs during rest. Ultimately, as more exercise is
heaped onto damaged muscles, pain results.
A properly designed exercise program starts off slowly and builds by no more
than 10% per week (total volume). Often, every third or fourth week is very
light to allow for recuperation and healing.
Posterior shin splints
Abnormal biomechanics can cause posterior shin splints. Overpronation of the
foot during running tugs on the muscular attachment to the tibia, resulting in
inflammation. The conditions leading to this are:
- tight calf muscles
- flat arches
Anterior shin splints
Often these occur on both legs. They are seen in circumstances in which an
individual is just beginning a running program, excessive downhill running, and
engaging in sports requiring rapid starts and stops. These conditions cause
damage to the tibialis anterior muscle, resulting in pain.
TREATMENT. The hallmark of treatment is rest. The rest doesn't have to be
absolute unless there is pain with walking and daily activities. Otherwise,
relative rest is applied. This means a dramatic decrease in both frequency and
duration of exercise -- usually a 50 - 90% drop in duration, and doubling or
tripling the time between workouts. Many individuals make the mistake of taking
a few weeks off and then going right back in to the same schedule. In this
circumstance, the problem will return.
Relative rest is continued at a constant level while other techniques are
employed (see below) until healing occurs. Then, a gradual increase in workouts
is permitted.
ICE therapy is very useful for decreasing inflammation following a workout.
Apply ice for 10 - 15 minutes, directly onto the sore area.
STRETCHING. Gradual progressive stretching increases flexibility and can
prevent the injury from returning. The two most useful stretches are,
MASSAGE. Deep tissue massage is perhaps one of the most useful techniques
for getting rid of shin splints. Often this must be done be a qualified
physical or massage therapist. Thickened, tight areas within the muscle can be
broken down and smoothed out. This gets rid of the pain and can prevent
recurrence.
ANTI-INFLAMMATORY MEDICATIONS, such as ibuprofen, are very useful in
the acute stages. All anti-inflammatory medications have the potential to cause
gastric irritation, ulcers, or kidney damage and so their use should be limited
to the acute phase. Injuries that go on for months without improvement should
not be treated with anti-inflammatories alone. Often, this is a sign of some
other problem that has not been addressed or corrected.
CORRECTION OF ANY ABNORMAL BIOMECHANICS is crucial because if not
addressed, the problem will simply come back. A good arch support is important
for people who have posterior shin splints. Sometimes orthotics are required.
The choice of footwear is also important since different running shoes have
different degrees of support and motion control. Running shoes lose 30- 40% of
their shock absorbing capabilities after 500 miles. The tread may look fine,
but the capacity to prevent injury is not.
For long distance runners, examining the tread of the shoes can give a clue
as to abnormal biomechanics. Uneven wear when comparing one shoe to another,
may signal abnormal motion in one leg.
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