If you are a regular avid runner or just a weekend warrior, no matter what, you may be injured at any time.  A very common complaint in athletes is shin splints.  Shin splints can mean various things - from a strain to an actual stress fracture. But in any case, it is important to have this injury examined and treated sooner than later.  

What Does It Mean To Get A Shin Splint?

The lower leg consists of two bones, the tibia and the fibula. The shin is referred to as the front of the leg just beneath the knee cap (patella bone) but in reality it is the anterior (front) part of the tibia.  So when athlete's complain of shin splints, it is the pain that they feel at the front of the leg, or on the tibia and any of the muscles that originate from this part of the leg.  Some people describe it as a sharp shooting pain with every step they take, others describe it as an aching pain. Often it comes after repetitive stress or at the end of a workout.  Nevertheless, it is still painful and can be debilitating.  The pain comes from excessive force on the bone and the muscles attaching to it and the soft tissue around the area. This causes inflammation in the muscles causing pain.  

Who Typically Gets Shin Splints?

Anyone can get shin splints, and in any sport.  There are many factors that contribute to this injury.  It can be due to factors such as:

-biomechanical abnormalities in the foot and how it is aligned when it strikes the ground

-over training on hard surfaces

-running without proper shoe gear

-running or training on uneven ground, or on excessive hilly terrain

-lack of flexibility


What Should You Do If You Think You Have A Shin Splint

The first thing to do is to stop training.  You may have to take a few days off to a few weeks off of training or alter your training so that there is not a lot of pain or pressure during exercise. You may have to resort to other nonweightbearing exercises, such as swimming.   Rest and elevating the legs will help as well.  In addition,  icing the area helps as this is a natural analgesic cooling the area that will decrease the inflammation to the area that is warm and painful and swollen.  Most times, the pain and swelling subside after rest, ice, and elevation after a few days. Patients ask if theycan take an NSAID (non-steroidal anti inflammatory drug) but there are side effects to these medications, even if they are considered over the counter.  Beware of side effects such as GI upset, increase in blood pressure, and long term use can affect your kidneys. 

  At this time, you can try to ease back into your activity.  However before going back, it is advisable to see a podiatrist in order to prevent the pain from coming back.  This may include altering your workouts, changing your terrain, changing shoes, or adding custom orthotics. 

When you visit our office, we will examine your foot and ankle and determine if the cause is related to the foot.  Since our expertise is the foot and ankle, if we examine your lower leg and feel there is pinpoint pain upon physical exam, we may order a leg radiograph to rule out a stress fracture and if the pain persists, then advanced modalities may be needed.  However if the pain is markedly decreased with rest but returns with activity, then the issue may be originating from the foot.  

Your foot structure can have everything to do with pain shooting up your leg.  Although the tendons from the lower leg actually insert into the foot, often the pain shoots up the leg and can affect the muscle belly itself where it attaches to the leg.  The inflammation of the muscle in the leg can cause the symptoms of a shin splint.  The most common tendon for this is the posterior tibial tendon. The posterior tibial tendon starts in the lower leg, and the tendon coming from this muscle travels behind the ankle bone and inserts into the inside of the foot near the arch.  If you don't have proper arch support and your arch collapses, this tendon is stretched out and this causes inflammation and pain in the foot that travels up the leg.  Therefore, custom orthotics that help support the arch and the foot will prevent this stretching and aggravation that will prevent this pain. A full exam by our doctors will determine if and how custom orthotics can help you.  

Other causes of shin splints may have to do with muscle imbalances in other muscles and tendons.  Again, custom orthotics can help with these muscle imbalances by placing your foot in a biomechanically neutral position, or as close to it as possible.

This allows your muscles, tendons, ligaments, and bones to be aligned in a position where the foot can function most efficiently upon weightbearing.  Our doctors may also determine that all the icing and rest may need a little more help to decrease the inflammation.  You may need physical therapy to help decrease inflammation and increase strength and balance. 

Physical therapy can also help with flexibility, and your physical therapist will help with teaching you exercises that can be performed at home to also prevent further injuries.  They will also direct you on proper stretching techniques and using a foam roller to decrease tightness. The physical therapist that our office works with may even have alternative modalities such as dry needling. 

 For any acute pain, our MLS laser is helpful to treat the condition as well.  The MLS laser is painless, has little known side effects, and can be used in conjunction with the rest of the treatment plan.  It increases blood circulation to the injured area, bringing with it your body's natural healing factors to the affected site.  In addition, it will also act as a natural analgesic, or pain reliever, when patients don't want to (or are not able to) take oral anti inflammatory medications.  It is a great alternative and works within a few sessions. 

How Can I Prevent This Pain From Returning?

There are many ways to prevent this pain from recurring.  The most important thing is to make sure the biomechanics of the foot are solid. This means that if a custom orthotic is recommended for this condition, then this will prevent the shin splints from recurring.  In addition, make sure that you have the proper shoes for that activity.  For example, if you are running, you definitely want a running shoe that has increased padding in the forefoot and heel for shock absorption. This will help depending on what type of terrain you are forced to deal with.  If you are training, be sure to follow a proper program that does not ramp up too quickly as you want to increase your speed and intensity and mileage gradually. Ramping up too soon will cause overuse and can aggravate the original injury. It is also important to take the time to warm up and stretch before starting the training session. And most importantly, remember that pain is not normal!  Do not try to exercise through the pain as this could be more harmful in the long run. 

Shin splints are a common injury, and there are a few causes.  But knowing how to prevent shin splints is also important.  Most importantly, if you think you have shin splints, make an appointment with your podiatrist to make sure your foot structure isn't contributing to the injury.  And if it is your foot structure that is causing this injury, our doctors at Prairie Path Foot and Ankle can help!  We will make sure to diagnose the cause, and make sure you have the proper support in your shoe with an orthotic to help get you out of pain and help you stay that way.