Sports Medicine

Overuse Bone Injuries

Shin Splints, Stress Response, Stress Fracture

Shin Splints

Shin splints are a common exercise-related problem. The term “shin splints” refers to pain along the inner edge of the shinbone (tibia).

Shin splints typically develop after physical activity. They are often associated with running. Any vigorous sports activity can bring on shin splints, especially if you are just starting a fitness program.

Simple measures can relieve the pain of shin splints. Rest, ice, and stretching often help. Taking care not to overdo your exercise routine will help prevent shin splints from coming back.

What are shin splints?

Shin splints (medial tibial stress syndrome) is an inflammation of the muscles, tendons, and bone tissue around your tibia. Pain typically occurs along the inner border of the tibia, where muscles attach to the bone. Shin splint pain most often occurs on the inside edge of your tibia (shinbone).

What causes shin splints?

In general, shin splints develop when the muscle and bone tissue (periosteum) in the leg become overworked by repetitive activity.

Shin splints often occur after sudden changes in physical activity. These can be changes in frequency, such as increasing the number of days you exercise each week. Changes in duration and intensity, such as running longer distances or on hills, can also cause shin splints.

Other factors that contribute to shin splints include:

  • Having flat feet or abnormally rigid arches, as this increases the stress transmitted to the tibia.
  • Exercising with improper or worn-out footwear
  • Runners are at highest risk for developing shin splints. Dancers and military recruits are two other groups frequently diagnosed with the condition.

What are the symptoms of shin splints?

The most common symptom of shin splints is pain along the border of the tibia. Mild swelling in the area may also occur.

Shin splints pain may:

  • Be sharp and razor-like or dull and throbbing
  • Occur both during and after exercise
  • Be aggravated by touching the sore spot

Physical Examination

After discussing your symptoms and medical history, Dr. Faucett  will examine your lower leg. An accurate diagnosis is very important. Sometimes, other problems may exist that can have an impact on healing.

At your visit, Dr. Faucett will examine your lower leg, checking for pain and tenderness along the inner border of the tibia (shinbone).

Dr. Faucett may order additional imaging tests to rule out other shin problems. Several conditions can cause shin pain, including stress fractures, tendinitis, and chronic exertional compartment syndrome.

Stress Fracture

If your shin splints are severe or are not responsive to treatment, Dr. Faucett may want to make sure you do not have a stress fracture. A stress fracture is a small crack(s) in the tibia caused by stress and overuse.

Imaging tests that create pictures of anatomy help to diagnose conditions. A bone scan and magnetic resonance imaging (MRI) study will often show stress fractures in the tibia.

Stress Fractures

One of the most common injuries in sports is a stress fracture. Overcoming an injury like a stress fracture can be difficult, but it can be done.

What is a stress fracture?

A stress fracture is an overuse injury. It occurs when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone causing a tiny crack called a stress fracture.

The weight-bearing bones of the foot and lower leg are especially vulnerable to stress fractures.

What causes a stress fracture?

Stress fractures often are the result of increasing the amount or intensity of an activity too rapidly. They also can be caused by the impact of an unfamiliar surface (a tennis player who has switched surfaces from a soft clay court to a hard court); improper equipment (a runner using worn or less flexible shoes); and increased physical stress (a basketball player who has had a substantial increase in playing time).

Where do stress fractures occur?

Most stress fractures occur in the weight bearing bones of the lower leg and the foot. More than 50 percent of all stress fractures occur in the lower leg.

What activities make athletes most susceptible to stress fractures?

Studies have shown that athletes participating in tennis, track and field, gymnastics, and basketball are very susceptible to stress fractures. In all of these sports, the repetitive stress of the foot striking the ground can cause trauma. Without sufficient rest between workouts or competitions, an athlete is at risk for developing a stress fracture.

Are women more susceptible to stress fractures than men?

Stress fractures affect people of all ages who participate in repetitive sporting activities, like running. Medical studies have shown that female athletes seem to experience more stress fractures than their male counterparts. Many orthopaedic surgeons attribute this to a condition referred to as “the female athlete triad”: eating disorders (bulimia or anorexia), amenorrhea (infrequent menstrual cycle), and osteoporosis. As a female’s bone mass decreases, her chances of getting a stress fracture increase.

What are the symptoms of a stress fracture?

Pain with activity is the most common complaint with a stress fracture. This pain subsides with rest.

How are stress fractures diagnosed?

It is very important that during the office visit that Dr. Faucett assess’s your risk factors for stress fracture. X-rays are commonly used to determine stress fracture. Sometimes, the stress fracture cannot be seen on regular x-rays or will not show up for several weeks after the pain starts. Occasionally, a computed topography (CT) scan or magnetic resonance imaging (MRI) will be necessary.

How are stress fractures treated?

The most important treatment is rest. Individuals need to rest from the activity that caused the stress fracture, and engage in a pain-free activity during the six to eight weeks it takes most stress fractures to heal.

If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. Re-injury also could lead to chronic problems where the stress fracture might never heal properly.

In addition to rest, shoe inserts or braces may be used to help these injuries heal.

Prevention

Here are some tips developed by the American Academy of Orthopaedic Surgeons to help prevent stress fractures:

  • When participating in any new sports activity, set incremental goals. For example, do not immediately set out to run five miles a day; instead, gradually build up your mileage on a weekly basis.
  • Cross-training — alternating activities that accomplish the same fitness goals — can help to prevent injuries like stress fractures. Instead of running every day to meet cardiovascular goals, run on even days and bike on odd days. Add some strength training and flexibility exercises to the mix for the most benefit.
  • Maintain a healthy diet. Make sure you incorporate calcium- and Vitamin D-rich foods in your meals.
  • Use the proper equipment. Do not wear old or worn running shoes.
  • If pain or swelling occurs, immediately stop the activity and rest for a few days. If continued pain persists, please follow up with Dr. Faucett.

It is important to remember that if you recognize the symptoms early and treat them appropriately, you can return to sports at your normal playing level.

Ankle Tendinitis

Tendons attach muscles to bones. Tendinitis or Tendinosis occurs when tendons become inflamed. This can be painful like shin splints, especially if there is a partial tear of the involved tendon. An MRI can help diagnose tendinitis.

Chronic Exertional Compartment Syndrome

An uncommon condition called chronic exertional compartment syndrome causes symptoms like shin splints. Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. In chronic exertional compartment syndrome, this is brought on by exercise. Pain usually resolves soon after the activity stops. The tests used to diagnose this condition involve measuring the pressure within the leg compartments before and after exercise.

Treatment

Nonsurgical Treatment

  • Rest: Because shin splints are typically caused by overuse, standard treatment includes several weeks of rest from the activity that caused the pain. Lower impact types of aerobic activity can be substituted during your recovery, such as swimming, using a stationary bike, or an elliptical trainer.
  • Nonsteroidal anti-inflammatory medicines: Drugs like ibuprofen, aspirin, and naproxen reduce pain and swelling.
  • Ice: Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
  • Compression: Wearing an elastic compression bandage may prevent additional swelling.
  • Flexibility exercises: Stretching your lower leg muscles may make your shins feel better.
  • Supportive shoes: Wearing shoes with good cushioning during daily activities will help reduce stress in your shins.
  • Orthotics: People who have flat feet or recurrent problems with shin splints may benefit from orthotics. Shoe inserts can help align and stabilize your foot and ankle, taking stress off of your lower leg. Orthotics can be custom-made for your foot, or purchased “off the shelf.”
  • Return to exercise: Shin splints usually resolve with rest and the simple treatments described above.
    • Before returning to exercise, you should be pain-free for at least 2 weeks.
    • Keep in mind that, when you return to exercise, it must be at a lower level of intensity. You should not be exercising as often as you did before, or for the same length of time.
    • Be sure to warm up and stretch thoroughly before you exercise.
    • Increase training slowly. If you start to feel the same pain, stop exercising immediately. Use a cold pack and rest for a day or two.
    • Return to training again at a lower level of intensity. Increase training even more slowly than before.

Surgical Treatment

Very few people need surgery for shin splints. Surgery has been done in very severe cases that do not respond to nonsurgical treatment. It is not clear how effective surgery is, however.

Prevention

There are things you can do to prevent shin splints. Proper Fitted Shoewear: To get the right fit, determine the shape of your foot using the “wet test.” Step out of the shower onto a surface that will show your footprint, like a brown paper bag. If you have a flat foot, you will see an impression of your whole foot on the paper. If you have a high arch, you will only see the ball and heel of your foot. When shopping, look for athletic shoes that match your particular foot pattern.

In addition, make sure you wear shoes designed for your sport. Running long distances in court-type sneakers can contribute to shin splints.

Slowly build your fitness level: Increase the duration, intensity, and frequency of your exercise regimen gradually.

Cross train: Alternate jogging with lower impact sports like swimming or cycling.

Barefoot running: In recent years, barefoot running has gained in popularity. Many people claim it has helped to resolve shin splints. Some research indicates that barefoot running spreads out impact stresses among muscles, so that no area is overloaded. However, there is no clear evidence that barefoot running reduces the risk for any injury.

Like any significant change in your fitness regimen, a barefoot running program should be started very gradually. Begin with short distances to give your muscles and your feet time to adjust. Pushing too far, too fast can put you at risk for stress injuries. In addition, barefoot runners are at increased risk for cuts and bruises on their feet. Several brands of minimalist shoes with “toes” are available and these also require a slow working in period as your body adjusts to this different activity.

If your shin splints do not improve after rest and other methods described above, be sure to see Dr. Faucett to determine whether something else is causing your leg pain.


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