People who are physically very active or who have just started with jogging or walking might some time experience pain in the front of the leg this is called shin-splints. Shin-splints are also known as Medial Tibial Stress Syndrome (MTSS). The American Medical Association defines shin-splint syndrome as “Pain and discomfort in the lower leg. It is caused by repetitive loading stress during running and jumping, and occurs in 4% to 35% of athletic and military populations.  The diagnosis should be limited to musculoskeletal inflammation, excluding stress fractures or ischemic disorders.” Shin-splints is the most common exercise induced overuse injury in the leg.

 

Anatomy:

Leg has 4 muscle compartments;

Anterior compartment with Tibialis anterior muscles, superficial medial compartment  with calf muscles, deep medial compartment with Tibialis posterior, flexor digitorum longus and flexor hallucis longus, and lateral compartment with peroneal muscle group.

 

Epidemiology:

Shin-splint is very common in people who run or jump. Dysfunction of the tibialis anterior or tibialis posterior muscle weakness or tightness of the calf muscle  group, hamstring or quadriceps etc. could be a possible cause of shin-splints as it changes the biomechanics of the activity thereby putting extra stress on the leg muscles. Some time a change in footwear, intensity of activity or having flat foot could also be a contributing factor in developing shin-splints symptoms.

 

Symptoms and diagnosis:

The main symptoms is a dull ache in the distal two third of the front leg more to the inner side which is worse after the physical activity or a game. In the earlier phase it prominents at the beginning of the activity and dies down later. As the condition gets worse pain can persist even during the activity and might feel worse at the cool down period.

The only complication of the shin-splint is a possible fracture of the tibia which a physiotherapist or your family doctor can rule out after a thorough examination. In shin splints the pain seems to be more of a generalised pain in the middle third of the anterior medial leg whereas in tibial stress fracture there will be a sharp point of pain on palpation.

Make sure that your health care provider has ruled out the possibility of tibial stress fracture, deep vein thrombosis, sciatica, infection and nerve entrapment etc before continuing on with the treatment of shin-splints.

 

Treatment:

The earlier you start the treatment the better will be the outcome. In the acute and severe painful phase rest is recommended to reduce the inflammation. But prolonged rest is not recommended in this case, make sure you ice the area 10 – 15 mins a few times a day and immediately after the game or exercise session. If pain is significantly worse a course of physiotherapy sessions focused on stretching out the tight muscles, strengthening the weak leg/knee/hip muscles, soft tissue mobilisations, use of Ultrasound and other electrical modalities are recommended. If foot wear/flat foot is considered an indicating factor consider changing your foot wear and getting orthotics to support the foot and reduce the stress on the affected muscles.

 

Majority of the cases treated for shin-splints respond well to the above mentioned treatment strategies. If the pain seems to be recurring and getting worse despite of the conservative management your family doctor might suggest you to see an orthopaedic surgeon and consider surgical management to control/manage the symptoms.

Shin-Splints