Shin splints

Shin splints

The term "shin splints" - tibial pain - refers to pain in the lower leg along the inner edge of the tibia. It is a fairly common ailment with varied causes. This injury most often develops after physical activity and is associated with running. However, in fact, any dynamic sports activity can cause pain in the tibia, especially when just starting a training program. Nor is shin pain along the tibia exclusive to athletes. It can be triggered by improper work hygiene habits such as frequently staying in the wrong position or walking in ill-fitting work shoes.

Pain in the tibia - symptoms

The predominant symptom is pain in the tibia area, felt mainly during exercise. Initially, the ailment appears at the end of training, with time it can also occur at the beginning of training. In extreme cases, the pain is felt while walking or even resting. In most cases, the area is also sensitive to touch. Sometimes there is swelling and subcutaneous thickening along the medial edge of the tibia. At first, the pain in the front of the tibia may stop on its own when you stop exercising. However, over time, the discomfort can be continuous, progressing to a fatigue fracture.

Different forms of the course of tibia pain

Pain in the tibia (shin splints) can be acute or chronic:

• acute complaints - periostitis or muscle tendonitis,
• chronic complaints - micro-fractures of the bone, weakness of the periosteum.

Shin splints - causes

Tibia pain can have a variety of causes, even causes we wouldn't expect: the training volume we use, the hardness of the ground we run on, ill-fitting footwear used during training, incorrect running technique, insufficient warm-up, running in cold temperatures, and even too little calcium in the diet. These are external factors.

However, internal factors have a much greater impact on the onset of shin pain: age, gender, history of previous injuries, incorrect kinematics of the musculoskeletal system, muscle imbalance, lack of flexibility and muscle weakness, and postural instability.

Recent studies show that abnormal functioning of the hip joint may also be responsible for tibial pain (known as shin splints). Limited range of motion in this joint forces a specific running pattern, likely causing increased stress in the tibial region. Increased lateral displacement of the pelvis, increased internal rotation at the hip joint and reduced knee flexion capacity also predispose to overload injury.

Pain in the tibia when walking

Pain in the tibia while walking can accompany people who wear inappropriate or uncomfortable - too tight - footwear. For example, women who frequently walk in stilettos, as well as lovers of flip-flops, complain of pain in the tibia. Pain in the tibia while walking can also be related to the characteristics of one's occupation. This will affect, for example, people who put too much strain on their legs while doing standing work or that requires walking for long hours, as well as those who lead sedentary lifestyles, including professional drivers.

Tibia pain after impact

Tibial pain can also result from a minor injury to the tibia after a fall. Such an injury, in addition to pain, is characterized by hematoma, swelling, tumor, and, depending on the type of impact, bleeding. In injuries resulting from an accident, bone contusion is also common, causing micro-fractures that do not show a clear fracture line or change in the shape of the bone on X-ray imaging. The main symptom of a bone contusion is bruising, soft tissue swelling, discoloration of the damaged area prolonged pain and tenderness.

Shin splints in fatigue fracture

A fatigue fracture is a microfracture of the bone resulting from repetitive trauma. It is a typical overload injury commonly seen in athletes, especially long-distance runners. It most commonly affects the tibia and foot. In this case, pain in the front of the tibia occurs when directly touching the fracture site and putting weight on the leg, and is long-lasting. In addition to pain, there is also swelling, and on the X-ray image there is a clear protrusion on the bone.
Pain in the tibia after a bone fracture

The tibia bone is quite often fractured, mainly as a result of serious trauma to the leg, for example, during a traffic accident or a fall from a height. The effect of the fracture is clearly visible on an X-ray, where a break in the continuity of the bone can be observed. Any case of tibia fracture requires orthopedic consultation.

Shin splints - what to do when the tibia hurts?

• rest during the acute phase,
• modification of the training program: reducing intensity, frequency and volume, performing low-load training,
• introduction of muscle-strengthening functional training during the rehabilitation period,
• in the situation of cessation of pain symptoms, gradual return to sport,
• carrying out regular strength and stretching exercises,
• use of well-shaped shoes with cushioning soles,
• use of custom orthotic insoles,
• treating key kinetic chain dysfunction, using manual therapy,
• considering other therapies: anti-inflammatory injections, acupuncture, eventually surgery.

How to treat Shin splints

No fatigue injury is caused by a single factor, but rather is a reciprocal interaction between internal and external risk factors. It should be noted, however, that factors alone are not enough to cause injury, but only increase the likelihood of injury. A final causative factor is still needed that will lead to injury. The basis for the creation of an effective rehabilitation program is a biomechanical analysis of running and the capture of abnormalities that affect the appearance of ailments.

Non-surgical treatment

Since tibial pain is usually caused by overexertion, standard treatment includes several weeks of rest from the activity that caused the discomfort. For intractable pain, non-steroidal anti-inflammatory drugs can be used. During the recovery period, less intense exercises like swimming or stationary cycling can be introduced. Stretching exercises are also advisable.
Tibialgia pain usually subsides with rest and simple treatments. We should feel pain free for at least 2 weeks before returning to exercise. When doing so, it is important to remember that the return to training must be at a much lower intensity level. After the injury, one should not exercise as often and as dynamically as before. Before exercising, remember to warm up and stretch thoroughly. If the pain in the tibia starts to recur, you should immediately stop activity and return to rest for a day or two.

Operative treatment

Surgical treatment is required in a very small percentage of cases. Surgery is performed only in very severe cases that do not respond to conservative treatment methods.

How to prevent tibia pain

• Ensure correct running technique. Video analysis of your running technique can help identify movement patterns that may be contributing to tibia pain. In many cases, a small change in the way you run can help reduce the risk of injury.
• Avoid excessive training loads. Too many exercises performed for too long and at too high an intensity can overload the shins.
• Take care of the right training equipment. Choose the right running shoes, remembering to replace them with new ones every 800 kilometers or so.
• Make your physical activity more varied. Try to train cross-training, interspersing running with sports that have less impact on your shins, such as swimming or cycling.
• Add strength training to your activities. Exercises that strengthen and stabilize your legs, hips and torso can help your body adapt to tough workouts.

Orthotics

One form of treatment, and part of the prevention of tibia pain, is the use of orthotics. They allow to restore the correct alignment of the foot, thus preventing the development of excessive muscle tension in the limbs, a common cause of tibia pain. Gait analysis and, based on this, customized shoe inserts selected by an experienced physiotherapist, can reduce discomfort, maintaining comfort throughout the day.

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Learn about other possible injuries and injuries to the knee joint.

Bibliography:

• Injury Clinic - Published: 23 October 2012 - Chronic Shin Splints - Classification and Management of Medial Tibial Stress Syndrome - Don E. Detmer - Sports Medicine volume 3, pages436–446 (1986)
• Healthline - Shin Splints - Medically reviewed by Gregory Minnis, DPT, Physical Therapy — By Shannon Johnson — Updated on September 19, 2019
• OrhoInfo - Shin Splints - August 2019 - Contributed and/or Updated by Michael J. Alaia, MD, FAAOS, Peer-Reviewed by Stuart J. Fischer, MD, FAAOS
• Health Direct - Shin splints - Shin splints - Sports Medicine Australia - 2020