You started training this summer for a 5k run, a 10k race, a triathlon, or a half-marathon. Congratulations on choosing physical fitness as a health priority! The only problem now in reaching your goals is lower leg pain with increased mileage, speed, or exercise intensity. If you have lower leg pain, you might have shin splints, one of the most common athletic injuries, especially if you increased your exercise regimen quickly. This should not stop your training, but it is important to seek help from a healthcare professional in order to prevent a chronic problem that could halt your workout progress and leave you with painful legs.
According to the American Physical Therapy Association (APTA), shin splints, or medial tibial stress syndrome (MTSS), “Is a condition that causes pain on the inside of the shin (the front part of the leg between the knee and ankle).” MTSS is commonly referred to as shin splits due to the location of pain over the shin bone. Shin splints affect both the muscle on the inside of the shin and the bone to which it attaches. MTSS may affect up to 35% of athletes who run and jump, such as distance runners, sprinters, basketball or tennis players, or gymnasts. Military personnel, dancers, and other active people can also develop MTSS. While the exact causes of shin splints are unclear, the most common possibilities seem to be anatomical malalignments or weakness, training mistakes, and poor footwear or exercise surface.
Medial tibial stress syndrome develops when too much stress is placed on the tibia (main shin bone). The muscles that attach to the tibia can cause an overload of stress on the bone. These muscles include the posterior tibialis muscle, the soleus muscle, and the flexor digitorum longus muscle.
The most common risk factors of MTSS include:
- Flattening of the arch of the foot while standing (over-pronation)
- Being an athlete who participates in repetitive jumping and/or running
- Being female (about 17% of injuries are in female runners; aerobic dancers are even worse at 22%)
- Excessive hip range of motion
- Smaller calf girth in males
- A high body mass index (>20.2)
You may have MTSS if you feel pain in the middle or bottom third of the inside of the shin. The pain may be sharp when you touch the tender area or occur as an ache during or after exercise. When MTSS is developing, the pain may be present during the beginning of exercise and less noticeable as exercise progresses. Over time the condition can worsen, and pain may be felt throughout any exercise regimen, and it also may continue after exercise.
Common medical advice on pain relief from shin splints includes:
- Rest from the aggravating activity or exercise
- Icing the tender area for 5-10 minutes, 1-3 times a day
- Exercises to gently stretch the muscles around the shin
- Taping the arch of the foot or the affected leg muscles
- Hands-on massage of the injured tissue
- In some cases, an x-ray may be needed to rule out stress fractures
If leg muscle weakness is contributing to your shin splints, then a physical therapist or other health care provider may prescribe:
- Exercises that increase hip rotation, abduction (lifting the leg away from the other leg), and extension (lifting the leg behind your body) to decrease stress to the lower leg
- Exercises that increase your arch and shin muscle strength to decrease the over pronation (flattening out) of the arch of the foot
Your physical therapist or other health care provider may also prescribe:
- Calf and foot muscle stretches
- Single-leg exercises including squats, reaching exercises, or heel raises
- Modified takeoff and landing techniques for jumping athletes
- Modified leg and foot control during walking and running
- New footwear to provide better support when walking or exercising
Your physical therapist may also prescribe orthotics or shoe inserts that support the arch of the foot if your feet flatten out too much, or if your foot muscles are weak.
So for all of you female athletes who read Forsyth Woman magazine, if you want to avoid shin splints, check to see if you have flat feet, and get arch supports if you do, increase your exercise regimen at a reasonable rate, replace your running shoes every 300-500 miles, and run on a softer surface. Stretch and strengthen your legs and see a physical therapist if you experience chronic leg pain.
More information on how to evaluate and treat shin splints can be found on the American Physical Therapy Association website at apta.org.