Medial Tibial Stress Syndrome
Description
Shin splints is a term broadly used to describe pain in the lower extremity brought on by exercise or athletic activity. Most commonly, it refers to medial tibial stress or periostitis. Periostitis is inflammation of the lining of the bone (periosteum).
Common Signs and Symptoms
- Pain in the front or more commonly the inner part of the lower half of the shin (lower leg), above the ankle
- Pain that initially occurs after exercise, progressing to pain in the beginning of exercise that lessens after a short warm-up period
- With continued exercise and left untreated, constant pain that eventually causes the athlete to stop sports participation
Causes
Shin splints are caused by overuse from repetitive activity, which leads to breakdown of the tissues. Continued activity, before the breakdown can be repaired, leads to inflammation of the periosteum (lining of the bone) and the tendon insertions into the bone and its lining. This breakdown exceeds the ability of the tendon and periosteum to heal completely, which results in injury, more inflammation, and pain.
Risk Increases With:
- Weakness or imbalance of the muscles of the leg and calf
- Poor physical conditioning (strength and flexibility)
- Inadequate warm-up and stretching before practice or play
- Sports that require repetitive loading or running, such as marathon running, soccer, walking, and jogging, particularly on uneven terrain or hard surfaces (concrete)
- Lack of conditioning early in the season or practice
- Poor running technique
- Flat feet
- Sudden change in activity level, distance, or intensity
Preventive Measures
- Appropriately warm up and stretch before practice or competition.
- Maintain appropriate conditioning:
- Leg and ankle flexibility
- Strength and endurance
- Cardiovascular fitness
- Ensure proper shoe fit with adequate cushioning
- Wear cushioned arch supports
- Use proper technique and have a coach correct improper technique.
- Gradually increase activity
- Run on surfaces that absorb shock, such as grass, composite track, or sand (beach)
Expected Outcome
This condition is usually curable with appropriate treatment and slow return to activity. Recovery may take anywhere from two weeks to two or more months.
Possible Complications
- Frequent recurrence of symptoms, resulting in a chronic problem; appropriately addressing the problem the first time decreases frequency of recurrence
- Prolonged healing time if not appropriately treated or if not given adequate time to heal
- Altered level of performance or need to end sports participation due to pain if activity is continued without treatment
