Posted by Brendan Hill G.S.R on Thursday, July 17, 2014
Shin pain is a common complaint among athletes and the term ‘shin splints’ is commonly used as a way of describing pain in that region. When people say that they have ‘shin splints’ they are usually referring to Medial Tibial Stress Syndrome (MTSS). While MMTS is the most common cause of shin pain it can also be caused by : 1) Stress fracture of the tibia; usually more common for athletes in impact, running and jumping sports. Stress fractures usually present as pain that is pin point or that is specific to an area of the tibia. It usually hurts when walking as opposed to easing after you warm up. 2) Chronic exertional compartment syndrome; this is the most serious of the conditions where there is an increase in pressure in one of the 4 compartments in the lower limb which leads to reduction in blood flow and a reduction of the transfer of blood to the capillary beds in the muscle.
By far the most common cause of shin pain is MMTS, which has been defined as ‘a specific overuse injury producing pain over and along the posterior-medial border of the tibia’, which is basically pain along the border of the bone on the inside of your leg. The pain is due to muscular and fascial traction on the bone which causes inflammation of the periosteum, a layer of connective tissue which surrounds the bone. MTSS is thought to be down to the interaction of internal risk factors (e.g. muscle imbalances, flexibility, biomechanics) and extrinsic risk factors (training volume, footwear, training type, surface). In the beginning the area may be sore after and intense work out but over time the condition may worsen to the point where it may be painful when walking and morning pain and stiffness may be present. Pain may also be felt on the front of the shin, more towards the top, this is known as Anterior Tibial Stress Syndrome (ATSS) and comes about in much the same manner as MTSS.
Rest, ice and anti-inflammatory medications may reduce the symptoms in the early stages of treatment. Switching to pain free training such as cycling or swimming may help maintain fitness levels while avoiding weight bearing training. When treating MMTS a therapist will need to examine what are the main causes of the condition occurring. With many people it is due to an increase in training coupled with poor flexibility and excessive pronation (flat foot). Orthotics may be needed to help stop excessive pronation while soft tissue therapy will be need to be carried out on the calf muscles, especially the soleus muscle which has been implicated as one of the muscles causing the pain as it may repeatedly be over worked when trying to resist pronation. Abnormalities in the tibialis posterior muscle may be addressed by relaxing the overlying muscles. Increasing the flexibility of the muscles in the calf region is important as is addressing any muscle weakness that may be present.
A return to full activity should be made when there is boarder of the shin is not tender to touch, when flexibility and biomechanical issues has been addressed, and when the patient has completed a gradual running program and a sport specific functional program without an increase in symptoms.
Image credit: http://www.bodyheal.com.au/
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