Shin splints, medically known as medial tibial stress syndrome (MTSS), refers to pain in the shins – the front lower legs. It is an inflammatory condition of the front part of the tibia. The pain is brought on by strenuous activity, more commonly in stop-start sports such as squash, tennis or basketball. Running too much on hard surfaces is also a common cause of shin splints.

Shin splints have two main causes:

  • Exerting excessive pressure on the lower leg muscles
  • Excessive impact on the muscle

Pain is usually felt early on during the physical activity, dies down somewhat, and then returns later on, sometimes during the same exercise session; this may occur during a long run. The pain can gradually become so bad that the activity has to be abandoned altogether.

A serious mistake is to try to “run through the pain” if it is a shin pain. This type of pain usually means there is injury to the bone and/or surrounding tissue. Forcing it more may worsen the injury and make the pain more intense and longer lasting.

What are the signs and symptoms of shin splints?

A symptom is something the patient feels and describes, such as pain, dizziness, fatigue, or anxiety, while a sign is noticeable by everybody, including the doctor or nurse, such as a rash, swelling or discoloration.

The patient has a dull, aching pain in the front part of the lower leg. For some, the pain and discomfort emerge only during exercise, while for others it comes after the physical activity is over. Pain can also be there all the time.

The pain can be on either side of the shinbone, or in the muscle itself – this depends on the cause. Signs and symptoms related to shin splints may include:

  • Pain along the inner part of the lower leg
  • Tenderness or soreness along the inner part of the lower leg
  • Moderate swelling in the lower leg
  • Feet may feel numb and weak, because swollen muscles irritate the nerves

What are the causes of shin splints?

The main cause of shin splints is too much force on the shin bone and connective tissues that attach the bone to surrounding muscle. The excessive force is usually caused by:

  • Running downhill
  • Running on a slanted surfaces or uneven terrain
  • Running with inappropriate shoes, including proper shoes than have worn out
  • Taking part in sports that include bursts of speed and sudden stops

An increase in activity, intensity or period of exertion can easily lead to shin splints, if the muscles and tendons struggle to absorb the impact of the shock force, especially when they are tired.

Females have a higher risk of complications from shin splints, e.g. stress fractures, especially if their bone density is diminished, as may occur in osteoporosis.

People with flat feet or rigid arches have a higher risk of developing shin splints.

Diagnosing shin splints

Shin splints are usually fairly easy to diagnose. The doctor carries out a physical exam, checks the patient’s medical history, and may ask relevant questions regarding lifestyle and physical activities.

Sometimes, the doctor may order some diagnostic tests in order to rule out other possible causes, such as a stress fracture. Tests may include imaging scans or an X-ray.

What are the treatment options for shin splints?

The best treatment for shin splints is rest. It is not one of those leg pains that recovers faster with physical activity. In the majority of cases the doctor will recommend two weeks’ rest. This means no running or taking part in any kind of sport linked to higher shin splint risk. However, gentle activities, such as cycling, swimming or walking are probably acceptable (check with your doctor or physical therapist).

Raising the leg and applying an ice pack to the affected area can help reduce the swelling.

To alleviate pain, an OTC (over-the-counter) analgesic, such as paracetamol (acetaminophen, Tylenol) or ibuprofen may help. Check with your doctor first.

When to do exercise again

In most cases, the individual can return to normal physical activity within two weeks, unless the doctor or physical therapist says otherwise. Ideally, you should start slowly and gradually build up your speed and intensity. Make sure you are warmed up before exercise.

How to avoid shin splints

  • Use proper fitting shoes with good support
  • Make sure the insoles are shock-absorbing. If you have flat feet, good insoles are vital
  • Avoid hard surfaces, uneven terrain, or slanted slopes
  • Increase your intensity gradually
  • Make sure you warmed up properly before doing exercise

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