So I've talked about nomenclature and causes of shin splints. Now it's time to get into the prevention and treatment of shin splints.

Prevention

"Running Shoes" by barbourians

As always, prevention is the best medicine. Following some simple guidelines for exercise may help you stave off shin splints. For example, if you're picking up running again for the first time is months/ years or a completely new runner ease yourself into it. Don't go out on your first day and try to run 3km. You'll likely struggle to do it and your body will pay for it later. Learnt to pace yourself and have a progressive exercise routine. With that in mind, always have an adequate warm up and cool down when exercises. this will prepare your musculoskeletal and cardiovascular system for the higher-intensity as well as gradual bringing them back to a resting state. Speaking of rest. You need it. Give your muscles time to repair! I know the whole "no pain, no gain" attitude, but sometimes you just have to listen to your body. These are simple things that will help prevent any injury, not just shin splints.

Aside from that, one of the common causes of shin splints is improper footwear. You're going to want to get yourself a good pair of running/training shoes for over-pronation. I'm not going to try to steer you in one direction or the other with regards to brands because they all have something to offer. Just look for a lightweight pair, with adequate arch support (to prevent overpronation) and also a heel post. I'm not an expert on footwear, but these are basics things. Get help from an in-store associate. You should also realize that running shoes wear out. replace them every 6 months at least or every 600-800km (400-500miles) Alternatively, if you're willing to shell out a little extra cash, many physiotherapist and podiatrist will be able to set you up with a custom orthotic. Check with your local health professionals for more information

Treatment

If you're already suffering from shin splints then the above mentioned preventative measures can still help, but they're unlikely to solve the entire problem. Given that shin splints are more often than not considered an overuse injury then they should be treated like any other tendonitis.

In the actue stage rest will be most important in treating shin splints. Some literature even suggests that cessation of sport for 2-6 weeks may be required. This is probably one of the hardest pills to swallow for most. I've had patients who were just unable to rest because of a compulsion to run. They would routinely report to me that they just went for a "short run." These are the ones who suffered through the pain longer than the ones who were able to slow things down and take a period of rest. Now, I'm not saying you have to completely give up activity. I am saying you should work with a physical therapist who can help tailor a progressive return to activity plan with you. 

Other than rest the main goal, as will any tendinitis, will be to control inflammation the rest will help with this, as will ice. I typically recommend ice following activity for 15 minutes on, 15 minutes off for 1 hour. A physical therapist can also use modalities such as ultrasound to help control inflammation. The use of NSAIDS, such as ibuprofen, can also be beneficial. 

Once inflammation can be controlled you can start with rehabilitation, which will involve modifying your workouts, being educated on prevention, as well as strengthening/flexibility training. Strengthening of the anterior tibialis, and stretching of the calf will be the mainstay of strength and flexibility training. Many studies support the use of eccentric strengthening of the calf and stretching of the calf in the treatment of shin splints.

Having a physical therapist analyze your gait (how your run/walk) as well as do a full lower body physical assessment with also help in recognizing any other deficits that may be attributing to the injury. Your physical therapist can then develop a rehabilitation program focused on these deficits which may or may no include strengthening of your core, gluteals, and hip musculature. A physical therapist may also use manual therapy techniques to help restore normal movement if the assessment warrants such intervention. A wide array of techniques can be used, which is beyond the scope of this article. 

There are other treatments such as acupuncture and steroid injections that may to be useful, however there are few studies to support whether or not these treatments work. If all else fails then surgery is the final option. While it would not be the first choice of treatment, it has been shown that a posterior fasciotomy can help reduce pain and improve function, but may or may not completely resolve the issue. 

Shin splints - or whatever else you want to call them - are a pain. No pun intended. They are difficult to treat and fully resolve, but if you can focus on prevention and getting help early on rather then waiting until the pain is unbearable, then they can be managed and cured. 

Do you have experience with shin splints? Tell me about it
Are you a physical therapist who has treated shin splints? What do you find most helpful?
How often do you change your running shoes?
Any other questions?

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References:

Galbraith, R. M and Lavallee, M. E (2009). Medial tibial stress syndrome: conservative treatment options. Current Reviews in Musculoskeletal Medicine, 2(3), 127-133.

Thacker, S. B. et al. (2002). The prevention of shin splints in sports: a systematic review of literature.

Medicine and Science in Sports and Exercise, 34(1), 32-40.

This post really has no physical therapy or fitness content. It's just a verification notice for bloglovin'. However, since I'm posting it I might as well make good use of it so here goes.

First of all, I want to give my condolences to those affect by the bombing at the Boston marathon. Tragic events indeed. I would like to say I find it hard to believe that these senseless acts happen, but it seems too commonplace nowadays. It's such a frustrating thing.

Other than that I started running again today for the first time in quite a while. I will admit that since started my masters (and completing it) I've not been as active as I have been in the past. I'm trying to take the advice that I would give my clients and ease back into things. I did a 2km run today, trying to break in some new shoes, get the feel for things. It was surprisingly cold outside today, I was ill-prepared for that.

What else? I'll be finishing part 3 of my shin splints series. you can read Part1 and Part 2 to catch up if you like. Part 1 was on the nomenclature surround the term "shin splints" and Part 2 was about the common causes. Part 3 will be on the prevention and  treatment of the condition. 

If any of you have suggestions on topics you would like to have covered than by all means contact me or write your suggestions in the comments below. I've made a little departure from writing about fitness lately. This wasn't intentional really, my interests have just been more on the physical therapy and injury side of writing lately. I'll try to give you guys a better mix in the futre. 

Ok, so now that that is covered, the link below is for the bloglovin' thing I had mentioned earlier. Cheers!

Follow my blog with Bloglovin

In my previous post I talked about the nomenclature surrounding shin splints. In this post I'll actually get into the nitty gritty of what shin splints are. I'll focus mainly on the most common pathologies, but if you recall from my first post, shin splints can be an all encompassing term for lower leg pain. If you have questions about anything not mentioned in this post then please comment below and I'll answer any and all questions to the best of my ability.

Medial Tibial Stress Syndrome

As I've mention in Part 1, a commonly used synonym for shin splints is Medial Tibial Stress Syndrome (MTSS). As the name suggest, it's classified as a stress along the medial (and distal) third of the tibia.
There are a number of causes of MTSS, one of which is believed to be periostitis of the tibia in response to tibial strain under load. Periostitis is inflammation of the periosteum, which is the membrane that lines outer surface of the bone, and, consequently, which which muscles will connect. Other causes may include remodelling of the perisoteum, and tendinopathy - all of which can be considered a consequence of overuse.

The muscles that are mostly involved are the tibialis posterior, tibialis anterior and the soleus. This explains why pain from MTSS is typically felt along the inferior medial border of the tibia, this is where the belly of the three muscles turn into the more fibrotic tendon and therefor the area of the most stress. As I've mentioned previously, MTSS is typically a consequence of overuse, hence why the areas of greatest pull (tendons) will be the area of greatest pain.

There are also underlying biomechanical reasons why MTSS may be present, and one of the most common being overpronation of the foot. Overpronation places added stress on the tibialis posterior and the soleus because pronation of the foot stretches the soleus and tibialis posterior. This puts them in a less then optimal alignment during running activity. Another somewhat common predisposing factor for MTSS is a narrow tibial diaphyseal width - or in layterms - a teeny tiny middle bit of the shaft of the shin. Unfornately shin width can't really be altered, but overpronation can be. I'll get into this in the treatment section later.

Tendinopathy

Another cause of shin splints is simple tendinopathy, much like a tennis elbow. This can expalin why some people experience pain in areas other than that of MTSS. Personally, when I get pain I feel it somewhat laterally, just below the knee. To be a little more precise, I get pain at the origin of the tibialis anterior. This is one of the other more typical areas that people describe when they say they have shin splints. This is also around the area of the origin of extensor digitorum longus. Besides the commonly felt area above, tendinitis may also appear along the anterior surface of the shin where other muscles originate or in the belly of the muscles above.

Other

Depending on the health professional you talk too there may be mother causes of shin splints, or they may classified shin splints differently depending on their personal definition. To me the above two pathologies best describe the pain of shin splints when ruling out stress fractures and compartment syndrome. inflammation of the interosseus membrane may also be a reported cause of shin splints. There are other factors that are considered to be causes or predisposing factors for shin splints. I'll simply list them.

Running downhil
Overtraining on uphill/uneven terrain
Fallen arches/overpronation

Fatigue

Short bursts of sprinting activity

Inappropriate footwear

The take home message from all of this is that shin splints can most often fall into the overuse category of injuries if you consider that compartment syndrome and stress fractures are their own separate pathologies.

In my next post I'll take about prevention and treatment of shin splints.

What do you guys think:

Would you consider shin splints to be predominantly an overuse injury?

Have you experienced shin splints? Tell me about it.

Can you think of any other causes for shin splints?

Tell me if this sounds familiar. You run 3-4 days a week and for the first mile or so you feel fine then the front of your lower legs start to BURN! You push through the pain anyway to finish your run. By the time you get home all you can think about about lying down, or getting a hot bath, anything to sooth the pain in your legs. You've been getting this pain consistently for a while now and it's starting to get to the point where you can no longer run. Chances are you have shin splints. Ok, so not all cases of shin splints are severe enough to prevent you from activity, you may only get them once in a while or during the last leg of a run.

So, what are shin splints?

First off all, there is no splinting of the shin bone (tibia). This name probably derived as an adaption to an early description of the "spike soreness" by Dr. Hutchins in 1913. The term shin splints has been an area of debate, which I find silly, but science minded folk are all about debating terms. Some use it as a generic term for lower leg pain, others feel that it describes specific lower leg pathologies - typically medial tibial stress syndrome (MTSS). There has been a push to not use the term shin splints to describe the pain because of it's non-specificity, but at least it says where the pain is right? The term is so confusing to the best and brightest of us that Batt, ME decided to write an entire review on the matter, and eventually decided that the term exercise related leg pain should be used. Oh how fickle medical professionals can be.

In my opinion, shin splints are an overuse injury, somewhat akin to a tendonitis. So that's not very specific, it doesn't change how I go about treating the issue. I'm still going to analyze your gait, look at your footwear, rule out stress fractures or compartment syndrome and develop an appropriate treatment regime.

Sorry that post was a little bit of a rant. I just don't like getting to caught up on nomenclature when it has little to no effect on treatment. In my next post I'll get into the causes of shin splints.

Stay tuned for Part 2 - Causes of Shin Splints

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References:

Batt ME. Shin splints–A review of terminology. Clin J Sport Med. 1995;5:53–57

Hutchins CP. Explanation of spike soreness in runners. American Physical Education Review.1913;18:31–35

source: javcon117

Happy Easter everyone.

I'm spending Easter in my hometown and stuffing my face with an assortment of delicious food. I hope all of you get to do likewise.

A while back I had a guest post about how to follow through with your New Year's resolutions. By now you've all either done that or failed to follow through. If you were able to keep to your resolution then congrats! If you weren't why not use easter a a reset button? After all, Easter is a time of rebirth.

Also, you may have noticed the new blog layout. I'm sorry for all the changes over the last little while. I promise that all the major changes that I've wanted to make are done now. All that's left is a little tweaking, which you won't really see. I've also registered my domain name as exercisebasics.net, so if you have exercisebasics.blogspot.com bookmarked, now is a good time to switch it. You'll still be redirected to the right page if you use the .blogspot domain though.

So, HAPPY EASTER. Spend some time with your family, eat good food, go to church (if that's your thing), and if you're in newfoundland have a snowball fight or something. Seriously, snowstorms be crazy.

PS. ignore the random numbers and letters below. it's for a technorati thing.

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