Symptoms, Prevention and Treatment
Just two short weeks after my friend "Bob" started walking for exercise, the pain started. It was a throbbing that centered around his shins and it flared up every time he moved his legs. After several days of trying to "push through the pain," Bob agreed to see a doctor.
It didn't take long for the doctor's diagnosis. Bob had shin splints, also known as medial tibial stress syndrome (MTSS).
Shin splints is a general term for pain that's below the knee, along the shinbone or tibia. The specific location of the problem is either on the front outside part of the leg (anterior shin splints) or the inside of the leg (medial shin splints).
Several things can cause shin splints, but it's generally a case of too much, too soon. My friend Bob had started from virtually no activity, to attempting a two-mile walk every other day. He succeeded the first few times, but muscles became irritated and started to swell. With so much constant stress and little recovery time, the pain continued to worsen. After just three weeks of his crazy routine, my friend had to completely stop and spend nearly 3 weeks recovering.
Other Shin Splints Causes:
- People who have weak stabilizing muscles in their muscles or body core.
- Anyone whose foot arches collapse when they walk, known as overpronation or flat feet.
Don't confuse shin splints with stress fractures. A stress fracture is an incomplete crack in the bone and it can be much more serious. There are a couple of ways to tell the difference.
Shin splints produce a pain that is more generalized than a stress fracture. When you press down with your fingers along the shin, a stress fracture will reveal itself by causing sharp pain at a specific location. Shin splints have a more widespread aching.
Shin splints also tend to be more painful in the morning. Overnight the soft tissue tightens, causing more pain. But stress fractures usually feel better because the bone has been resting and healing all night.
The best way to tell if you have a stress fracture or shin splints is by getting a bone scan. The bone scan will reveal the fractures (if that's the problem) and you'll have a definitive answer.
Treatment Options to Avoid:
In the past, doctors typically recommended one of two approaches. The first was to push through it and continue the activities that caused the problem. But that often led to a worsening of the injury and more pain.
The second approach was bed rest for a week or two, taking all weight and pressure off the legs until the muscles began to heal. But that wasn't a great option either. Athletes would lose too much muscle and working people often couldn't afford to take the time off.
Current Treatment Strategy:
Workouts can continue, but the type of workout may have to change. Switching to a stationary bike or swimming in a pool can keep your cardiovascular system strong without putting the muscles under too much additional stress.
Ice packs can relieve some pain, but they don't really help with long term healing. Anti-inflammatory medications including ibuprofen (Advil or Motrin) and naproxen (Aleve or Naprosyn) are typically used to reduce swelling and pain.
Stretching exercises that target the calf and the front of the leg can be prescribed by your doctor or physical therapist. Those are often combined with strengthening exercises. Typically you'll do both stretching and strengthening, at least twice a day.
A podiatrist can evaluate the root cause of the problem. They will look at your running shoe and your gait. If your feet are the problem, you may need inserts (orthotics) that go into the shoe to correct imbalances.
When you're ready to start moving again, follow these simple rules. Stick to terrain that's more level, while avoiding serious inclines and declines when possible. Don't walk on pavement or cement if you can find softer ground. Cut both the speed and distance to 50% of your pre-injury levels. Then, slowly increase both over six-weeks to avoid re-injuring yourself.
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