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Shin Splints

What are Shin Splints?

Shin Splints or Medial Tibial Stress Syndrome (MTSS) is pain along the Tibia or shin bone with activities. This is often presents as an overuse syndrome. In very rare cases does pain along the tibia present as a stress fracture.
Conditions - Shin Splints
Symptoms:

  • Pain is often along the medial side (inside) of the Tibia but can appear on the anterior aspect or front of the shin as well.
  • Pain can feel sharp initially and result in a dull aching sensation.
  • Pain is often decreased or relieved with rest.
  • Jumping and activities on hard surfaces can exacerbate the pain.

Causes:

The pathophysiology of MTSS is due to an increased axial load or force going directly from the ground through the narrow Tibia bone causing the bone to pathologically bend. The posterior muscles that attach along the tibia pull along the Tibia as well causing inflammation along the bone.

Any high impact activity and can lead to increased stress on the tibia leading to continued pain. The increased axial load can be exacerbated by biomechanical abnormalities.

  • Running, Gymnastics, Soccer, Hiking
  • Excessive pronation (rolling inward of the foot/ankle)
  • Wearing flats or shoes with low heel height for activities
  • Increasing sports activities too quickly
  • Tight calf muscles
  • Many biomechanical factors

Diagnosis:

Both clinical testing and imaging are used to provide a definitive diagnosis. A one leg hop test is used to help determine the severity of the injury as well as help determine if advance imaging such as MRI or Bone Scan are indicated to rule out a stress fracture. X-rays are often taken at the first visit to rule out any initial signs of stress fracture.

Treatments:

  • Appropriate shoes
  • Stretching
  • RICE Therapy
  • Changes in running or activity surfaces
  • Custom orthotics
  • Taping of the foot and anterior shin
  • Anti-inflammatory Medications
  • Physical Therapy
  • Activity modification
  • Cast Boot Immobilization
  • Cross training: swimming, biking, elliptical, rowing machines, yoga

Return to activities:

Patients want to know when they can return to activities with MTSS. When symptoms are mild, changes in activity surfaces and cross training can allow a patient to continue with activities to tolerance. In severe cases or when returning from a Tibial stress fracture, the one leg hop test is used to guide our recommendation for return to full activities. When the patient can perform the hop test without pain, they are cleared to return to full activity.