Health Talk: Shin splints

For some of the most determined athletes, rest is a foreign concept. However, according to the American Medical Society for Sports Medicine, an estimated 13.1 percent of all athletes are afflicted with a condition for which rest is the best treatment. This condition is known as shin splints.

Shin splint is the general term given to pain along the front or inside edge of the shinbone. The splints range in severity from nerve irritations to tendonitis (an inflammation of the tendon, the connection between the muscle and the bone) to stress fractures (a crack in the bone resulting from repeated stress).

The majority of shin splints are not serious and do not require medical attention.

Although these splints do not require consultation with a doctor, this does not mean that they are not painful. Shin splints often hurt so badly that they make even the most determined athletes stop during their workouts.

The way shin splints are caused can be thought of most simply as stress on the muscle tissue that attaches to the front of the lower leg, which can cause the muscles to rip or tear.
The lower leg is made up of two bones: the fibula, the long thin bone that connects the ankle to the knee, and the shinbone (also known as the tibia), which consists of an anterior and posterior. The anterior and posterior run on either side of the fibula. The stress occurs in the muscles of the tibia.

The tibia’s attachment to the fibula and central location in the lower leg causes pain to shoot through a person’s leg.

However, the irritation is not evident in the entire leg; shin splints are often only visible through inflammation or swelling of the tibia.

While an athlete cannot predict when a splint will occur, the causes behind these inflamed shins are well known. Each time a runner’s foot hits the ground, a shockwave travels up the leg starting at the musculoskeletal system.

Located in the lower leg, the musculoskeletal system is the network of bones, muscles, and joints that work together to provide the runner with the power to move. The ability of the system to handle this shockwave depends on the athlete’s fitness level. If an athlete has not run for a very long time, the system can easily get stressed or torn.

Similarly, if athletes push themselves far beyond their limits in terms of speed or distance, the musculoskeletal system may not be able to handle the shock.

The unique ways in which an athlete’s foot hits the ground can add complications, such as pronation. For the ideal runner, pronation is described as the outside of the heel touching the ground first, then the heel rolling slightly inward, after which the foot lands flat and the ankle rolls inward.

This rotation is the reaction of the foot after the initial shock to the musculoskeletal system.

Pronation allows for the optimal absorption of shock by the musculoskeletal system. When a runner faces overpronation or underpronation, the foot rolls either too much or too little inward, respectively. These conditions are especially prominent among people with abnormally high arches, since their feet hit the ground at different angles than those with normal arches.

However, there are a number of risk-reducing strategies that all athletes can follow, regardless of their pronation tendencies. Adequate breaks between workouts allows the muscles to recover before experiencing another shock.

Additionally, external factors such as the running surface and shoes play a key role in preventing shin splints.

Running on soft grass is ideal for reducing shock; on the other hand, concrete is the worst type of running ground as it allows no bounce back at all for the athlete’s foot. Running on a treadmill — while clearly not as entertaining — is much better for an athlete’s body than running on a city street, as it does allow the foot to bounce back and thus weakens the shock to the muscles in the lower leg.

Similarly, running shoes are designed to absorb shock and enable the runner to maintain the right posture. Worn-out and ill-fitting running shoes do little to protect the athlete from shin splints and other injuries.

Like prevention techniques, the signs of a shin splint are universal. The pain begins slowly in the shinbone, and worsens with each step of physical exertion. There is frequently a tender zone along the vertical lining of the shin that can be mapped out with the athlete’s fingertips.

The most common treatment for shin splints, except the rare fractures that require surgery, is simply rest. While applying cold packs and taking anti-inflammatory medications calm pain and inflammation, they cannot cause the stress or tear to disappear.

Calf-building exercises also help strengthen the muscles, which can help them recover.

However, once an athlete begins exercising again, the cycle restarts. There is no way of telling if some sudden movement of the foot or ankle will cause the muscle system to rebel yet again.