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1st Mar

2012

Shin Splints- It’s in the Bone

The term shin splints has been used for a long time, describing a condition common in runners, who develop pain on the inside of the shin bone, by the calf. The more accepted medical term today for this condition is medial tibial stress syndrome (MTSS). This is in particular common in young athletes, who have progressed their running or jumping too quickly, and who have mostly trained on hard surfaces. We also know that this is more common in female athletes than in males.

It used to be believed, that this condition was caused by traction on the membrane around the bone, called the periosteum, by muscles attached along the inside of the shin bone, or tibia. This would then cause inflammation of this membrane, or periostitis. Others believed that it also caused strain or inflammation of the muscles attaching here, including of the posterior tibial and soleus tendons.

However, research today has shown that the pain is caused by bony overload, and there is no evidence of periostitis or tendinitis. Imaging studies have shown mild bone weakness and loss of bone density, or osteopenia, of the tibia which returns to normal when the condition resolves.

Based on recent research, we know that a person may be prone to developing MTSS, if she or he has over pronated feet, i.e. feet which have fairly good arches when not standing up, but which flatten excessively when walking or running. This can cause the lower leg to rotate excessively inwards, and put greater torsion strain on the shin bone.

Other risk factors are ankles which can point down more than average, and people who land on the forefoot when running versus on the heel, which increases the strain on the tibial bone. An abnormal amount of hip rotation mobility and hip muscle weakness may also contribute to this condition, as it can change the mechanics of the entire leg during running. It has also been shown that people who have a higher body mass index take longer to heal.

Initially, the athlete will need to rest from running or jumping, and perform other forms of conditioning training such as swimming, bicycling or elliptical trainer. If the running intensity or mileage had been excessive, it’s important to adjust the training program in the future, and later have the athlete very gradually return to running.

If the foot over pronates, a foot orthotic may be helpful to improve the foot and lower leg mechanics during running. A runner who tends to land on the forefoot versus the heel will need to work on the running technique. It is also advised to return to training on softer surfaces, such as dirt, grass or
sand, and to later on alternate with running on harder surfaces.

Exercise rehabilitation is important, to correct any weakness present in muscles which can pull the arch of the foot up, and in key hip muscles which would prevent the leg from buckling in or rotating in an abnormal fashion. Even core trunk and back stability may need to be trained to allow for normal pelvic and hip rotation during running.

If you know of anyone with this type of condition, please feel free to forward this information to them.

Best wishes,

Gunnar

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