Diagnosis And Management of Shin Splints

If you are regularly physically active and consider yourself somewhat of an athlete, it is likely that shin splints have presented in either yourself or someone you know. Shin splints is becoming increasingly common in those with extended periods on their feet or taking part in impact activities. Shin splints is largely defined as exercise-induced pain along the posteromedial border of the tibia (i.e. your shin bone) and can occur in up to 35% of athletes. The medical term for shin splints is Medial Tibial Stress Syndrome (MTSS).

Diagnosis

Diagnosis of such a condition is largely based on the physical or clinical examination. Patients typically complain of pain along the distal third of the medial border of the tibia during exercise, particularly on contact. Palpation of the distal two thirds of the tibia must show greater than 5cm range of tenderness to be considered a “positive test”. In some cases, small amounts of swelling may be visible. However, symptoms of shin splints can mimic those of a tibial stress fracture, and this requires immediate differentiation. Although the use of imaging is not particularly useful in diagnosing shin splints, it can be used to exclude other pathologies around the region such as a stress fracture. In this case, an x-ray is largely unhelpful and an MRI is required to detect such changes in the bone structure. Patients with a tibial stress fracture could also be complaining of night pain, tenderness more anteriorly along the tibia and that pain does not stop after exercise. Excluding fracture and the neurological symptoms that accompany compartment syndrome, allows a clearer clinical picture of shin splints to be made.

Repetitive loading and stress often elicited in change or increases in training volume are clear causes of MTSS. This highlights the importance of gradually increasing training volumes over a period of weeks rather than a dramatic increase in a short space of time. Evidently, the bone structure cannot tolerate the loading to which it is being placed under. Other factors which also contribute to this condition can be things such as poor running shoes with poor shock-absorption capabilities and biomechanical abnormalities. It has been suggested that foot arch dysfunctions, increased pronation and poor running mechanics are all factors in increasing risk of MTSS.

Treatment & Management

To date, there is no clear treatment for MTSS and is increasingly frustrating for athletes to manage. Most commonly, conservative management involves periods of rest from any aggravating activities that provoke pain. Other forms of off-feet conditioning can be used to maintain fitness over this time as long as symptoms are not provoked. Other physiotherapy tools such as ultrasound, massage, shockwave therapy and frictions have all been highlighted in the research, however, none have been proven to be more effective than another. If a biomechanical abnormality has been highlighted as a strict cause of shin splints, then this is the optimal time to work with your physiotherapist in correcting these changes while training is low. Once symptoms have initially subsided, a graded exercise program can be commenced to return an athlete to on-feet training as long as symptoms are minimized. Working alongside our highly trained physiotherapists and building a sound relationship with them is key to managing this condition. In very rare cases, surgical intervention is required but often does not lead to changes in pain or function in the long term.

If you have pain when exercising in the shin region, contact us today to help settle your pain, increase your strength and flexibility and to get you back out on the field, road or court, pain free.