by Hamid L. Sadri, DC, CCSP, ICSSD, CSCS, CKTP, CES, PES
A commonly seen condition in our clinic is what most people refer to as shin splints. The term itself is a general one, not considered to be a diagnosis, describing pain along the inside or outside of one, or both legs. It is usually an overuse syndrome that is brought on by repeated impact activities such as running, jumping, dancing, basketball, volleyball, gymnastics, or various other activities that involve repeated forceful contractions of the front or back leg muscles.
Perhaps the most frequent presentation of this condition is found in long distance runners and endurance athletes. The symptoms begin to present themselves gradually and if not handled properly, can become constant. Usually, there is leg pain that is experienced shortly after the offending activity begins. The pain, during the initial stages, may actually subside as the athlete continues with the activity. With time the pain will last longer into the activity and become more pronounced. It, however will typically subside once the activity ceases. As the condition worsens, the symptoms may continue to be present for longer time periods, even being present at night. At this stage it will usually prevent the individual from engaging in their activity as the symptoms will be rather severe.
The true cases of shin splints usually will involve either the anterolateral (front) or the posteromedial (inside) part of the leg. If anterior, it will typically involve the Tibialis Anterior muscle, and if medial, the Tibialis Posterior, Flexor Digitorum Longus, or the Soleus muscles will be involved. Some of the other conditions that result in similar symptom patterns include acute compartment syndrome, deep vein thrombosis, thrombophlebitis, intermittent claudication, and stress fractures. A proper differential diagnosis is essential as the management of these conditions differs and the outcome is dependant upon an accurate diagnosis.
Several factors may contribute to the development of this condition. Leg length inequality, overpronated foot, improper footwear or worn out shoes, inappropriate increase in the amount of training, inadequate rest, tight or weak anterior or posterior leg muscles, excessive running on hills or hard (concrete is worst) surfaces are a few of the most common causes that predispose the individual to the development of shin splints. The symptoms will typically be caused by either myofasciitis (involving the muscle and its surrounding fascia), tendonitis (inflammation of the tendon), or periostitis (inflammation along the outer layer of the bone, in this case, usually the Tibia). When anterior, the symptoms are usually in the upper part of the leg, and when posterior, the pain will usually be in the lower 1/3 of the leg. There may be pain or painful nodules found when pressure is applied in those areas as well as pain with stretching of the involved muscles. Frequently, when the patient presents in the office, they will have a combination of some or all of the above.
As is typical and necessary in treating this and any other condition of this type, there are three main elements that the treatment will focus on. First is the resolution of symptoms; second is the determination of the cause of the symptoms and its correction; and finally the factors that will help the patient prevent its reoccurrence. If anatomical deviations (short leg, overpronation, gait variances, etc.) are detected, they must be corrected accordingly. These will usually require heel lifts or proper orthotics and or shoes. During the acute phase of the condition cessation of the offending activity is the most important element. Periodic repeated intervals of icing to the areas of pain will be most helpful in rapid reduction of symptoms. Gentle pain free stretching should be started as soon as possible and as tolerated. If walking or performance of other daily activities is difficult, taping of the leg or elastic bracing may prove somewhat beneficial. Anti-inflammatory medications have been known to provide some relief during this stage as well. Some of the therapeutic modalities used, which have been found to be beneficial include interferential current, high volt galvanic, therapeutic ultrasound and microcurrent.
Once the acute phase has subsided, soft tissue treatments such as Graston Technique and Active Release Techniques have been shown to produce rapid resolution of the adhesions that typically form within the above referenced muscles and fascia. Some of the other methods of treatment, although unable to produce results as fast as the other two methods mentioned above, may include myofascial trigger point therapy, deep tissue and cross friction massage. Once the soft tissue adhesions have been satisfactorily resolved, a rehabilitation program consisting of targeted stretching and isolated strengthening routines for the leg muscles needs to be started. There should be a warm up period prior to the start of the exercise session followed by stretching (and icing of the front or back of the leg) for the cool down when the session is finished. Other areas such as the quadriceps, hamstrings, hips, and the core muscles may need to be evaluated and included in the exercise routine. As the patient is able to tolerate the intensity of the exercise routines, they will continue to become more challenging in nature. Gradually the patient is returned to sports related activities and the training is increased incrementally (remember the 10% rule = no more than a 10% increase per week in the amount/distance of training) to help return the patient to the desired level of physical activity. Routine and regular stretching and strengthening of the leg muscles must continue after the treatment has ended in order to prevent reoccurrence of the symptoms. Proper warm up and cool downs are essential to prevention and must be observed.
As always and in all conditions, early diagnosis and appropriate treatment produces the best results in the shortest amount of time.
Atlanta Sports Chiropractor, Dr. Hamid Sadri has been practicing in Decatur, GA for 28 years and specializes in athletic injuries and rehab. The clinic, 1st Choice Sports Rehab Center, was named “The Best Sports Injury Center in the Southeast” by Competitor Magazine. To subscribe to our newsletter click here. To schedule an evaluation, call 404-377-0011.