Shin Splints


 

What is a Shin Splint?

A shin-splint is the most common cause of exercise-induced leg pain encountered by athletes of all levels. It is commonly used as a “garbage can” term to include a variety of exercise-induced leg pathologies but actually represents a very specific problem. It is essentially an inflammatory reaction involving the connective tissue of the leg (called the deep or crural fascia) at its insertion into the inside (medial) or front (anterior) aspect of the leg bone (tibia).

Thus “tibial stress syndrome” is the common medical term used to refer to this condition though many prefer the term “tibial fasciitis” because it specifically implicates the deep fascia as the etiologic anatomic structure involved. This condition needs to be differentiated from other common and uncommon causes of leg pain as the correct diagnosis will dictate treatment. Treatment for shin-splints can vary depending on the location (medial vs anterior), duration and severity of the problem. Listed below is a comprehensive four stage initial treatment program that has met with excellent success. It is important to complete all four stages of the program to obtain a more predictable result. If the response to this program is not favorable then the re-evaluation of the patient is indicated. If the diagnosis remains firmly established, additional (more aggressive) treatment measures may need to be considered.

Tibial Fasciitis Initial Treatment Program

Note: depending on the severity of the problem the acute phase can be bypassed but should always be considered especially if clinical symptoms are significant. When palpation of the involved shin area exhibits minimal to no discomfort the rehabilitation phase can be initiated.

Note: when the patient can complete these exercises without symptoms then the functional phase can begin. The techniques used to decrease scar formation can initially exacerbate the condition, especially when using ASTM.

  • PHASE 1- Acute Phase:
    Goal: Decrease acute pain & inflammation

    • Absolute rest (NWB with Crutches) or relative rest (WB with boot).
    • ‘ICE’ – ice, compress, elevate.
    • NSAIDS.
  • PHASE 2- Rehabilitation Phase:
    Goal: Further decrease pain and inflammation

    • Physical Therapy –ultrasound, phonophoresis, neuroprobe, contrast baths, decrease scar/message, ASTM
    • Maintain/increase the flexibility of tissue – active>passive joint ROM, strengthening.
    • Strengthen fascial to the bone interface – open to closed chain therapeutic exercise
      (isometric>insometric>isokinetic)
  • PHASE 3- Functional Phase:
    Goal: Functionally strengthen fascial/bone interface

    • Open to closed chain exercises, plyometric training (trampoline>jump rope>vertical jump)
    • Protect injured area during functional activity with shin taping, neoprene shin sleeve, leg bracing, appropriate shoe gear

    Note: this is probably the most important phase because it prepares the patient for their return to activity. Care needs to be taken at this stage not to allow the patient to overdo these exercises and stay within their limits as re-injury can easily occur.

  • PHASE 4- Return To Activity
    Goal: Return to desired sport activity

    • Gradual, systematic ‘to tolerance’
    • Preventive strategies with an orthosis, shoegear selection, functional exercise (pilates, plyometrics)

Note: There is an approximate one month window after the patient returns to their activity where the chance of re-injury is great.
Patients must realize their limits and be patient.

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