Shin Splints – or Something Else?
Written by Joe Ekhoff, Head AT, Mountain Vista High School
Lower leg pain is a common problem plaguing many athletic training rooms this spring. I know I have my fair share of athletes coming in complaining of “shin splints.” Shin splints is often a catch-all term used to describe a broader range of potential injuries. There are a number of injuries that present themselves in very similar ways and are often hard for athletes to differentiate on their own. Go see your athletic trainer. We may be able to tell you if your lower leg pain is just “shin splints” or exertional compartment syndrome, stress fractures/reactions, or tendonitis.
Medial tibial stress syndrome (MTSS), or “shin splints,” is the most common of the overuse lower leg injuries. It is characterized by pain in the front part of the lower leg that worsens with activity. MTSS occurs when the muscle and bone tissue of the lower leg become overworked by repetitive activity. A key differentiating factor in MTSS is that it is more of a diffuse pain with no point any more tender than the rest, usually covering over a third of the tibia. With stretching, strengthening, icing, and modification of activity, MTSS usually resolves fairly quickly.
Stress fractures or stress reactions occur when repetitive microtrauma to the bone causes excessive stress, preventing the bone from rebuilding properly. Athletes often present with pain on the bone while running. The difference between stress fractures and MTSS is there is one specific point of tenderness and pain over the bone. This is an injury that requires physician referral. X-rays may not show any abnormalities, so often MRI and bone scans are necessary. If an athlete has a stress fracture, they must stop activity and are often placed in a boot. Non-impact cross-training may be performed if it does not cause pain. Most athletes complete a return to sport program 6-8 weeks later.
Chronic exertional compartment syndrome (CECS) is a lesser known injury to the lower leg that can be debilitating to athletes. During exercise increased blood flow to working muscles of the lower leg expand. If the fascia surrounding the compartment does not allow the swelling to occur, pressure builds up in the compartment. This pressure can cut off some of the muscle’s blood supply. This results in the athlete having pain and numbness in the lower leg. Most athletes with CECS report that at a certain point in activity, pain occurs and becomes progressively worse, often to the point of needing to cease activity. Once activity is stopped symptoms often resolve quickly. The only way to diagnose CECS is by measuring the pressure of the compartments in the lower leg. To do this the athlete must go to a specialist. To measure the pressure, needles are inserted into the compartments at rest, immediately following activity, and at rest. Conservative treatment for CECS include stretching, strengthening, massage, and modification to the athlete’s running form.
The lower leg is made up of many muscles that provide movement, stability, and proprioception to the foot and ankle. Common sites of tendinitis are the posterior tibialis, peroneals, and Achilles. Tendonitis of the posterior tibialis is the most likely to mimic MTSS. Inflammation of this tendon causes pain when the muscle is stretched and contracted. Overpronation, when the inside of the foot collapses inward toward the ground while standing, is a common stressor to the posterior tibialis tendon. Modification of activity intensity, stretching, strengthening, and orthotics help reduce the pain of the tendinitis.
Keep these other injuries in mind as you are out participating in your sport!
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