Athletic Training Column

Got shin pain?

By Jenn Mroz | Sep 05, 2013
Photo by: File Jenn Mroz

Throughout my long career, I’ve been asked numerous questions about shin splints.  This catch-all term is used frequently for all shin pain.  Today’s column will discuss some of the causes of shin splints, how to prevent them, and how to treat them.  David Hollowell, a physical therapist with the rehabilitative services at MedWest Haywood, will be joining me in sharing his expertise on this topic.
Shin splints don’t discriminate:  they can happen to any athlete in any sport.  With that being said, there are some sports and activities that have a higher rate of shin splints than others.  Runners, whether long-distance or sprinters, commonly suffer from shin splints.  Sports like volleyball and basketball, where there is a lot of jumping and landing on a hard surface, see a high incidence of shin splints as well.  The most recognizable symptom is a dull-ache pain in the shin area, more commonly seen on the medial, or inside, part of the lower leg.  In the beginning stages, pain may only occur after activity, but if not treated, the pain may progress to both during and after activity, and then all the time.
Two other injuries that need to be of concern, especially for someone with chronic (long-term) shin splints, are stress fractures and anterior compartment syndrome.  Stress fractures are found in the larger lower leg bone called your tibia, which is the main weight-bearing bone in your shin.  One way to differentiate a stress fracture from shin splints is the size of the area where pain is.  If an athlete comes in complaining of shin pain, I always ask for the range of where the pain is located.
If the pain area is the majority of the shin, it’s shin splints.  If the pain area is the size of a quarter, a stress fracture is more likely the diagnosis.  Anterior compartment syndrome occurs when the swelling in the shin compresses the nerve and causes numbness or tingling in the shin that can radiate into the foot.  It is important to note that both of these injuries should be evaluated by a physician.
There are several theories of what causes shin splints.  Hollowell explains, “the most common cause is typically over-training in regards to doing too much, too fast, without building up a base level of activity.  
Often times high school athletes go between seasons doing very little activity and then return to their given sports without the base conditioning they need to start high level practices.  This is most commonly seen with cross country and track where off season workouts are not as mandatory and kids show up just to try.”   
“Most of the time,” continues Hollowell, “for the novice athletes in the community (weekend warriors), I think it comes down to over activity and shoes.  If someone were to start running for exercise or playing another recreational sport they need to slowly build their way up and assess the type of shoes they are wearing (purpose of the shoe vs. style and colors).”
So, by gradually increasing the length and intensity of the workouts, and wearing the proper footwear, shin splints (as well as other injuries) can be avoided.  
Another common cause that I see frequently is a muscle imbalance between the large bulk of the calf muscles and the smaller muscles of the shin.  When the calf is tight, the smaller shin muscles have to work harder to pull the toes up during walking or running, resulting in pain and inflammation in the shin.  Stretching the calf properly and regularly can eliminate this problem.  Hollowell says that most athletes spend time stretching the hamstrings and quads, but often neglect the gastroc (calf).
What should you do if you think you have shin splints?  Well, the first thing I tell all of my athletes is to ICE!  One of my favorite sayings is “ice is your friend.” Ice bags (or frozen peas) work, but I like ice massage better for shin splints.  Fill paper cups with water and freeze; then peel the edge off and massage the ice over the shins for about 10 minutes.  Stretch the calf muscles.  Rest is a good idea, but not always possible; ease up on intensity or cut back on distance/length until symptoms resolve.  I use a taping technique that helps compress the shin, but calf support sleeves are a much more convenient method.
Physical therapy will also help, not only in reducing symptoms, but also in determining what may be causing them.  “In therapy I would start with an assessment of what might be causing the symptoms to occur, such as overuse, poor biomechanics, muscle imbalance or footwear, and then try to address those issues.  
Often times with some basic strengthening of the ankle, foot and hip, combined with education on proper footwear, these symptoms resolve quickly.  The focus of the exercises is often to control the biomechanics, which can make a world of difference in their symptoms and overall ability to perform a given sport,” explains Hollowell.
Shin splints are a common injury for the seasoned athlete to the weekend warrior, but steps can be taken to prevent them.  Early recognition and treatment can allow for continued enjoyment of the sport or activity.
Next time I’ll discuss often misunderstood battle of when to use ice or heat for an injury.  
Until then, play safe!