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Scott Drum, Ph.D, FACSM Wednesday, 28 December 2011 07:45 TWEET COMMENTS 3

What's That Thorn in My Shin? - Page 2

Defining Shin Splints

According to a case study by Dr. Bernard J. Krenner, DC, a chiropractor in Woodbury, Minnesota, "shin splints" is any lower leg pain as a result of activity. Probably the most widespread cause of shin splints is medial tibial stress syndrome (MTSS), a hard-to-define condition with many possible causes, such as repetitive motion involving impact forces. Hmm ... sounds like running. MTSS is often associated with early season downhill running or progressing too fast in training (e.g. upping weekly running mileage too quickly on rugged terrain).

Dr. Debbie Craig, PhD, ATC, of Northern Arizona University in Flagstaff, describes MTSS as "one of the most common leg injuries in sports," accounting for up to 50 percent of lower-leg running injuries. Dr. Craig emphasizes that "experts do not agree upon the cause of MTSS," as studies thus far have been limited and inconclusive.

Shin splints can arise acutely, become sub-acute and trend toward becoming chronic if not properly treated. In extreme cases, surgery, such as a posterior fasciotomy (incision through fascia surrounding a muscle), may be warranted but is never a guaranteed cure. If you begin to feel shin pain on either side of your tibia, including posterior discomfort, from running, get the problem diagnosed right away.

"I'll see a sudden increase in shin splints at two major times in Western State College of Colorado distance runners," says Tim Poppe, MPT, Clinical Director of Physiotherapy Associates in Gunnison-Crested Butte, Colorado, "once at the start of cross-country season after summer training and again at the start of track season after winter break." Poppe, of course, is blaming a sudden increase in mileage at both times as a possible cause of shin splints.

Diagnosis

According to Drs. Robert Galbraith and Mark Lavallee, sports-medicine physicians from South Bend, Indiana, "a thorough history and physical exam are usually sufficient to make the diagnosis of MTSS." An athlete will most likely feel pain on the medial-posterior region around the shin, especially when palpated by a clinician and, according to Janine Pleau, ATC, at Western State College of Colorado, "high-impact-sport athletes may also feel pain around the lateral or anterior area of the shin, but by far the most common symptom of `shin splints' is in the medial tibial region."

The pain may persist during training along with noticeable swelling afterward. If a shin-splint sufferer does not improve with conservative treatment, imaging tests, such as X-ray, bone scan or magnetic resonance imaging (MRI) tests may be warranted in order to rule out stress fractures or other issues.

Treatment

Conservative shin-splint treatment consists of rest, ice and analgesics (e.g. ibuprofen) during the acute phase, normally lasting a few weeks to a year, according to Poppe. "If I diagnose a runner with early onset shin splints, I may shut them down completely if the tibial region is really inflamed," says Poppe. "Then it's time for iontophoresis (a way to electrically propel a drug across the skin barrier), ice, possibly soft-tissue mobilization or massage and NSAIDS."



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