Another winter has come to pass here in Kansas, and thankfully, we are all headed back outside to enjoy the sun and warm air. It’s usually this time of year that many of us get our running shoes out of the closet to hit the road or track for a brisk walk or jog. As a Sports Medicine doc, I sing the praises of exercise daily, so I love seeing our great city active again. Unfortunately, I also know that along with a renewed commitment to exercise often come aches and pains.
Injury is a part of exercise and sports, and our legs tend to take a beating. Chronic lower leg pain is common in both competitive and recreational athletes, and one of the more common causes athletes endure is shin splints.
What are shin splints?
Shin splint, known in the medical field as medial tibial stress syndrome (MTSS), is a common cause of exercise-induced lower leg pain. It is typically seen in sports that require running and jumping regularly, such as jogging, track and field and soccer. People with MTSS usually complain of pain along the inside of the shin bone near the calf muscle. As the calf muscles contract, they pull away from that shin bone, which sometimes leads to periostitis, the root problem of MTSS. Periostitis simply means inflammation of the periosteum, the tissue that connects the muscles to the shin bone.
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▪ Diffuse pain along the inside of the shin bone where it meets the calf muscle
▪ Limited ability to continue to exercise at the same intensity or distance as usual because of the pain
▪ Pain that is worse with exercise, and gets better with rest, but can persist for days
Not everyone who runs develops MTSS, but there are a few risk factors that increase the likelihood of developing the problem:
▪ A change in exercise routine
▪ Taking on a new activity, like jogging
▪ Relative inactivity for a period of time (wintertime, for example) followed by a jump back into exercise full bore
▪ Increasing the intensity or distance of exercise
▪ Being female. Up to 35 percent of female runners experience MTSS at some time in their running career.
▪ Above average body mass index (BMI)
▪ Weight gain
▪ Orthotic use
▪ Certain biomechanical problems with the legs and feet
Usually, MTSS can be diagnosed in the clinic by a health care provider well-versed in orthopedic issues, such as a primary care physician, Sports Medicine physician, or orthopedic surgeon. The provider will examine the patient’s legs for swelling, bruising and tenderness, and should also examine the foot structure and gait of the patient.
Anytime someone is seen for lower leg pain, a stress fracture should be considered as a possible cause. Occasionally, it is difficult to determine if the pain is from a MTSS or a stress fracture and an x-ray may be helpful. Rarely is an MRI or bone scan needed to help make the diagnosis.
Other causes of lower leg pain include:
▪ Chronic exertional compartment syndrome – an exercise-induced muscle and nerve condition that is often accompanied with pain, tightness or numbness in the lower legs
▪ Tendinopathy – an overuse injury to a tendon leading to tiny tears in the connective tissue in or around the tendon causing pain
▪ Arterial or nerve entrapment syndromes – nerve or tissue injury that results in pain and lost function
Treatment for MTSS
▪ Rest followed by a gradual return to activity when pain free
▪ Ice or ice massage along the affected area
▪ Pain medications, such as anti-inflammatories and acetaminophen, can be helpful for the pain
▪ Physical therapy is a good idea, especially if there are strength or flexibility issues found on exam. Certain physical therapists specialize in running gait analysis, and it is worth asking the provider if that is a resource in your area, as this type of evaluation can be extremely beneficial in identifying issues that predispose an athlete to developing this problem
▪ Devices like orthotics, lower leg compression sleeves, or taping can be considered
Of course, the best way to deal with MTSS is to avoid it all together. Naturally, this is not always possible, but certain training strategies can help diminish your risk.
▪ Avoid quick changes in training regimens in terms or distance of intensity. A gradual return to activity after a sedentary period is extremely important, as the body takes time to adapt.
▪ Rotate running shoes out every 300 to 500 miles; this has been associated with a lower injury risk.
Kyle Goerl is a sports medicine and family medicine physician for Via Christi Clinic on N. Emporia and the associate director for KU School of Medicine-Wichita Sports Medicine Fellowship & Family Medicine Residency.