1. Shin Splints

Shin splints are a common condition that occurs as a result of physical activity.

Shin splints, also known as Medial Stress Syndrome (MTSS), are very common among runners who recently increase the intensity of their exercises or who modify their training schedules.

They are caused by strained and torn tendons because of weak or inflexible calf muscles having too much stress placed on them.

Increased physical activity causes overuse of muscles, tendons, and bone tissue which can result in muscle and tendon fatigue, especially if you are just starting a fitness routine.

2. Anatomy of Shin Splints

A shin splint is a term used to describe pain along the shin bone (tibia). It is the huge bone at the front of your lower leg known as the fibula.

The tibia and fibula are the two bones that make up the structure of the lower leg. The periosteum (outer layer of the bone where the muscles attach) along the inner section of the tibia can be affected by MTSS. These muscles primarily help stabilize the lower leg and foot, as well as help you push off when running. Repetitively exerting muscles in the periosteum results in inflammation and pain.

The tibialis anterior and posterior muscles are frequently exerted, meaning the area attaching these muscles can also be the source of pain. MTSS is frequently linked with muscle imbalance and inflexibility, such as your muscles tightening.

3. Pathophysiology of Shin Splints

• Anterior
• Posterior
• Lateral
• Superficial posterior

3.1. Anterior

Anterior shin splints are a condition that affects the anterior tibial muscle and tendon, causing pain at least four to five inches across the frontal (anterior shin splint), depending on the severity. As a consequence of overworking the anterior, there is an increasing probability of compartment syndrome or stress fractures.

3.2. Posterior

Posterior shin splints are a condition that affects the posterior tibia muscle and tendon. They can occur anywhere from one to six inches across the posterior to the medial malleolus or the medial ankle bone, depending on the severity. For younger runners, it is most often caused by micro-tears in the muscle or connected muscle fibers on the bone referred to as periostitis (bone origin of muscle fibers).

3.3. Lateral

Lateral shin splints are a frequent issue among runners. Lateral shin splints are usually caused by stress and inflammation in the anterior tibialis muscle and the muscle compartment at the front of the leg.

3.4. Superficial posterior

The gastrocnemius and soleus muscles are found in the superficial posterior of the ankle and are mostly affected due to excessive plantar flexion (movement).

4. Symptoms and Causes

4.1. Symptoms

Shin splints are a common complication following a sudden increase or decrease in physical activity. The activity usually consists of a high-impact, repetitive workout that works your lower leg muscles.

• The intensity of the damage is determined by several factors and the level of exercise performed. Pain only occurs during activities in the early stages and tends to disappear after a short rest.
• As the condition worsens, exertion causes more pain and the discomfort lasts long after the activity is ceased. In the third stage, the pain might occur even while the person is at rest, indicating a more serious condition.
• Pain at the tibial border is the most common symptom of shin splints. Swelling in the affected area is also possible. Both during and after an exercise, shin splint pain can be intense and razor-like or dull and aching. Touching the sore area can make it worse.

If the symptoms persist, the amount of time spent running should be reduced or terminated. It is also recommended you get an appropriate medical examination to identify any stress fractures. As an adjunct to physical therapy, anti-inflammatory medications may also be taken to alleviate pain.

4.2. Causes

If you do any of the following, you are more prone to developing shin splints:

• Having flat feet or foot arches that are extremely stiff.
• Running on hills.
• Increasing the intensity of an exercise or increasing the distance traveled.
• Exercising with a lot of stops and starts.
• Wearing worn-out shoes.

Other common causes include:

Stress Imbalance:

Shin splints usually affect one leg at a time rather than both. The strains associated with running or other workouts can result in an imbalance between the muscles in the front and back of the leg.

Chronic Exertional Compartment Syndrome:

Chronic exertional compartment syndrome is a rare illness that causes symptoms similar to shin splints. Compartment syndrome is a painful condition that occurs when muscular pressure rises to dangerous levels.

Stress Fractures:

A disruption of the periosteum causes stress fractures in the tibia or calf muscles. During rehabilitation, your condition usually improves after six weeks of rest.

Jumping Rope:

Jumping rope puts all of your body weight on your knees and ankles. Putting too much strain and pressure on your lower leg and shin without taking a break, warming up, or switching between different activities can result in injury.

Tendonitis:

Tendonitis can affect any of the tendons that span the ankle, although the posterior tibial tendon tends to get injured the most. Running on uneven surfaces with one ankle in constant rotation increases the risk of injury.

5. Treatments

Shin splints often heal on their own. Unfortunately, there is no way to predict when leg pain will go away completely. It all depends on what caused the injury in the first place. Following the onset of pain, immediate rest is advised.>

5.1. Nonsurgical Care

• Use ice on your shins
• Warm up your muscles by stretching them.
• Wear arch supportive orthotics. Go to a running shoe store and ask for help matching your foot size to an appropriately-sized running shoe.
• Allow your muscles and bones to recuperate between activities.
• Avoid running on hard, uneven, or hilly surfaces. If you run frequently, consider adding low-intensity workouts (like swimming) to your routine to relieve your legs of excess strain.
• Steadily increase your level of activity and the intensity of the exercise. Avoid rapid bursts of activity. Stick to the 10% to 15% guideline and don't increase your activities past this per week.
• If you have shin pain, limit your activities until it goes away. Avoid pushing through pain.
• Take over-the-counter medication to relieve your pain.

If your shin splints don't improve within a few weeks or if they reappear, your doctor may recommend you consult a physical therapist. They can address any problems with your legs that may be contributing to the problem.

It is, nonetheless, good to work with a physical therapist before returning to exercise.

5.2. Intensive Care

Only a small percentage of people with shin splints require surgery. Surgery is only necessary for the most severe cases where non-surgical treatments have failed.