Medial Tibial Stress Syndrome (Shin Splints)

Medial Tibial Stress Syndrome (Shin Splints)
Kayla Fulghum, ATC
Hughston Athletic Training Fellowship

What are they?
Medial Tibial Stress Syndrome, or shin splints, is a term that has been used to refer to pain in the lower leg. Conditions such as muscle strains and stress fractures have been given the term shin splints. Most people who develop shin splits are involved in sports which involve running. Shin splints are more commonly seen in sports such as track, cross country, basketball, and gymnastics, as the athletes run or pound on hard surfaces both during competition and at practice.

How common are they and what leads to shin splints?
Shin splints account for about 10 to 15 percent of all running injuries. It has also been found that up to 60 percent of all conditions that cause leg pain in athletes have been contributed to shin splints. There are many factors that can contribute to shin splints.

  • Having weakness in the muscles of the leg
  • A tight heel cord
  • Having shoes that provide little support or cushioning
  • Training errors such as running on hard surfaces or overtraining
  • Abnormal foot pattern (could be slightly tilted in or out when walking)

Signs and Symptoms
There are different categories to classify shin splits depending on when the pain arrives. The different grades are as follows:

  • Grade 1 – Pain occurring after athletic activity
  • Grade 2 – Pain occurring before and after athletic activity, but does not affect the performance of the individual
  • Grade 3 – Pain occurring before, during, and after athletic activity and does affect the performance of the individual
  • Grade 4 – Pain that is so severe that performance in activity is impossible

Treatment/Management
Immediate management for an individual with shin splints is to have a physician rule out a possible stress fracture in the bone, which can cause serious consequences if left untreated. Next, it is imperative to modify activity. For example, a cross country runner can do cardiovascular exercises in the pool to take pressure off of the legs. Most of the time, a break in activity or modification of training techniques will help eliminate the problem.

If the problem is occurring from an abnormal foot pattern, custom made foot orthotics (insoles) will aid in correcting it. Another treatment technique that can be utilized is stretching. Stretching the calf muscles is a good way to help relieve tightness that may be causing the pain in the front of the leg.

In addition to stretching, all athletes with lower leg pain can use ice massage. The ice along with the massaging technique helps deliver cold to the area and allows for pain management by numbing the area and reducing inflammation (or swelling). The best way to make an ice massage tool is to do the following:

  1. Take a small or medium paper cup (i.e. Dixie cup)
  2. Fill the cup with water but do not overflow the cup
  3. Put the cup of water in the freezer
  4. Remove the cup of water after it has frozen
  5. Peel away the top of the cup until the ice is exposed
  6. Take the exposed ice and gently massage the area on the front of the leg
  7. Massage the area for 5-15 minutes until the area is numb
    1. Cold creams or gels (i.e. Biofreeze or Mineral Ice) can also be used in conjunction with the ice massage and allows for deeper treatment
  8. Repeat steps 1-7 every hour or when pain occurs

References
Prentice, William. “Arnheim’s Principles of Athletic Training: A Competency-Based Approach” 2003 McGraw-Hill

Kayla Fulghum, ATC is a second year graduate student and recipient of the Hughston Athletic Training Fellowship in Columbus, Georgia. She graduated Magna Cum Laude from Valdosta State University with a Bachelor of Science Degree in Athletic Training/Sports Medicine.

While at VSU she served as President of the Student Athletic Trainers Association, received the Outstanding Senior Major Award for the Athletic Training Department and the Kinesiology, Health and Physical Education Department, and was named the Outstanding Clinical Student from 2004-2005.

She is an active member of the National Athletic Trainers Association (NATA) and currently serves as the Head Athletic Trainer at Columbus High School.