Taking Advantage of A Cooler Run

For runners, one of the best things about a change of season is how it affects your run. Running in near perfect weather that Florida is known for this time of year gives us quite an advantage than our neighbors in the north. Take heed that comes with excessive running or jogging including shin splints. Read below steps how to avoid this injury.

The Best Rehabilitation Approaches for Overcoming Shin Splints.

Posted by Stephen Messineo on Fri, Jun 04, 2010 @ 09:16 AM 

During this time of year when people are running more outdoors for exericse, shin splints are an extremely common problem. Anyone who has ever suffered from shin splints will tell you how frustrating and painful it can be.

Shin splints are a general term used to describe pain at the front of the lower leg. There are a number of different causes of shin pain, the most common of which is due to irritation of the lower leg muscles, (particularly Tibialis Posterior and Soleus) at the point where they join onto the shin bone 

(1). This type of problem is sometimes also known as medial tibial stress syndrome (MTSS) and should be differentiated from other causes of pain which may be due to stress fractures of the tibia or neural/vascular problems.

Symptoms should be checked by an appropriately qualified health professional for clarification of diagnosis. The evidence to support or contest the recommended treatments for shin splints is poor.  A recent critical review of the available literature concluded that rest was as effective as any other treatment tested 

(2) . It could be argued however that this conclusion is more a reflection of the quality and range of studies undertaken as opposed to the actual value of treatments. 

Physical Therapists offer number of treatment options to patients in an effort to cure shin splints which include:

• Massage
• Ice
• Orthotics/Insoles
• Strengthening
• Calf Stretching
• Surgery (via referral to orthopedic surgeon)
• Rest

The primary aim of treatment is to relieve the inflammatory changes that have occurred at the muscular attachment of the lower leg muscles. Massage, ice and rest are all used to help achieve this goal. Stretching and the use of insoles/orthotics aim to decrease the load placed on the muscles and thus reduce the traction forces at their point of attachment onto the shin.

Strengthening can be used to increase the body's ability to cope with the stresses placed upon it. Strengthening should focus not only on those muscles local to the area, but also on those further up the leg and the ‘core'.

In extreme cases surgery can be useful to reduce the pain associated with shin splints. This however is not an option to be considered lightly full uninhibited return to sport is not always achieved (3).

Prevention is better than cure (and often is the cure!)

Whichever treatments are utilized the recurrence rate of shin splints is high. Unfortunately too many people stop running and enjoying the exhilaration of exercise because of their shin pain, this is often an outcome of poor advice and a failure to completely rehabilitate their initial injury. There is no ‘blueprint' for exercises to correct the causes of shin splints; an individualized programme is required. Positive results have been demonstrated in the use of custom made orthotics (2) (4).

Despite mixed reports in the literature regarding the ‘best' interventions for the treatment of shin splints, what does seem to be clear is that a multi-faceted approach should be taken (5). Not only should the treating clinician aim to reverse the inflammatory changes causing symptoms, it is also important to identify and correct the causative factors to prevent recurrence and increase recovery time.

With a methodical and graduated approach which includes structured training plans, education and advice regarding appropriate selection of footwear and training surface alongside manual therapy, it is possible to cure shin splints and prevent recurrence.

References

1. Bradshaw, C, Hislop, M and Hutchinson, M. Shin Pain. [ed.] P Brukner and K Khan. Clinical Sports Medicine. 3rd Edition. Sydney : McGraw Hill Medical, 2006.

2. Medial Tibial Stress Syndromme - A critical review. Moen, M H, et al. 7, 2009, Vol. 39, pp. 523-546.

3. Outcome of surgical treatment of medial tibial stress syndromme. Yates, B, Allen, MJ and Barnes, MR. 10, 2003, Journal of bone and joint surgery - American Volume, Vol. 85, pp. 1974-1980.

4. Medial Tibial Stress Syndromme - Evidence based prevention. Craig, D I. 3, 2008, Journal of athletic training, Vol. 43.

5. Comprehensive management of medial tibial stress syndromme. Knenner, B J. 3, 2002, Journal of chiropractic medicine, Vol. 1.