Pain in the leg

By Kim O’Leary

Do you ever wonder what the term ‘shin splints’ means?

Shin splints has been widely used as a catch-all term referring to a collection of different conditions that cause lower leg pain.

The term Medial Tibial Stress Syndrome (MTSS) better defines this injury, and separates it from injuries such as stress fractures or compartment syndrome.

Major causes of MTSS are:

  • Flat feet
  • Calf tightness
  • Old shoes or shoes that offer poor support
  • A rapid increase in training workload; either in speed or distance

MTSS is the most common presentation of lower leg pain, with pain localized to the inner portion of the tibia in the middle/lower thirds of the lower leg and the surrounding soft tissue.

Despite being the most common lower leg complaint, MTSS is often a common misdiagnosis for similar conditions such as stress fractures or compartment syndrome.

It is important to remember that stress fractures can also give you leg pain. It often follows as a result of shin-splints that have not been managed correctly, or when a patient tries to “run-through” the problem. This is why it is important to manage MTSS correctly.

Common signs of MTSS:

  • Aching along the front of the shin with physical activity: the pain may begin as a dull aching sensation after running. The aching may become more intense, even during walking, if ignored
  • Pain along the inside (medial) part of the lower leg
  • Pain that develops gradually over weeks/months
  • Swelling in the lower leg
  • Small bumps along either side of the shin bone

How to manage shin splits:

Initially you can manage it with rest, ice and anti-inflammatories (ie nurofen, voltaren). Physiotherapy at this stage will involve ultrasound, light massage, and education with guidelines into exercise intensity and frequency. This aims to settle and relieve the inflammatory process, and thereby relieve symptoms.

After this initial period, more intense physiotherapy can be commenced. This usually involves deep tissue massage, Myofascial releases, muscle frictions, structure rehab programs to increase flexibility, strength and endurance, as well as gradual recommencement of normal activities.

Throughout rehabilitation, your physiotherapist will advise you on continuing aerobic fitness activity, however it will likely be modified to reduce lower limb impact (ie. activities such as swimming, orbital training, beach walking/running).

In conclusion:

MTSS can be painful but it is usually easily resolved. If you experience pain in your shin:

  • Thoroughly stretch before exercising, reduce your activity level, and check your footwear
  • If you run on a hard surface, find some softer ground to train on
  • Avoid training errors (ie. ‘start low and go slow’)
  • Introduce gradual changes in intensity, activity, and terrain
  • Maintain adequate calf and anterior tibial flexibility, strength, and endurance.

Happy Running!

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