Shin splints
Shin splints | |
---|---|
Other names | Medial tibial stress syndrome (MTSS), exertional compartment syndrome[1] |
Treatment | Rest with gradual return to exercise[1][2] |
Prognosis | Good[2] |
Frequency | 4% to 35% (at-risk groups)[2] |
A shin splint, also known as medial tibial stress syndrome, is pain along the inside edge of the shinbone (tibia) due to inflammation of tissue in the area.[1] Generally this is between the middle of the lower leg and the ankle.[2] The pain may be dull or sharp, and is generally brought on by high-impact exercise that overloads the tibia.[1] It generally resolves during periods of rest.[3] Complications may include stress fractures.[2]
Shin splints typically occur due to excessive physical activity.[1] Groups that are commonly affected include runners, dancers, gymnasts, and military personnel.[2] The underlying mechanism is not entirely clear.[2] Diagnosis is generally based on the symptoms, with medical imaging done to rule out other possible causes.[2]
Shin splints are generally treated by rest followed by a gradual return to exercise over a period of weeks.
Signs and symptoms
Shin splint pain is described as a recurring dull ache, sometimes becoming an intense pain, along the inner part of the lower two-thirds of the tibia.[4] The pain increases during exercise, and some individuals experience swelling in the pain area.[5] In contrast, stress fracture pain is localized to the fracture site.[6]
Women are several times more likely to progress to stress fractures from shin splints.[7][8][9] This is due in part to women having a higher incidence of diminished bone density and osteoporosis.[10][citation needed]
Causes
Shin splints typically occur due to excessive physical activity.[1] Groups that are commonly affected include runners, dancers, and military personnel.[2]
Risk factors for developing shin splints include:
- Flat feet or rigid arches[1]
- Being overweight[3]
- Excessively tight calf muscles (which can cause excessive pronation)[11]
- Engaging the anti-pronatory (supinating) muscles in excessive amounts of eccentric muscle activity[7]
- Undertaking high-impact exercises on hard, non-compliant surfaces (such as running on asphalt or concrete)[7]
People who have previously had shin splints are more likely to have them again.[12]
Pathophysiology
While the exact mechanism is unknown, shin splints can be attributed to the overloading of the lower leg due to biomechanical irregularities resulting in an increase in stress exerted on the tibia. A sudden increase in intensity or frequency in activity level fatigues muscles too quickly to help shock absorption properly, forcing the tibia to absorb most of the impact. Lack of cushioning footwear, especially on hard surfaces, does not absorb transmitting forces while running or jumping.
Diagnosis
Shin splints are generally diagnosed from a history and physical examination.[3] The important factors on history are the location of pain, what triggers the pain, and the absence of cramping or numbness.[3]
On physical examination, gentle pressure over the tibia will recreate the type of pain experienced.[12][18] Generally more than a 5 cm length of tibia is involved.[12] Swelling, redness, or poor pulses in addition to the symptoms of shin splints indicate a different underlying cause.[3]
Differential diagnosis
Other potential causes include
Treatment
Treatments include rest, ice, and gradually returning to activity.
Less-common forms of treatment for more-severe cases of shin splints include extracorporeal shockwave therapy (ESWT) and surgery.[21] Surgery does not guarantee 100% recovery, and is only performed in extreme cases where non-surgical options have been tried for at least a year.[22]
Epidemiology
Rates of shin splints in at-risk groups are 4% to 35%.[2] Women are affected more often than men.[23][24]
References
- ^ a b c d e f g h i j k l Alaia, Michael J. (August 2019). "Shin Splints". OrthoInfo. American Academy of Orthopaedic Surgeons. Retrieved 15 November 2020.
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- ^ Healthwise Staff. (7 December 2020). Low bone density. University of Michigan Health. Retrieved 26 June 2021, from https://www.uofmhealth.org/health-library/tp23004spec
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- ^ S2CID 40720414.
- ^ a b De Permentier, Patrick (2014). "An Anatomical and Physiological Evaluation of the Periosteal Layer Surrounding Bone and Its Implication in Massage Therapy". Journal of the Australian Traditional-Medicine Society. 20: 272–277.
- ^ PMID 18523568.
- ^ PMID 19809896.
- ^ Lobby, Mackenzie (9 September 2014). "Running 101: How To Select The Best Pair Of Running Shoes". Competitor.com. Archived from the original on 13 September 2014.
- ^ "Shin Splints Symptoms, Treatment, Recovery, and Prevention". WebMD.
- ^ S2CID 1736230. Archived from the original(PDF) on 12 February 2019.
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