Shin splints , also known as medial tibial stress syndrome ( MTSS ), defined by the American Academy of Orthopedic Surgeons as "internal pain sharp edges of the shin. (tibia). "Shin splint is usually caused by recurrent trauma to the connective tissue of the muscles surrounding the tibia. They are common injuries affecting athletes involved in running sports or other forms of physical activity, including running and jumping. They are characterized by general pain at the bottom of the foot between the knee and ankle. The wounds of Shin splints are typically located in the middle to the lower third of the anterior or lateral portion of the tibia, which is larger than the two bones consisting of the lower leg.
Shin splint is the most common lower leg injury and affects various individuals. It affects most runners and accounts for about 13% to 17% of all run-related injuries. Middle school age runners see shin splints injury rate of about 13%. Aerobic dancers are also known to have shin splints, with injury rates as high as 22%. Military personnel undergoing basic training experience an injury rate of 4-8%.
Video Shin splints
Signs and symptoms
Shin splint pain is described as a blunted, recurring pain along the inside of the two thirds of the lower part of the tibia. In contrast, stress fracture pain is localized to the fracture site.
Biomechanically, over-pronation is a common factor in shin splints and action must be taken to improve the biomechanics of the gait. Pronation occurs when the medial curve moves downward and toward the midline of the body to create a more stable contact point with the ground. In other words, the ankle rolls inward so that more arches have contact with the ground. This abnormal movement causes muscle fatigue more quickly and can not absorb any shock from the foot that hit the ground.
Maps Shin splints
Cause
While the exact cause is unknown, shin splints can be attributed to overloading of the lower legs due to biomechanical irregularity resulting in increased stress given to the tibia. Increased intensity or abrupt frequency at the activity level injures the muscle too quickly to actually help absorb the shock, forcing the tibia to absorb most of the shock. This stress is associated with the onset of shin splints. Muscle imbalances, including weak, stiff and rigid core muscles of the lower legs, including gastrocnemius, soleus, and plantar muscle (usually flexor digitorum longus) may increase the likelihood of shin splints. The pain associated with shin splints is caused from a Sharpey fiber disorder that connects the medial soleous fascia through the tibial periosteum where it is inserted into the bone. With repetitive stress, the impact forces the eccentric fatigue of the soleus and makes the tibial bend over and over or bend, contributing to shin splints. The impact is exacerbated by running uphill, downhill, in uneven terrain, or on hard surfaces. Improper footwear, including worn-out shoes, can also contribute to shin splints.
Diagnosis
Shin splint can be diagnosed by a doctor after taking a thorough history and performing a complete physical examination. Physical examination uses gentle pressure to determine if there is tenderness above 4-6 inches at the bottom, in the shin area. Pain has been described as a dull pain for increased pain during exercise, and some individuals experience swelling in the pain area. People who previously had shin splints were more likely to have it again.
Vascular and neurologic examinations produce normal results in patients with shin splints. Radiography and three-phase bone scans are recommended to distinguish between shin splints and other causes of chronic leg pain. Scintigraphy bones and MRI scans can be used to distinguish between stress fractures and shin splints.
It is important to distinguish between different lower leg pain injuries, including shin splints, stress fractures, compartment syndrome, neural trapping, and popliteal artery trap syndrome. This condition often has many overlapping symptoms that make late diagnosis difficult, and a correct diagnosis is needed to determine the most appropriate treatment.
If the shin splints are not treated properly, or if the exercise continues too early or aggressively, shin splints can become permanent.
Treatment
Common treatments include rest, ice, strengthening and gradually return to activity. Rest and ice work to allow the tibia to recover from sudden high stress and reduce inflammation and pain levels. It is important to significantly reduce the pain or swelling before returning to the activity. Reinforcement exercises should be done after the pain subsides, in the muscles of the lower legs and hips. Individuals should gradually return to activity, starting with a short and low intensity level. For several weeks, they can slowly work up to the level of normal activity. It is important to decrease the activity level if the pain returns. Individuals should consider running on surfaces other than asphalt, such as grass, to reduce the amount of force that must be absorbed by the lower leg. Orthoses and soles help to offset biomechanical irregularities, such as pronation, and help support the arch of the foot. Other conservative interventions include footwear reparations, orthotics, manual therapies, balance exercises (eg using a balance board), cortisone injections, and calcium and vitamin D supplements.
Less common forms of treatment for heavier shin splint cases include extracorporeal shock wave therapy (ESWT) and surgery. Surgery is only done in extreme cases where more conservative options have been tried for at least a year. However, surgery does not guarantee 100% recovery.
Epidemiology
Risk factors for developing shin splints include:
- Excessive pronation in the subtalar joint
- A very tight calf brain (which can lead to excessive pronation)
- Spy on the medial shin muscles in excessive amounts of eccentric muscle activity
- Conduct high impact workouts on hard and non-compliant surfaces (eg walking on asphalt or concrete)
- Smoking and low fitness levels
While the medial tibial stress syndrome is the most common form of shin splints, compartment syndrome and stress fracture are also common forms of shin splints. Women 1.5 to 3.5 times more likely to develop into fractures than shin splints. This is because some women have a higher incidence of reduced bone density and osteoporosis.
References
Further reading
- Alonso-Bartolome, P. (2006). Tibia medial stress syndrome due to methotrexate osteopathy. 65 (6): 832-833. doi: 10.1136/ard.2005.043281. PMID 16699055. PMC 1798176.
- Haycock C. E., Gillette J. V. (1976). Female athlete's vulnerability to injury: Myth vs. reality. Journal of the American Medical Association, 236 (2), 163-165.
- Moen, M., Tol, J., Weir, A., Steunebrink, M. & amp; De Winter, T. Medial tibial stress syndrome: critical review. Sport Med 2009; 39.7: 524-544
- Raissi, G.R. (2009). The relationship between lower extremity alignment and the Medial Tibial Stress Syndrome between non-professional athletes. 1: 11. doi: 10.1186/1758-2555-1-11. PMID 19519909. PMC 2700791.
- Rompe, J., Cacchio, A., Furia, J., & amp; Maffulli, N. Therapy of low-energy extracorporeal shock waves as a treatment for medial tibial stress syndrome. The American Journal of Sports Medicine 2010; 38.1: 125-132
- Sommer, H. & amp; Vallentyne, S. Effect of foot posture on the incidence of medial tibial stress syndrome. Medicine and Science in Sports & amp; 1995 Exercise; 800-804
- Tweed, J., Avil, S., Campbell, J., & amp; Barnes, M. The etiologic factor in the development of medial tibial stress syndrome. Journal of the American Podiatric Medical Association2008; 98.2: 107-112
- Yates, B., Allen, M. J., & amp; Barnes, M.R (2003). Results of Surgical Treatment of Medial Tibial Stress Syndrome. Journal of Bone and Joint Surgery, American Volume, 85 (10), 1974. Retrieved from EBSCOhost.
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