Shin Splints (Anterolateral)
The term shin splints is often used to describe any persistent pain in the front part of the lower leg, but medically, the condition involves an injury to the muscles that attach to the tibia, or shin bone. The direct cause is scarring from small tears in the shin muscles, especially where they attach to the bone.
The underlying problem often stems from an imbalance in muscle strength; the shin muscles, which pull the forefoot upward, typically are weaker than the calf muscles, which pull the forefoot down. As calf muscles become disproportionately stronger, running or jogging increases wear and tear on the weaker shin muscles.
Pain, ranging from mild tenderness to progressively severe achiness that is centered in the outer side of the shin's bony ridge is the major symptom. It is usually felt in both legs and in mild cases, occurs only when running or walking. Sometimes, the shin muscles become inflamed and swollen, causing chronic pain because they are encased in a tight-fitting sheath, or compartment, that allows little room for swelling. In unusual cases, the inflammation may spread to the membrane surrounding the shin bone, a condition referred to as periostitis.
Diagnostic Studies and Procedures
A principal diagnostic clue is the location, nature, and duration of the pain. A medical history that includes the patient's daily activities helps pinpoint the source of discomfort. A physical examination might reveal swelling and tenderness. X-rays or a bone scan may be ordered to rule out a stress fracture or other bone problem.
Medical Treatments
Mild shin splints generally can be handled by self-treatment and physical therapy (see below). Aspirin, ibuprofen, or other anti-inflammatory medication might be prescribed. More severe swelling and inflammation may require a cortisone injection. Surgery is sometimes needed if swelling within the muscle compartment threatens to block the flow of blood.
Alternative Therapies
Herbal Medicine. Although it cannot cure the problem, a soothing poultice may alleviate pain. One combination said to relieve muscle pain consists of comfrey, echinacea, goldenseal, mullein leaves, poke root, turmeric, and yellow dock. To prepare a poultice, mix the herbs and add lukewarm water to make a thick paste. Cover the painful area with a clean cloth and spread the paste over it. Cover with another cloth and elevate your legs with the poultice in place for 30 minutes.
Hydrotherapy. Ice packs help relieve pain, swelling, and inflammation, but ice should never be placed directly on the skin; put it in a plastic bag and cover it with a clean cloth. Remove the pack after 20 minutes and wait 10 to 15 minutes before applying it again.
Physical Therapy. A therapist who specializes in sports medicine can design a program of rehabilitation for a specific type of shin splint, the extent of inflammation, and the patient's athletic goals. One basic strategy involves strengthening the shin muscles and lengthening the calf muscles. Exercises might include running up stairs to exercise the shin muscles and doing wall pushups to stretch the calf muscles.
T'ai Chi. The gentle exercises and stretching of this movement therapy can help retain muscle tone and strength while waiting for your muscles to heal. It also fosters a sense of well-being to compensate for the frustration that comes with inactivity.
Self-Treatment
Rest is an essential element in self-care. Because most shin splints result from too much exercise, they will become progressively worse unless the legs are rested and the muscles given a chance to heal -- a process that may take up to six weeks. If pain persists after that time or if it recurs with the gradual resumption of exercise, check with a doctor. It could be due to a stress fracture or some other problem.
Recurrent shin splints may indicate a need for physical therapy or a change in your exercise program. Perhaps you can run on a softer surface, or less often. Swimming, bicycling, and using a stair-climber or a cross-country skiing machine all provide aerobic benefits and are unlikely to cause a recurrence. Devise a cross-training program in which you alternate among these forms of exercise and keep your running to a minimum. A personal trainer can help you find the type and level of exercise that provide health benefits without creating new problems.
Other Causes of Shin Pain
Tingling shin pain that lasts several hours after exercising may be caused by swelling within the compartments that encase the lower leg muscles. This condition, known as anterior compartment syndrome, often results from muscle enlargement due to overtraining or frequent uphill running. A stress fracture of the tibia can also produce shin pain.