Shin Splints and Stress Fractures

If you’re a runner or participate in activities that include running and jumping, from football to dancing, and feel throbbing or aching in your shins, you could have shin splints, or possibly a lower leg stress fracture. Both shin splints and stress fractures are considered overuse injuries, usually resulting from changes in training. Increasing running speed and distance and running on hard or angled surfaces can also contribute to overuse, as can running in flimsy footwear or in shoes with soles that are worn out.

Shin Splints

The term shin splints, or medial tibial stress syndrome as it is called by orthopaedists, refers to pain and tenderness along or just behind the inner edge of the tibia, the large bone in the lower leg.

Anterior shin splints tend to affect people who take up a new activity, such as jogging, sprinting, or playing sports that require quick starts and stops. These activities place a heavy strain on the anterior tibialis muscle, causing it to become irritated and inflamed. People who run on the balls of their feet or who run in shoes with poor shock absorption also tend to get anterior shin splints.

Posterior shin splints are generally caused by imbalances in the leg and foot. Muscle imbalances from tight calf muscles can cause this condition. Imbalances in foot alignment, such as having flat arches (called pronation), can also cause posterior shin splints. As the foot flattens out with each step, the posterior tibialis muscle gets stretched, causing it to repeatedly tug on its attachment to the tibia. The posterior tibialis muscle attachment eventually becomes damaged, leading to pain and inflammation along the inside edge of the lower leg.

Symptoms of shin splints generally get worse with activity and ease with rest. Pain may be worse when you first get up after sleeping as the sore tibialis muscle shortens while you rest, and it stretches painfully when you put weight on your foot. When suffering from shin splints you don’t feel the pain with other activities like walking, stretching, or climbing stairs.

If you have shin splints, take a gradual approach whenever making changes to your routine. When switching to different running surfaces, run shorter distances. When increasing your pace, try adding in sprint intervals to your regular routine rather than doing the whole run at a faster pace. And when increasing the distance of your run, you should never increase your weekly mileage by more than 10 percent as compared to the previous week. When doing strength and flexibility training, pay special attention to your shins by doing toe lifts and gentle stretches.

Medical diagnosis of shin splints is usually made using your history and physical examination. The doctor may ask you questions about your training schedule and footwear, and may also want to know whether you’ve recently begun a new sport that requires running or jumping.

Rest plays a key role in decreasing pain and inflammation. Patients are usually encouraged to stop doing the activity that caused the problem, at least until their symptoms are under control. Applying cold packs and taking antiinflammatory medications ease pain and inflammation and are useful in the early stages of treatment. Physical therapy may also be helpful, including electrical stimulation (HVGS) and ultrasound to treat the issue. Some doctors will also treat pronation, which is a major contributing factor to this syndrome, and in the long run, may be approached with improved shoes and over the counter or custom orthotics.

In most cases, the pain is tolerable with ordinary walking. After several weeks of rest, low-level training may begin. Be sure to warm up and stretch thoroughly before you exercise. Increase training slowly. If you start to feel the same pain, stop exercising immediately. Use a cold pack and rest for a day or two. Return to training again at a lower level of intensity. Increase training even more slowly than before.

It is important that the cause of the pain be addressed rather than just treating the shin pain alone, as the pain could be the result of a stress fracture.

Stress Fractures

Stress fractures are caused by actual cracks or breaks in either the tibia or fibula, the bones in the lower leg. Typically caused by an increased intensity in training or increased time spent training, stress fractures that are left untreated will not heal on their own, and could become a true fracture. If you suffer from this injury, you’ll usually experience pain in the lower third part of the shin, tenderness or swelling in the specific injured area, and pain when you press on your shin. With stress fractures the pain doesn’t subside when you stop running, and regular activities like climbing stairs or jumping will cause pain as well.

If you think you’re suffering from a stress fracture, see your doctor. During the exam, your doctor will ask about your symptoms, physical activities and general health, and will also press on the bones and soft tissues around the site of your pain, to try to pinpoint what exactly has been injured.

While doctors can sometimes diagnose a stress fracture from the medical history and physical exam alone, imaging tests are often needed to confirm the diagnosis. An x-ray will be taken of the affected area, but in many cases, stress fractures aren’t apparent on regular X-rays taken shortly after the time your signs and symptoms begin. It often takes several weeks for evidence of stress fractures (callus formation that appears once the bone has begun to heal) to show up on X-rays. Usually a bone scan is needed to detect a stress fracture. Many types of bone problems look alike on bone scans, so an MRI may be ordered as well.

Treatment varies depending on the location of the stress fracture and on how quickly you need to resume activity. The most important treatment for any stress fracture is rest. In most cases of stress fracture, it is recommended that you stop running and rest the area for six to eight weeks. During this time, you can do lower impact exercise like walking, swimming, deep water running, and weight training. If you don’t rest your shins enough, the area may never heal properly. Once the pain begins to subside, you can start to work out. Just be sure to gradually build up time, distance, and intensity.

To reduce the bone’s weight-bearing load until healing occurs you may need to wear a walking boot or brace, or use crutches. In severe cases, the doctor may need to immobilize the affected bone with a splint or cast. Physical therapy to increase muscle strength and flexibility may be considered to help prevent future injury.

Anti-inflammatory medications such as ibuprofen are useful to help with inflammation and pain. Other medications may prescribed, initially, to help with pain control. While most stress fractures heal with time and rest, occasionally some fractures displace (the bone edges move apart and are not aligned properly) or refuse to heal. In these rare instances, surgery may be required.

If you have questions about shin splints or stress fractures and their treatment options, talk to J. Lex Kenerly, M.D. Orthopaedic Surgeon, and the staff at the Bone & Joint Institute of South Georgia. The Bone and Joint Institute of South Georgia, is a 15,000 square foot stateof- the-art facility with on-site X-Ray, MRI and ambulatory surgery center, providing comprehensive orthopaedic care in a single facility. From shin splints and stress fractures, to severe injuries requiring surgery, the Bone & Joint Institute of South Georgia is your first choice for comprehensive, compassionate orthopaedic care.

Download PDF