I am a keen runner and have recently been told I have shin splints. What does this mean?
Shin splints is an old generic term relating to exercise-induced lower limb pain but is rarely used in the field of sports medicine these days. Patients usually complain of shin pain made worse by high impact activities, such as running.
What are the causes of shin splints?
The usual diagnosis is of a medial tibial stress syndrome (MTSS) which typically produces pain on the inner, distal shin bone in a linear fashion. Often the patient will notice an area of tenderness on the inner, distal shin bone where the shin muscles attach. Other causes of exercise-induced shin pain include tibial stress fractures and chronic exertional compartment syndrome.
What are the causes of MTSS?
The exact cause is often uncertain but can be precipitated by training errors, for example too much, too soon, running on hard surfaces, poor or inappropriate footwear.
What tests are available to help the diagnosis?
Usually MTSS is a clinical diagnosis. However, x-rays and MRI scans may be required to exclude a tibial stress fracture, particularly if the pain is localised to one specific area of the tibia.
How is it MTSS treated?
Relative rest is initially indicated to assist with tissue healing. Usually a low-impact, cardiovascular programme (cycling or swimming) can be continued during this period to maintain fitness levels. Ice can be useful in the acute situation. It is important to address biomechanical issues in conjunction with a sports physiotherapist or a sports physician. A formal podiatry opinion may also be needed. Usually a gradual return to high impact activities with a walk/run programme can be helpful. Surgery is rarely needed for MTSS.
Dr Geoff Davies is a consultant sports physician at Vale Healthcare’s Cardiff Bay Clinic. He is a Fellow of the Faculty of Sports & Exercise Medicine in the UK & Ireland. Visit www.DrGeoffDavies.com