A Patient’s Guide to Shin Splints Orthopedic and Sports Physical Therapy 245 North College Lafayette, LA 70506 Phone: 337.232.5301 Fax: 337.237.6504 Compliments of: Orthopedic and Sports Physical Therapy DISCLAIMER: The information in this booklet is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments orA treatments.Patient's The information Guide shouldto Shin NOT be Splints used in place of a visit with your health care provider, nor should you disregard the advice of your health care provider because of any information you read in this booklet. Orthopedic and Sports Physical Therapy Thank you for requesting your Orthopaedic and Sports Physical Therapy Patient Guide and giving us the opportunity to help you better understand your condition. Once you've had a chance to review the information provided, you may have additional questions. If that's the case, we would like to offer you a FREE consultation to discuss your condition more fully, answer all of your questions, and give you our best advice on how you can resolve your pain quickly and easily. To arrange your FREE consultation, please contact us at 337.232.5301 and begin feeling good again! Call today and begin feeling better tomorrow. The OSPT Team Orthopedic and Sports Physical Therapy 245 North College Lafayette, LA 70506 Phone: 337.232.5301 Fax: 337.237.6504 www.ospt.net All materials within these pages are the sole property of Medical Multimedia Group, LLC and are used herein by permission. eOrthopod is a registered trademark of Medical Multimedia Group, LLC. 2 Compliments of: Orthopedic and Sports Physical Therapy A Patient's Guide to Shin Splints Introduction Pain along the front or inside edge of the The tibia and fibula provide a connecting shinbone (tibia) is commonly referred to point for several muscles that move the foot. as shin splints. The problem is common The main muscle that bends the foot upward in athletes who run and jump. It is usually caused by doing too much, too quickly. The runner with this condition typically reports a recent change in training, such as increasing the usual pace, adding distance, or changing running surfaces. People who haven't run for awhile are especially prone to shin splints after they first get started, especially when they run downhill. Shin splints on the front of the tibia are called anterior shin splints. Posterior shin splints cause pain along the inside edge of the lower leg. This guide will help you understand connects on the front (anterior) of the tibia. It • how shin splints start is called the anterior tibialis. The posterior • what shin splints feel like tibialis, which pulls the foot down and in, • how this condition is treated attaches along the back (posterior) and inside edge of the tibia. Together, the anterior and Anatomy posterior tibialis muscles are called the tibialis What parts of the leg are involved? muscles. The lower leg is made up of two bones. The The tibialis muscles have tiny fibers that shinbone is the larger of the two bones. It is fasten the muscle to the bony surface of the called the tibia. The small, thin bone that runs tibia. This bony covering, or membrane, is alongside the tibia from the knee to the ankle called the periosteum (periperi means around, and is the fibula. osteum means bone). 3 Compliments of: Orthopedic and Sports Physical Therapy A Patient's Guide to Shin Splints Causes Why do I have shin splints? Shin splints usually result from overuse. Repeated movements of the foot can cause damage where the tibialis muscles attach to the tibia. Soon the edge of the muscles may begin to pull away from the bone. The injured flattens out with each step, the posterior tibialis muscle and the bone covering (the periosteum) muscle gets stretched, causing it to repeatedly become inflamed. tug on its attachment to the tibia. The posterior tibialis muscle attachment eventually becomes Overuse commonly happens after changes in damaged, leading to pain and inflammation training. Increasing running speed and distance along the inside edge of the lower leg. and running on hard or angled surfaces can contribute to overuse. Overuse can also occur A stress from running in flimsy footwear or in shoes fracture in with soles that are worn out. the tibia is a serious Anterior shin splints tend to affect people problem that who take up a new activity, such as jogging, at first may sprinting, or playing sports that require quick have the same starts and stops. The unfamiliar forces place symptoms as a heavy strain on the anterior tibialis muscle, shin splints. A causing it to become irritated and inflamed. stress fracture This commonly happens when people who is a crack in aren't regular runners decide to go on a long a weakened jog. The anterior tibialis muscle must work area of bone. Continual stresses from running hard to control the landing of the forefoot with on hard surfaces or from heavy strain in the each stride. Running downhill puts even more tibialis muscles can weaken and eventually demands on this muscle in order to keep the fracture the tibia. People with shin pain who forefoot from slapping down. People who run try to work through it sometimes end up devel- on the balls of their feet or who run in shoes oping a stress fracture in the tibia. with poor shock absorption also tend to get anterior shin splints. A concerning complication of shin splints is compartment syndrome. Compartment Posterior shin splints are generally caused by syndrome is a condition where pressure imbalances in the leg and foot. Muscle imbal- from muscle damage and swelling builds ances from tight calf muscles can cause this up inside a section, or compartment, within condition. Imbalances in foot alignment, such the body. There are four compartments in as having flat arches (called pronation), can the lower limb. As the pressure builds in the also cause posterior shin splints. As the foot 4 Compliments of: Orthopedic and Sports Physical Therapy A Patient's Guide to Shin Splints compartment, the small blood vessels (called Symptoms of shin splints generally get worse capillaries) that supply blood to the muscles with activity and ease with rest. Pain may be in the compartment are squeezed shut. This worse when you first get up after sleeping. The happens when the pressure in the compartment sore tibialis muscle shortens while you rest, is higher than the blood pressure that keeps the and it stretches painfully when you put weight small blood vessels open. When the muscle on your foot. loses its blood supply it begins to ache, like a Diagnosis muscle cramp. How will my doctor know if I have shin If the pressure continues to rise, it can squeeze splints? the larger blood vessels and nerves as well. Patients may feel coldness, numbness, and The diagnosis of shin splints is usually made swelling in the lower leg and foot. If pressure using your history and physical examina- builds up and is not treated, it can cause tion. The doctor may ask you questions about serious tissue damage in the leg and foot. your training schedule and footwear. The doctor may also want to know whether you've recently begun a new sport that requires running or jumping. The physical examination lets the doctor see exactly where your leg hurts. The doctor will probably move your ankle in different posi- tions and have you hold your foot against the doctor's pressure. By stretching the tibialis muscles and by feeling where these muscles attach on the tibia, the doctor can begin to tell where the problem is. X-rays may be ordered to make sure you don't have a stress fracture. However, recent stress injuries may not show up on X-ray for the first Symptoms few weeks. In these cases, a bone scan may What do shin splints feel like? be ordered. A bone scan involves injecting tracers into your blood stream. The tracers then Dull, aching pain is felt where the involved show up on special X-rays of your leg. The tibialis muscle attaches to the tibia. Redness tracers build up in areas of extra stress to bone and swelling can also occur in this area. tissue. The extra stress can be caused by a Tenderness is felt where the muscle attaches to stress fracture or an inflamed periosteum (bony the bone. covering). This condition is called periostitis. Anterior shin splints are usually felt on the Your doctor may also order a magnetic reso- front of the tibia, especially when using the nance imaging (MRI) scan. An MRI scan is a anterior tibialis muscle to bend your foot special imaging test that uses magnetic waves upward. to create pictures of your body in slices. The Posterior shin splints produce symptoms along MRI scan shows tendons as well as bones. It the inside edge of the lower leg. Small bumps also shows abnormal swelling or scar tissue. may also be felt along the edge of the tibia in An MRI is painless and requires no needles or this area. injections. 5 Compliments of: Orthopedic and Sports Physical Therapy A Patient's Guide to Shin Splints A test for measuring pressure in the sore leg Surgery may be needed if you have symptoms of Surgery is rarely needed to correct problems compartment syndrome. Pressures within the of shin splints. However, shin splints that are tissues of the leg are checked before and after complicated by compartment syndrome may exercise to see if exercise causes the pressure require surgery, sometimes immediately.