Shin Pain and Treatment
Shin Splints - An MSK Therapy perspective
Shin Splints are another reasonably common running injury, though the condition does not only affect runners. There are many sports and activities which involve placing loads on the lower legs and which can lead to Shin Splints. As per the name, Shin Splint pain occurs over the shin bone or Tibia area of the lower leg. The diagram below shows a lower left leg, the larger Tibia (shin bone), smaller Fibula and part of the ankle/foot complex.
The pain may appear over a small or large area of the shin. The pain can dull in nature, though more often than not is quite sharp. In some cases, people can push through the pain in the earlier stages of the condition. However, the pain tends to become intense longer term and usually stopping activity. Sufferers of the injury tend to notice pain shortly after commencing exercise. Shin splints can often affect both shins too. The pain usually fades with rest in the shorter term, though in more chronic cases may remain even with rest.
Image of the Tibia and Fibula
Images produced with kind permission of 3d4medical.com from Essential Anatomy 5
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Possible Causes of Shin pain
The “Basic Running Injury Preventive Measures” article covers many of the typical variables that can lead to Shin Splints, such as:-
- A rapid increase in mileage, distance or speed.
- Altered running surface.
- Footwear changes, old, new.
- Additional weight carriage, physically (overweight) or additionally (rucksack etc.)
- Biomechanical variations which affect the "Kinetic Chain" and gait (flat feet, previous injuries).
- Hypertonic (tight/shortened muscles, such as Tibialis Anterior or Calf Muscles).
Any combination of the factors above can place an extra load on the Shin Bones (Tibias) and the surrounding soft tissues. Such excess load can then create microtrauma in the soft tissue structures near the bone. Trauma leads to inflammation and swelling within the affected tissues, adding pressure to the bones and other tissue structures. The pressure within the lower leg then leads to shin pain and restricted movement, and a cycle can easily form without proper action. Also, the body naturally adapts to avoid pain, which can cause other issues later (see the Soft Tissue Adaptation to activity and injury article). It is fairly easy to irritate things further if one does not take proper action. Hence, shin splints can easily result in persistent pain when the condition becomes chronic. Chronic conditions can prove harder to treat due to a range of factors see the article on Chronic or Persistent Pain.
Professional help and treatment options
One of the critical aspects of treatment with Shin Splints is early intervention, as this aids the bodies healing process (see article on Soft tissue repair, healing and scar tissue). Rest, Ice, Compression and Elevation (R.I.C.E.) can be very useful in the condition's early stages. Ideally, one then does not want to irritate the injured tissues further, so rest is essential. The speed at which one can get back to activity can vary depending on one's early intervention strategy. If one keeps on just trying to run through the pain, then it is easily possible that one will end up having to stop activity for weeks and even months. Rest does not mean that one cannot train, and in some cases, there are other low impact training options available. However, it is best to seek professional advice before starting suitable types of training activity such as water running. A qualified professional should know the most likely cause of the initial injury and treat any specific affected tissues. A trained professional will also be able to check other aspects of biomechanics and the "Kinetic Chain" (see Biotensegrity and how everything is connected article for a better explanation). A professional can then treat and advise accordingly. The author has been treating sports-related musculoskeletal injuries since 2006 and has found that “Shin Splints” can be resolved relatively quickly with conservative treatment. In particular, the author has found Myofascial Dry Needling and soft tissue therapy (Sports and Remedial Massage techniques) to be highly effective. In other cases and where there have been biomechanical changes the author has found structural and soft tissue therapy to be very successful. Shin splints are another lower extremity condition that can easily become chronic and extremely painful. The article on Finding a good, ethical Musculoskeletal health professional - An MSK Therapy perspective offers some advice on what to expect from a good patient-centred practitioner.
The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.
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