Shin Splints
A Common Cause of Leg Pain in Athletes

Shin splints is a term used to describe pain in the lower leg that occurs during exercise. This condition has many causes and can affect athletes at all fitness levels.

One common cause of shin splints is posterior tibial syndrome (PTS). The pain associated with PTS occurs on the medial (inside) border of the tibia (shin bone). The pain present when you start exercising becomes less severe as you warm up but becomes worse than ever after you stop exercising. Posterior tibial syndrome often occurs in beginning runners, who are unaccustomed to the activity and running surface, but can occur in seasoned athletes when they change running surfaces, exercise in different shoes, or increase their intensity or duration of exercise.

The exact cause of PTS is unknown. Some experts believe that it is caused by posterior compartment syndrome, which means there is increased pressure within the thick sleeve of tissue containing the deep muscles of the leg. Others believe that PTS is caused by periostitis, which means the periosteum (bone covering) of the tibia is inflamed where the muscles attach to it.

To diagnose the cause of your shin splints, your doctor may measure compartment pressure in your aching leg before and after you exercise to see if pressure in the posterior muscle compartment increases with exercise. This type of pressure increase can also occur in the muscles in the front of the leg (anterior compartment), causing pain on the lateral (outside) side of the lower leg.

Stress fractures
The condition most commonly mistaken for PTS is a stress fracture. A stress fracture of the tibia is a crack that develops in the shin bone over time from repetitive stress on the bone. Normally, your muscles absorb the shock put on your legs during activity. When you continuously pound your legs during an activity, such as distance running, soccer, or basketball, your muscles tire, losing much of their ability to absorb shock. When your muscles do not absorb shock well, stress on the bone increases. The bone cannot endure the increased stress so it begins to crack. To help detect a stress fracture, your doctor may take x-rays or a bone scan. However, these fractures can be quite difficult to diagnose because they may not show up on x-rays when they first develop.

How are shin splints treated?
The treatment for shin splints must be tailored for each person according to whether the cause is PTS or a stress fracture and considering the person’s exercise habits. The most important form of treatment for PTS is rehabilitative exercises. Stretching before and after running, particularly the calf muscles, and strengthening your leg muscles through progressive resistance exercise usually help relieve the symptoms of PTS. In addition to rehabilitative exercises, your doctor and physical therapist may recommend some combination of changes in footwear, exercise intensity and duration, and running surface. Also, taking anti-inflammatory medications, such as aspirin or ibuprofen, and applying ice to the tender area immediately after exercise can help relieve symptoms. Your doctor may recommend you use orthotics (shoe inserts) to help support your foot and relieve stress in your leg. A person with compartment syndrome occasionally needs surgery to relieve the pressure in the muscle compartment. 
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Stress fractures will heal in several weeks with rest, although you may need to wear a cast or brace. Your doctor may suggest swimming or riding a bicycle during this time to maintain cardiovascular activity while allowing the bone to heal. Patience is important because returning to exercise, such as running, too soon can send you back to square one.

Don't let shin splints spoil the fun of exercising. If you have shin splints, ask Your doctor to recommend a treatment program for you.

Michael W. Wolfe, M.D.
Pineville, Louisiana