Tips and Hints to Deal with Shin Splints

The phrase "shin splint" is a generic term that describes pain in the lower leg, either on the medial (inside) or lateral (outside) side of the shin bone. This pain usually begins as a dull ache that can't be pinpointed; it can be felt along the entire region where the muscle attaches to the bone.

Early on, exercisers will usually feel pain only at the beginning and end of their workouts. But over time the discomfort becomes more severe, lasting throughout workouts and striking even when you're not exercising, like when getting out of bed.

Technically, shin pain can be caused by a number of conditions, such as tendonitis, periostitis (inflammation of the membrane covering the bone), or a stress fracture. Considering that the placement, causes and treatment of these three injuries are often the same, the term "shin splint" became a simple way to label the injury.

Shin splints almost always occur in sports that involve running or jumping, such as jogging, dancing, gymnastics and more. Even walkers can experience shin splints. Contrary to popular belief, they do not always represent a stress fracture of the shin bone (tibia), although stress fractures can be one of the reasons for lower leg pain.

What causes shin splints?

• Doing too much too soon. Often people with a lot of enthusiasm start an exercise program too aggressively. It is important to gradually progress in your running or conditioning program, allowing for adequate rest between workouts.
  
• Increasing the intensity or duration of your workouts. Overuse syndrome typically occurs when someone does too much and continually strains the muscles of the lower leg. Increasing your distance or intensity by more than 10 percent per week would make you a prime candidate for shin splints—especially if you don't cross-train to diversify your program.
  
• Your shoes. Quality running and cross-training shoes are designed to give the best anatomical support. If your shoes are broken down or old—even when the soles or top appear fine—then they have lost their ability to control the rotation of your foot and absorb shock. This "breakdown" usually occurs after 400 to 500 miles of wear.
  
• The surfaces on which you exercise. Hard surfaces can cause and aggravate shin splints. The optimal surface for running and aerobics should absorb shock, such as an all-purpose track or grassy surface.
  
• High impact exercise. Running sprints, running uphill, jumping, and repetitive impact exercises can all cause shin splints.
  
• Your anatomy. Fallen arches (flat feet), knocked or internally rotated knees, very high arches and over rotation of the foot are all prime causes of shin splints. An orthopedic physician, athletic trainer, or physical therapist can help identify mechanical problems and may prescribe orthotics (custom shoe inserts) as well as strengthening and stretching exercises.<pagebreak>

How can I ease the pain of shin splints?

A combination of these three approaches will usually help most people recover from shin splints and experience less pain:

1. Active Rest is the first mode of treatment for all types of shin splints. "Active rest" does not mean you must stop running or exercising. Many people make the mistake of not exercising for many weeks and then attempting the same distances that got them into trouble the first time. Rather, rest should be active to relieve stress on painful areas, yet maintain your conditioning. Completely stopping activities may give temporary relief, but injuries are likely to resurface when you resume activity, especially if you are trying to make up for lost time.

Active rest activities include low-impact exercises like the elliptical trainer, stationary cycling and swimming. Try any activity that doesn't involve the same muscles as running, and that doesn't require repetitive impact on hard surfaces. "Water running" is another effective way to rehab these injuries: Use a flotation device and run in the deep end of a pool. You can move to the shallow end, running on the bottom, as your pain begins to improve.

Remember, the human body is truly remarkable in its ability to adapt, but it prefers to adapt to gradual changes over time. With slow, steady progress, your muscles, tendons and other soft tissues will better adapt to the stresses you are asking of it.

2. Ice can be very helpful during the acute phases of your pain. This is especially true if your shin splints are accompanied by redness, localized tenderness, or swelling. Try an ice massage by holding an ice cube in a washcloth and rubbing the swollen, sore area for 10 to 15 minutes. Another trick of the trade is to use a bag of frozen vegetables.

Remember not to exceed 10 to 15 minutes each time you ice, and always wrap ice cubes, frozen veggies, and store-bought gel ice in a towel or washcloth to avoid burns and frostbite. You can repeat icing every few hours as needed.

3. Stretching and strengthening the calf muscles can help prevent and treat shin splints. Here are some stretches that will target this area. Take care to hold each stretch for 10 to 15 seconds, repeating two to three times.

• Calf stretch: Step forward into a half lunge, toes pointing forward. Your forward leg should be bent and the back leg should be straight. Stretch the calf of your back leg by pressing your heel down toward the floor, keeping the forward leg bent and stationary. You should feel a stretch in the calf of your back leg. Repeat on opposite side.
  
• Hamstring stretch: Begin by standing upright, feet under hips, toes pointed forward. Place the heel of your right forward so that your toes point upward. Keep your back leg slightly bent and abs tight to help with balance. Place your hands on your front thigh. Keeping torso straight, bend over from the waist, lowering your upper body towards your extended leg until you feel a stretch in the hamstring of your front leg. Repeat on opposite side.

Remember, these are general guidelines for the self-treatment of shin splints. The underlying problem is that your body is unable to cope with the stress of exercise that you are placing on it. Be patient; it will take time—sometimes weeks or months—to resolve. Never attempt to train through the pain, and always stop when your body tells you to. If you are not improving with this home treatment, if you worsen significantly, or if the pain becomes a continuous discomfort (even at rest), revisit your health care provider.