The Physician and Sportsmedicine
ISSN: 0091-3847 (Print) 2326-3660 (Online) Journal homepage: http://www.tandfonline.com/loi/ipsm20
How I Manage Shin Splints Jack Andrish & Janis A. Work To cite this article: Jack Andrish & Janis A. Work (1990) How I Manage Shin Splints, The Physician and Sportsmedicine, 18:12, 113-114, DOI: 10.1080/00913847.1990.11710192 To link to this article: http://dx.doi.org/10.1080/00913847.1990.11710192
Published online: 12 Jul 2016.
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Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipsm20 Download by: [Australian Catholic University]
Date: 27 August 2017, At: 20:41
How 1Manage Shin Splints
Downloaded by [Australian Catholic University] at 20:41 27 August 2017
Jack Andrish, MD, with Janis A. Work, PhD Photo: 0 1990. ALLSPORT
Shln spllnts are a common problem for athletes whose sports lnvolve a repeated, jarrlng lmpact to the leg. Often they are due to a change ln actlvlty level. Stopplng the actlvlty untll the pain subsides, and then gradually worklng back up to the deslred level ls generally the best treatment and protection agalnst recurrence.
hin splints, in a sense, is a wastebasket term referring to a collection of different conditions that cause leg pain resulting from repetitive impactloading activities such as walking, jumping, or running. The pain is typically located around the tibia.
S
Check the Activity Level The shin-splint syndrome may involve a number of clinical conditions including tibial stress syndrome, tibial stress fractures, periostitis (inflammation of the covering of the bone), and perhaps even compartment syndrome. Running is the most frequent cause, but not the only one. People who do a lot of walking or ma.rching, as in the military service, are also
Dr Andrish ls an orthopedie surgeon speclallzlng ln pediatrie and sports medicine orthopedies at the Cleveland Cllnlc Foundatlon ln Cleveland. Dr Work is a free-lance writer ln Minneapolis.
THE PHYSICIAN AND SPORTSMEDICINE
e
Uncondltloned people who begin a new tVnnlng or jumping actlv#ty ate moat at
risle for ahin spllnts. But condlt/oned tVnners who alter routines by lnct811Bing pace or distance may be just as /lkely to develop ahin spllnts.
prone to developing shin splints. Shin splints most often occur with changes in activity level. Unconditioned people who begin a new running or jumping activity are most at risk. For example, a bicyclist or a sedentary person who starts a running program is more likely to develop shin splints than a person who already runs regularly. But shin splints
Vol18 o No. 12 o December 90
may be just as likely to occur in conditioned runners who alter routines by increasing pace or distance, or by changing the type of shoe or terrain. Most often, shin splints result from chronic strain and microtrauma of the muscle origins at the tibia. This repetitive microtrauma from overuse produces microscopie tears of the muscle at the bony attachment continued 113
Downloaded by [Australian Catholic University] at 20:41 27 August 2017
shln spllnts continued
site, resulting in an inflammatory response. The inflammation is the body's general way of responding to trauma; it results in clearing injured tissue and allows the healing process to follow. However, the inflammation also produces pain and, to sorne degree, swelling. Shin splints may also be a problem related to chronic bane stress. With every step, the tibia (as in other weight-bearing long bones) bends slightly. The more impact, as with walking, running, or jumping, the more stress and strain occurs within the bane. Bane responds by remodeling-over time it can make itself stronger to stand up to this additional stress. During this remodeling process, however, the bane has to tear itself dawn in arder to build itself back up. While in this weakened condition, patients can develop a stress fracture. With stress fractures, the bane formation seems to be unable to keep up with the bane resorption. Verify the Diagnosis The differentiai diagnosis of shin splints includes tibial stress syndrome, tibial stress fracture, periostitis, and compartment syndrome. If the patient has leg pain, usually around the posteromedial portion of the tibia, which is aggravated by activities such as running and jumping and relieved by rest, the most likely diagnosis is shin splints. Tibial stress fractures, although usually not dangerous, may be confused with shin splints. Most tibial stress fractures are not displaced and in fact may not even be seen on a plain x-ray. However, if a patient continues to run on a stress fracture, further injury can result. Although few stress fractures are weil visualized on plain x-ray, virtually
114
ali can be detected by a technetium bane scan. It is only after 2 to 3 weeks of persistent symptoms that plain x-rays may demonstrate evidence of a stress fracture by the appearance of periosteal reaction or linear sclerosis across the bane. If the bane scan is positive but the plain x-rays remain negative, cr scans or tomograms can help in visualizing the stress fracture. In addition to stress fractures, shin splints may be confused with a potentially more serious problem: compartment syndrome. This syndrome occurs when the leg muscles become so swollen from exercise that the blood supply from the small vessels is eut off. The covering, or fascia, around the muscles becomes restrictive so that swelling produces a buildup of pressure inside the muscle compartrnent, thus preventing blood from entering and leaving. Occasionally, people may try to push their limits, as in a marathon race, and as a result may develop a full-blown compartment syndrome. Acute compartment syndrome is a medical emergency requiring immediate recognition and most often surgical treatrnent (fasciotomy). The diagnosis is often made certain by the presence of extreme pain and tenderness over the affected muscle compartment, severe pain with passive stretch of the muscles within the compartment, and elevated intracompartmental tissue pressures as determined by any one of a number ofwick catheter or needle-monitoring methods. Chronic compartrnent syndrome is also a possibility. Although more subtle in its presentation and not associated with the devastating consequences of untreated acute cornpartment syndromes, it can be a source of chronic morbidity and disability.
Choose a Realistic Treatment Shin splints require treatment; however, allowing the patient to continue the same activity is not a realistic option since this will probably increase symptoms and may lead to tibial stress fractures. 1 have tested a number of different treatment options, but relative rest works most consistently. This does not mean bed rest-it just means stopping the offending activity until the pain subsides. On the average, this takes about 1 week. The patient then can resume training, usually at about half the previous leve! of intensity, and can gradually work up to the desired leve! over 3 to 6 weeks. Returning tao quickly to the previous leve! of activity is the most cornmon reason shin splints recur. Patients sometimes rest for a few days, apply ice to the affected leg, take a nonsteroidal anti-inflammatory drug, and begin feeling better. But physicians should caution patients about returning to their prior level of exercise before they have recovered completely; returning tao saon puts them at risk for continued problems. Patients who have recovered from shin splints need not stop running permanently. To prevent a recurrence, the physician should encourage patients to do the following: • Work on flexibility, particularly heelcord stretching exercises. ePay attention to the warm-up and cool-dawn phases of the workout, and be sure to do stretching exercises before and after activity. • Wear shoes with a well-cushioned heel and insole that absorb energy at the point of impact. • Run on softer surfaces. • Return gradually to the desired leve! of intensity. RN
Vol1 8 • No. 12 • December 90 e THE PHYSICIAN AND SPORTSMEDICINE
ISSN: 0091-3847 (Print) 2326-3660 (Online) Journal homepage: http://www.tandfonline.com/loi/ipsm20
How I Manage Shin Splints Jack Andrish & Janis A. Work To cite this article: Jack Andrish & Janis A. Work (1990) How I Manage Shin Splints, The Physician and Sportsmedicine, 18:12, 113-114, DOI: 10.1080/00913847.1990.11710192 To link to this article: http://dx.doi.org/10.1080/00913847.1990.11710192
Published online: 12 Jul 2016.
Submit your article to this journal
Article views: 1
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipsm20 Download by: [Australian Catholic University]
Date: 27 August 2017, At: 20:41
How 1Manage Shin Splints
Downloaded by [Australian Catholic University] at 20:41 27 August 2017
Jack Andrish, MD, with Janis A. Work, PhD Photo: 0 1990. ALLSPORT
Shln spllnts are a common problem for athletes whose sports lnvolve a repeated, jarrlng lmpact to the leg. Often they are due to a change ln actlvlty level. Stopplng the actlvlty untll the pain subsides, and then gradually worklng back up to the deslred level ls generally the best treatment and protection agalnst recurrence.
hin splints, in a sense, is a wastebasket term referring to a collection of different conditions that cause leg pain resulting from repetitive impactloading activities such as walking, jumping, or running. The pain is typically located around the tibia.
S
Check the Activity Level The shin-splint syndrome may involve a number of clinical conditions including tibial stress syndrome, tibial stress fractures, periostitis (inflammation of the covering of the bone), and perhaps even compartment syndrome. Running is the most frequent cause, but not the only one. People who do a lot of walking or ma.rching, as in the military service, are also
Dr Andrish ls an orthopedie surgeon speclallzlng ln pediatrie and sports medicine orthopedies at the Cleveland Cllnlc Foundatlon ln Cleveland. Dr Work is a free-lance writer ln Minneapolis.
THE PHYSICIAN AND SPORTSMEDICINE
e
Uncondltloned people who begin a new tVnnlng or jumping actlv#ty ate moat at
risle for ahin spllnts. But condlt/oned tVnners who alter routines by lnct811Bing pace or distance may be just as /lkely to develop ahin spllnts.
prone to developing shin splints. Shin splints most often occur with changes in activity level. Unconditioned people who begin a new running or jumping activity are most at risk. For example, a bicyclist or a sedentary person who starts a running program is more likely to develop shin splints than a person who already runs regularly. But shin splints
Vol18 o No. 12 o December 90
may be just as likely to occur in conditioned runners who alter routines by increasing pace or distance, or by changing the type of shoe or terrain. Most often, shin splints result from chronic strain and microtrauma of the muscle origins at the tibia. This repetitive microtrauma from overuse produces microscopie tears of the muscle at the bony attachment continued 113
Downloaded by [Australian Catholic University] at 20:41 27 August 2017
shln spllnts continued
site, resulting in an inflammatory response. The inflammation is the body's general way of responding to trauma; it results in clearing injured tissue and allows the healing process to follow. However, the inflammation also produces pain and, to sorne degree, swelling. Shin splints may also be a problem related to chronic bane stress. With every step, the tibia (as in other weight-bearing long bones) bends slightly. The more impact, as with walking, running, or jumping, the more stress and strain occurs within the bane. Bane responds by remodeling-over time it can make itself stronger to stand up to this additional stress. During this remodeling process, however, the bane has to tear itself dawn in arder to build itself back up. While in this weakened condition, patients can develop a stress fracture. With stress fractures, the bane formation seems to be unable to keep up with the bane resorption. Verify the Diagnosis The differentiai diagnosis of shin splints includes tibial stress syndrome, tibial stress fracture, periostitis, and compartment syndrome. If the patient has leg pain, usually around the posteromedial portion of the tibia, which is aggravated by activities such as running and jumping and relieved by rest, the most likely diagnosis is shin splints. Tibial stress fractures, although usually not dangerous, may be confused with shin splints. Most tibial stress fractures are not displaced and in fact may not even be seen on a plain x-ray. However, if a patient continues to run on a stress fracture, further injury can result. Although few stress fractures are weil visualized on plain x-ray, virtually
114
ali can be detected by a technetium bane scan. It is only after 2 to 3 weeks of persistent symptoms that plain x-rays may demonstrate evidence of a stress fracture by the appearance of periosteal reaction or linear sclerosis across the bane. If the bane scan is positive but the plain x-rays remain negative, cr scans or tomograms can help in visualizing the stress fracture. In addition to stress fractures, shin splints may be confused with a potentially more serious problem: compartment syndrome. This syndrome occurs when the leg muscles become so swollen from exercise that the blood supply from the small vessels is eut off. The covering, or fascia, around the muscles becomes restrictive so that swelling produces a buildup of pressure inside the muscle compartrnent, thus preventing blood from entering and leaving. Occasionally, people may try to push their limits, as in a marathon race, and as a result may develop a full-blown compartment syndrome. Acute compartment syndrome is a medical emergency requiring immediate recognition and most often surgical treatrnent (fasciotomy). The diagnosis is often made certain by the presence of extreme pain and tenderness over the affected muscle compartment, severe pain with passive stretch of the muscles within the compartment, and elevated intracompartmental tissue pressures as determined by any one of a number ofwick catheter or needle-monitoring methods. Chronic compartrnent syndrome is also a possibility. Although more subtle in its presentation and not associated with the devastating consequences of untreated acute cornpartment syndromes, it can be a source of chronic morbidity and disability.
Choose a Realistic Treatment Shin splints require treatment; however, allowing the patient to continue the same activity is not a realistic option since this will probably increase symptoms and may lead to tibial stress fractures. 1 have tested a number of different treatment options, but relative rest works most consistently. This does not mean bed rest-it just means stopping the offending activity until the pain subsides. On the average, this takes about 1 week. The patient then can resume training, usually at about half the previous leve! of intensity, and can gradually work up to the desired leve! over 3 to 6 weeks. Returning tao quickly to the previous leve! of activity is the most cornmon reason shin splints recur. Patients sometimes rest for a few days, apply ice to the affected leg, take a nonsteroidal anti-inflammatory drug, and begin feeling better. But physicians should caution patients about returning to their prior level of exercise before they have recovered completely; returning tao saon puts them at risk for continued problems. Patients who have recovered from shin splints need not stop running permanently. To prevent a recurrence, the physician should encourage patients to do the following: • Work on flexibility, particularly heelcord stretching exercises. ePay attention to the warm-up and cool-dawn phases of the workout, and be sure to do stretching exercises before and after activity. • Wear shoes with a well-cushioned heel and insole that absorb energy at the point of impact. • Run on softer surfaces. • Return gradually to the desired leve! of intensity. RN
Vol1 8 • No. 12 • December 90 e THE PHYSICIAN AND SPORTSMEDICINE
