Shin Splints

Leg Pain From Medial Tibial Stress Syndrome

Getty Images / Christopher Futcher

The term shin splints is a common misnomer in sports medicine. It does not imply a specific diagnosis, rather it is the symptom of pain over the front of the tibia (shin) bone. The pain from shin splints can be due to either problems of the muscles, the bone, or the attachment of the muscle to the bone. Therefore, 'shin splints' is simply the name given to pain over the front of the lower leg.

Causes of Shin Splints

The symptoms of shin splints can be caused by several conditions.

These conditions include:

Shin splints are most commonly due to overuse. When the overuse causes irritation to the tendons and the attachment of these tendons to the bone, the condition is called medial tibial stress syndrome. This is what most people are talking about when they use the words shin splints as a diagnosis.

Medial tibial stress syndrome, or shin splints as most people call this problem, is commonly seen in athletes who suddenly increase their duration or intensity of training. This type of shin splints may also be seen in athletes who have very high demand training levels, such as marathon runners, even if their training levels are not dramatically increased.

Some people seem more prone to development of medial tibial stress syndrome, and this can be a source of frustration for these individuals.

Everyone has a different body, and each persons body mechanics differ slightly. One factor commonly implicated in causing shin splints is overpronation. Pronation occurs when the foot flattens out when weight is applied. The normal foot should flatten slightly, meaning pronation is a normal foot motion.

Overpronation occurs when the foot becomes too flattened out causing the foot to roll inwards. This can cause increased demand on the muscle over the front of the leg and may lead to complaints of shin splints.

Making The Diagnosis

As mentioned previously, the term shin splints is not actually a diagnosis, but a group of problems that causes a typical pain. Therefore, your doctor with perform a careful medical history and physical examination to determine the cause of the shin splints. The area of maximal tenderness may be different in patient who have different underlying problems causing shin splints. There are also physical examination tests that can help determine the cause of the shin splints.

Patients with medial tibial stress syndrome typically have a dull, aching type of pain on the inside of their tibia bone. On examination, patients with medial tibial stress syndrome will often be tender over this same part of the tibia. Patients may or may not have a small amount of detectable swelling over this part of the tibia.

Some specific maneuvers, especially resisted plantar flexion (pushing down of the foot against resistance), typically causes an increase of symptoms.

In order to determine the underlying cause of the shin splints your physician may order tests including x-rays, MRIs, or a bone scan. The x-ray can detect fractures, and occasionally detect long-standing stress fractures. MRIs and bone scans are useful tests to determine if there are signs of a more recent stress fracture.  The bone scan will detect areas of high bone turnover; these ‘hot’ areas indicate possible stress fractures or other bone problems. Patients with medial tibial stress syndrome may also have an abnormal bone scan, but there is usually a difference that can be detected to differentiate medial tibial stress syndrome and stress fractures.

Treatment of Medial Tibial Stress Syndrome

Medial tibial stress syndrome is an overuse injury that will respond to simple, non-invasive treatments.  That said, treatment can take time and prevent full athletic activities.  This can be a source of frustration for many athletes, but the good news is that with appropriate treatment steps, there is a solution to this condition.

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