Symptoms

• Aching along front of shin, at beginning of or after activity
• Pain along inside (medial) part of lower leg
• Generally develops gradually over weeks or months
• May have swelling in lower leg (in area of pain)

Definitions

Shin Splints

• Common, umbrella term used to identify pain along the shin or front of lower leg.
• More specific names for this condition are based on the area of the pain and theanatomy involved (see below).
• Injury generally occurs as a result of overuse

Stress Fracture - Posterior

• Most often occurring on the tibia (shin bone) and along the bottom third of thelower leg
• Often undetectable on x-ray until 10-14 days after pain starts

Compartment Syndrome – Anterior Or Posterior

• The four divisions of muscles in the lower leg (anterior, lateral, posterior-superficialand deep) are each covered by thick tissue called fascia that surround themuscles completely
• During exercise, muscle volume increases by 20%, increasing pressure withineach compartment. Such pressure can affect blood vessels and nerves in the lower leg potentially causing pain and damage to tissue and nerves

Tibial Periostitis - Posterior

• An inflammation of or trauma to the covering of the bone in shin (periosteum)
• Over-exertion causes small tears of the muscle from the covering of the bone (periosteum)
• Pain is most pronounced in the lower 3rd of the posterior tibia

Medial Tibial Stress Syndrome – Posterior

• Stress to the muscles along the front medial side of the shin
• Generally occurring along the bottom third of the inside of tibia (shin)

Primary Cause

Excessive Pronation

• Pronation is a normal movement of the foot, that allows the arch to flatten to a degree, which helps thebody to absorb and adapt to different ground surfaces.
• In analyzing ones gait, first contact is on the heel and outside of the foot; followed by a shift of bodyweight continuing forward, toward the arch and toes.
• If the foot is weak or tired and/or the footwear is not supportive, then the arch can flatten more thannormal, which is excessive pronation.
• Flattening of the arch (excessive pronation) places pressure on the arch and can cause some rotation intothe lower leg. This repetitive movement can cause overuse problems from the foot to the back.
• If excessive pronation occurs from lack of support, then, increased stresses can be placed on the lowerleg and contribute to overuse problems.

Contributing Factors

• Muscular imbalances of lower leg (calf muscles and anterior leg muscles)
• Insufficient shock absorption
• Poor biomechanics/improper foot positioning while running
• Worn out or inappropriate shoes
• Sudden increase in exercise or running (too much-too soon)
• Incorrect individual training plan
• Flat pronated feet

Treatment - Advice Given Most In Current Literature

The 3 S’s — Stretching, Strengthening and Supporting, along with ICE and REST, have been found tobe the simplest and most effective treatment for these injuries.

• Stretching of the calf ( both gastroc and soleus muscles) and achilles tendon.
• Strengthening of the anterior leg muscles (that pull the foot and toes up).
• Supporting the foot with proper shoes and insoles, can prevent and eliminate the vast majority of lowerleg problems due to overuse. This may be a Birkenstock sandal, with a broad base and contouredfootbed, that is low to the ground and conforms to the foot. It may also be a shoe with an upper thatwraps the foot and supports the arch and heel, thus limiting excessive pronation. The vast majority offootwear have more than enough cushion but very little support for the arch and heel. One of the easiestand most effective solutions is to add a simple over the counter insole that provides a forgiving support forboth the arch and heel.
• Physical therapy including massage, ultrasound and exercises.