Sunday, October 5, 2008



Shin splints is a general term used to refer to a painful condition in the
shins. The medical terminology assigned is medial tibial stress syndrome. It is often caused by running or jumping, and may be very slow to heal. In severe cases the result can be acute compartment syndrome (ACS, also see chronic compartment syndrome below) which requires emergency surgery to prevent ischemic muscle necrosis, muscle death due to lack of blood. It can present as an acute injury or DOMS (delayed-onset muscle soreness) due to overused muscle. Usually it is caused by any activity that involves running, jumping, also sometimes even walking, swimming, roller skating, or playing basketball. An individual not accustomed to running may experience pain in the shin muscles the next day even after a single, short bout of intensive running. Sometimes shin splints is also a result of stress fractures in the shin.
On the other hand shin splints can be mimicked by chronic condition called Chronic Compartment Syndrome (CCS). This is a serious debilitating condition which can lead to significant loss of function in the lower leg. CCS occurs when swelling within the indistensible anterior compartment of the leg reduces blood flow. This relative lack of blood, ischemia, can cause more swelling and generate a positive feedback loop. Diagnosis of CCS may be the problem if pain worsens steadily during exercise rather than improving. Tingling in the foot is a particular red flag; it indicates compression of the nerve. If a bone problem is suspected to be causing inflammation of connective tissue, a bone scan can be useful in confirming the diagnosis. Magnetic resonance imaging has been proposed as a diagnostic technique.
Treatment and prognosis
Acute treatment
1. Rest: The immediate treatment for shin splints is rest.
2. Avoidance of: Running and other strenuous lower limb activities, like football and other sports which include flexing the muscle, should be avoided until the pain subsides and is no longer elicited by activity.
3. NSAIDs: In conjunction with rest,
anti-inflammatory treatments such as icing and drugs such as NSAIDs (in particular, NSAID gel) may be suggested by a doctor or athletic trainer/physical therapist.
4. Taping: Lower legs may be taped to stabilize and take some load off the periosteum.
5. Keenly looking into foot biomechanics: Using good shoes (ideally compensating for individual foot differences) is important.
6. Training points:
a. Stretching: Improve static and dynamic flexibility through adaptation, which will diminish the contracting reflex, and allow the muscles to handle the rapid stretch. However, static stretching might not be enough. To adapt a muscle to rapid, eccentric contraction, it has to acquire greater dynamic flexibility as well.
b. To improve dynamic flexibility: dynamic flexibility of the anterior shin is to subject it to exaggerated stress, in a controlled way, such as walking on the heels.
c. further rehabilitation: Practice controlled downhill running as a part of training, which places greater eccentric loads on the
quadriceps as well as on the shins.
physical therapist, athletic trainer, or doctor should be consulted before engaging in this type of training.

Long-term treatment
The long-term remedy
1. Change in the running style to eliminate the overstriding and heavy heel strike. In preventing shin-splints, heel-striking offers the best shock absorption and natural form, reducing impact stress on the calf and shin muscles.
2. The shin muscles can also be somewhat alleviated by footwear and choice of surface (already discussed). When their cushioning capability degrades, the shoes should be replaced. The commonly recommended replacement interval for shoes is 500 miles (800 kilometres).
3. Excessive pronation can be reduced by extra supports under the arch. Running shoes which have a significant supporting bump under the arch are called "motion control" shoes, because they work by limiting the pronating motion. Also shoes with cushion shock features and shoe inserts can help prevent future problems.
4. Taping regularly: In, Running over rough terrain such as cross-country running tend should be helped by taping. Tape just above the ankle and just below the knee with sports tape to prevent movement of bones, primarily the shin to prevent painful shin splints.

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