Everything You Ever Wanted To Know About Shin Splints

This column provides a general overview of Roller Derby medical problems and their initial treatment, and it is not intended for advice for an individual. Therefore, you must consult appropriate medical professionals for advice in treating any injury or medical problem that you specifically have. This manual is not intended to be a complete or final guide to medical treatment of anyone's individual medical injury or problem.

OW, THAT HURTS! I THOUGHT ROLLER DERBY WAS FUN! You begin skating. After a few minutes, you feel pain in the front of your legs. You rest or skate slower and feel better. Then you skate harder, and it hurts again and gets worse. Do you have shin splints? Although the most likely diagnosis is “shin splints,” there is more than one thing that can cause pain in the front of the leg. It's important to know what to look for and how to manage the problem. Even more importantly, you need to know how to prevent “shin splints.”

What are Shin Splints?

“Shin splints” is not a formal medical diagnosis. The term is commonly used for pain in the front of the legs induced by exercise. “Medial Tibial Stress Syndrome” is the correct term. The sharp, aching pain occurs on the inside front of the lower leg and occurs within a few minutes to half an hour of beginning skating. The pain may resolve even while continuing to skate, but will likely come back after completion of skating. Most often, the pain is only relieved by decreased activity or rest. Without treatment, the pain comes more frequently and sooner. It may even become persistent despite rest.

Pain is located along the inside of the tibia (the larger bone in the lower leg) anywhere from just above the ankle to just below the knee. There may be some tenderness along the edge of the inside of the tibia. The cause is micro-trauma (tearing away) and inflammation of the ligaments and muscles attached to the tibia. The tearing comes about from the linear and torquing forces exerted on the tendons and muscles by vigorous athletic activities. Because the muscles are enclosed in firm sheaths of tendon, when swelling occurs, there is little room for swelling. Thus, pressure pain is added to muscle-tear pain. Female athletes tend to have “shin splints” more often than male because a woman's wider pelvis angles the legs, creating more torquing force.

How Do I Get Shin Splints?

There are two pathways that lead to injury-overloading the muscles and poor biomechanics--as listed below:

1. Increasing the activity level too quickly (when starting as a first-time athlete, or as an experienced athlete, increasing the level of effort)

2. Abnormal feet--either a flat, pronating (rolling in) arch or a high rigid arch

3. Inflexibility and/or weakness of lower leg muscles and tendons

4. Poor skating form-- too much weight on either the heels or toes

5. Sudden starts and stops with twisting of the legs (such as plow stops or agility drills)

6. Poorly fitting skates

Other causes of pain in the front of the leg must be considered to determine whether or not you truly have “shin splints.” A tibial stress fracture (actual cracking of the bone) can occur from repeated application of the forces that damage the tendons and muscles. The key here is the persistence of the pain without exercise and tenderness over a localized area of the tibia. Tendonitis can also occur in the same area. Chronic compartment syndrome occurs on the front outside of the lower leg; it results from over-stressing the muscles. Chronic compartment syndrome is more lingering but is prevented and managed similarly to “shin splints.”

“Shin splints” are not usually dangerous although they are very troublesome. However, if the swelling doesn’t resolve, the nerves and arteries running through the front of the leg can be compressed and damaged. This is signaled by severe pain and numbness and/or weakness in the foot. This is a serious situation, for which you should definitely seek specialized medical care.

How do I treat this?

Rest is the most important thing you can do to allow the tissues to heal. This may range from a day or two up to a couple of weeks. Sometimes just reducing the level of activity to avoid pain is enough. Another solution is to switch to a non-impact sport such as swimming or bike riding, for cross-training.

Ice will reduce the swelling and relieve the pain. It should be done for 20 minute sessions 3 - 8 times a day, until the pain has subsided. Some skaters find icing before warming up and skating is helpful.

Elevation is an essential component of treatment. The tissues are swollen with fluid, elevating the leg to the level of the heart allows gravity to drain the fluid. This not only reduces the pain, but also accelerates healing, as swollen tissues heal more slowly. Pain medications such as acetaminophen and NSAIDs may be needed.

Massage of the muscles may help relieve pain, but you must be careful not to further damage the tissues by over-vigorous massage. Some experts feel heating the muscles before exercise helps. However, heat does promote increased blood flow and swelling, so it can be counter-productive.

How is it prevented?

1.Take time to warm up well before exercise. Tracing the letters of the alphabet with your toes is one of many stretches to warm up your shins. Calf stretches are equally important to warming up the lower leg and preventing shin splints.

2. Plan on slow, gradual increases in activity or effort level.

3. Correct abnormalities of the feet, if necessary. If the arch is flat and rolls in, arch supports and a shoe heel that is stiff enough to prevent the heel rolling in will help. With a rigid, high arch, soft instep supports and possibly orthotics will be needed. You may need the help of a podiatrist to fully deal with these problems.

4. Flexibility is important. Flexible tendons and muscles can better tolerate the forces applied to them during skating. This means you have to warm up well before exercising. This also requires that you do consistent stretching of the muscles and tendons at the front and back of the leg all the time, not just when skating. Work with your trainer or coach on this. You can also find a good set of stretches at Sportsinjuryclinic.net.

5. Strengthening the muscles of the lower legs will also allow better tolerance of the stresses you put on them. Again, work with your trainer or coach on the best ones for you. Sportsinjuryclinic.net has a useful set for you as well.

6. Compression wraps (Ace-type and neoprene) are available for the lower leg if the problem is persistent and severe. Your trainer or medical personnel can do a special taping to reduce the swelling and pain before exercising.

7. Heating the muscles before exercise has also been recommended by some trainers.

Though “shin splints” are a common problem, there are effective ways to prevent them and to treat them. Here’s to skating pain-free – except for the trauma induced by other skaters!