Behind that overlooked shin pain is overworked muscle and bone tissue

Monday October 19 2020
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By Joan Salmon

Shin splints, a term for lower leg pain that occurs below the knee either on the front outside part of the leg (anterior shin splints) or the inside of the leg (medial shin splints), is one common condition that affects a number of people whether you are an athlete or not. 
The shin is the lower part of the large front bone of the leg (Tibia). 

“This bone, along with the Fibula bone and ankle joint bear the weight of the lower limb as well as the whole trunk during body movements. As per body biomechanics, the lower limb bears trunk weight which could be uneven, especially in those with obesity, hence misaligned functioning, resulting in difficulty moving or pain,” explains Dr Stephen Ataro Ayella, the team physician of Uganda Netball Federation.

Prone  
Shin splints are common in runners, especially long distance runners, dancers with prolonged dancing episodes, athletes who have recently intensified or changed their training routines and military recruits who undergo training but have not yet got combat hardening. 
Many mild cases tend to be unrecognised or taken as normal part of training hence not getting attention they deserve.
 According to Dr Ataro, shin splints could affect the performance of an athlete, especially if it involves severe damage. 

“Recurrent injuries could lead to long term disability or inability to endure training and competition. It is important to note that the impact is not only manifest in athletes but anybody involved in tasks that involve lower limb biomechanics or those who stand for long periods of time such as casual labourers, security operatives, farmers and builders,” he clarifies.

  Causes
Shin splints usually occur due to injuries to the muscles in the lower third of the leg. “If injuries occur to the anterior muscle (Tibialis Anterior), the pain will be manifested in the front of the leg, while if it occurs to the back of the leg muscle (Tibialis Posterior), the pain will be felt in the back of the leg,” says Dr Ataro.
Dr Franklin Wasswa, a general practitioner, explains that muscles and joints are connected in such a way that when one is injured, the other supports to replace the lost function. 

“For example, if the right limb is weak, you will unconsciously tilt your upper body to the left at the waist to balance weight off the right limb to the left. This will overwork the left limb and joint,, causing pain on that limb. So, a problem that starts from the right limb is now affecting the left. Understanding this explains how pain on the tibia could originate from elsewhere. This condition is called anterior or medial stress syndrome,” Dr Wasswa explains. 
“Many people use their running shoes until the sole is worn out, causing a tilt to their foot. If your shoe sole is worn out, especially on the inside, you will get anterior stress syndrome while if it is worn from the outside, you get medial stress syndrome,” he adds. 

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The same will happen to those who walk on uneven ground such as builders. Also, a person who takes a long walk on ground that is filled with rocks and gravel, will have a similar problem. For athletes, especially those playing impactful games such as soccer, injuries could occur due to sliding or hard tackle, especially by defenders. In the case of fast running athletes, the injury could occur as a result of over-stretching of the muscles.

Referred pain
It could also be referred pain from injuries in the ankle joint (dislocation, arthritis, fracture, and vasculitis) or due to inflammatory processes in the bones, ligaments, nerves or blood vessels supplying the leg.  
Common predisposing factors include presence of other illnesses such as diabetes, hypertension, arthritis, muscular diseases, and obesity that leads to lop-sided movement.  In cases of vascular disease, the pain could be felt but mostly in the calf muscle, which often occurs during cold weather. 

Symptoms
 The main symptom is leg pain, which could be mild or severe depending on the extent of the injury. In chronic cases, there can be inability to move, and swelling (oedema) resulting from tissue damage due to inflammation, secondary infections, especially in traumatic causes, with a wound resulting, hence a fever as well as localised signs of local tissue damage.

Prevention 
Brian Kasasa, a sports scientist, says splint shins are preventable. “Ensure you have a thorough stretching routine of hamstrings (thigh muscles) and calf muscles (back of leg muscles),” he advises.
 Exercise on softer surfaces when possible. “Most beginners are quick to go road running on tarmac yet murram is the better (softer) option for beginners. When in gyms, wooden surfaces are better than concrete or tile surfaces,” Kasasa says.

BMI
There should also be constant measurement of one’s body mass index (a value derived from the mass and height of a person). “This is necessary because too much weight will impact on the splint shins, especially in running. It is also important to strengthen your hip muscles to be able to accommodate the extra weight capacity of the body,” Kasasa shares.
 Wear the correct type of shoe for a given activity. “For example, do not jog with shoes whose sole is stiff. Rather, ask your trainer for advice on what is right,” Kasasa says.


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 Technique 
Get the right technique of running. “For example, when running uphill, toes should hit the ground first, while going downhill would require for one’s heel to hit the ground first. The technique balances weight on the body for efficiency,” Kasasa explains.
Treatment
Treatment of shin splints depends on the extent of the injury or damage caused as well as the phase (acute or chronic). Depending on the findings, the following can be done to alleviate the condition.  

Ice
For acute injury, applying ice would help cool the pain and reduce inflammation. “However, ice treatment is more of first aid and short therapy which should be followed by definitive therapy. In the absence of ice, cold spray therapy such as deep freeze can help to relieve the pain and reduce inflammation. To compress and reduce oedema and pain, one may also use compression socks or brace (bandaging) on the affected area,” Dr Ataro says.
 Bed rest can help relieve mild symptoms, which could take two to four weeks.

  How to diagnose a splint shin 

Just like any other medical condition, diagnosis relies on a  detailed history with information regarding the onset and nature of pain and location. It also considers how long the person had been in exertion, prior injury or similar symptoms, and history of other medical conditions. 

“A detailed physical examination of the affected area would help to determine the nature of pain, and related signs such as oedema, bleeding, presence of wounds or any obvious deformity. For mild cases, no laboratory investigations may be indicated but in severe cases, you will do X-rays, ultrasound scan for soft tissue injury as well as other tests for associated or secondary infections,” Dr Stephen Ataro Ayella, the team physician with Uganda Netball Federation, says.

In the case of a hyperpronated foot, Dr Franklin Wasswa, a general practitioner, advises to check your footprint “You can do that by stepping in water and then on a brown paper, which will leave a mark of your footprint. If there is no arch in the mid foot or too much arch, then you have an ankle deformation. This will also give you an idea on how your shoe sole is going to be worn out,” he says.

Home remedies
Shin splints normally require that you take a break from certain physical activities and give your legs time to rest. The discomfort will usually resolve in a few hours or at most in a few days with rest and limited activity.
The suggested amount of downtime is typically about two weeks. During this time, you can engage in sports or activities that are less likely to cause additional harm to your legs. These activities include swimming or walking.
Your doctor will often suggest that you do the following:
● Keep your legs elevated.
● Use ice packs to reduce swelling. Shop for cold compresses.

● Use a foam roller to massage your shins. 
Check with your doctor before restarting any activities. Warming up before exercising is also a good way to make sure your legs are not sore.

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