Shin Splints

Nearly every high school coach, student-athlete, and parent of a student-athlete has heard of shin splints. The term shin splints is actually a "catch-all" term used to describe pain in the lower leg.

Shin splints usually begin as a dull ache along the shin, or tibia. In the early stages, discomfort is felt at the beginning of a workout, disappears during the workout, and reappears when the workout is over. As shinsplints progress, the pain becomes more severe and lasts during the entire workout. Eventually, pain occurs when getting up in the morning and when doing daily activities, such as walking up or down stairs.

Shin splints are an overuse injury which occur most frequently in unconditioned or poorly conditioned athletes who begin a new running or jumping activity. Shin splints also occur frequently in runners who alter their workouts by increasing pace, frequency, or distance too rapidly. While these are the most common causes of shin splints, other causes include: changing to newer, or more rigid, running or workout shoes, changing to a harder running surface, frequent running in the same direction on a track or banked road, running and jumping on the toes, an imbalance in calf and shin muscle strength, poor posture, worn out shoes, fallen arches, leg length discrepancy, abnormal or strained running style, and poor flexibility in the calf muscles.

Properly fitting shoes that offer good arch support and adequate shock absorption are very important to the prevention of shin splints. When entering into a new activity, do so slowly to give the body time to adjust. When increasing existing training programs, the pace, frequency, or distance should be increased no more than 10% a week. Athletes should also cross-train and limit activities that continually demand a great deal of plantar-flexion (toe pointing), such as aerobics and toe running.

If an athlete pays particular attention to their workout habits and their shoes, and gives some thought to avoiding the other causes, shin splints may be avoided. If shin splints are not avoided, proper treatment is a must.

To better understand the proper treatment of shin splints, it is helpful to understand the varying symptoms and severity. Shin splints are classified according to the severity of the pain produced. The classifications are as follows:

GRADE 1 - The athlete complains of vague pain in the shin or calf following activity.

GRADE 2 - The athlete complains of pain before and after activity, but not during activity. Performance is not affected.

GRADE 3 -The athlete complains of pain before, during, and after activity with a negative affect on performance.

GRADE 4 - The athlete complains of pain so severe that practice and competition are not possible.

Proper treatment should begin when the athlete experiences GRADE 1 or 2 symptoms. If treatment is not begun in the early stages, the pain will increase and the athlete risks a loss of performance with continued activity. While rest from the offending activity is the preferred treatment for shin splints, that is not always practical in competitive athletics. Active rest, performing exercises that relieve stress from the lower legs, is the best choice. Active rest exercises can include stationary cycling, ski machines, swimming, or other cardiovascular conditioning exercises which limit the amount of stress put on the lower legs.

Athletes suffering from GRADE 1 or 2 shin splints should follow these treatment suggestions to allow continued competition with a minimum of discomfort and performance loss.

1) Anti-inflammatory medications can be very helpful in reducing swelling and controlling pain. These medications should only be used under the advice of a physician so the proper dosage can be prescribed and any possible adverse effects can be explained to the student-athlete.

2) Stretching before and after practice is extremely important in the treatment, and prevention, of shin splints. Stretching exercises are described at the end of this Update.

3) The choice of ice or heat to treat shin splints should depend upon which treatment effectively reduces the athlete's discomfort or pain during activity. Pre-practice treatment can consist of either "massaging" the injured area with an ice cup for 10, or using a whirlpool, or other form of moist heat, for 15 -20 minutes, immediately prior to practice. Proper stretching of the Achilles tendon and calf muscles before beginning activity is critical to the reduction of pain during activity.

4) During practice it is important that the athlete wear supportive footwear with adequate shock absorption and avoid hard or uneven surfaces, if possible. Taping can also be effective in some cases. Taping techniques are illustrated and explained in the supplement to this Update. Athletes with shin splints may very well have some discomfort during practice, but if an athlete suffers from pain during practice he should stop activity and ice the affected area immediately. Following the application of the ice they should follow the pre-practice stretching routine and perform non-weight bearing cardiovascular exercise.

5) If the athlete is able to participate throughout the entire practice session they should ice the area immediately after practice. This treatment may be in the form of a 10-minute ice massage, or a bucket filled with half ice and half water (ice buckets). If an ice bucket is used, it should be filled so the water covers the shins. The shins should stay immersed for 15 minutes.

6) Strengthening exercises for the arch, foot and lower leg also need to be part of a treatment, and prevention, program. Activities that strengthen the calf muscles, but do not strengthen the muscles of the front of the leg will cause the shin muscles to be overworked resulting in shin pain. Strengthening exercises are explained at the end of this Update.

In summary, the prevention of shin splints can best be accomplished by understanding the causes. The causes are most frequently an abrupt beginning of running or jumping activities, or too rapid of an increase in the intensity, duration, or frequency of workouts. Controlling the causes is also a key in the proper treatment of shin splints. By understanding the causes, prevention, and proper treatment, shin splints can be avoided or their negative effect on performance minimized. Without adequate attention, shin splints may nag an athlete for an entire season or career.

Questions and comments about shin splints and other athletic injuries are welcomed and encouraged. They should be directed to Alan Beste, ATC, Administrative Assistant for the Iowa High School Athletic Association. (515-432-2011)

STRETCHING EXERCISES TO HELP PREVENT SHIN SPLINTS

(All stretches should be done pain-free)

a) Achilles Tendon stretches - Stand on a step with the heels over the edge. Keeping your knees straight and lower your body so the heels are below the step. Hold 10 - 20 seconds, repeat 5 times, and do 2-3 sets per day.

b) Calf stretches - Stand on a step with the heels over the edge. Squat slightly so both knees are bent and lower you body so the heels are below the step. Hold 10 - 20 seconds, repeat 5 times, and do 2-3 sets per day.

STRENGTHENING EXERCISES TO HELP PREVENT SHIN SPLINTS

a) Two-leg and one-leg heel raises - Stand on the floor, next to a table or chair for support. Rise up on the toes of both feet and hold for 2 - 5 seconds. Repeat 10 - 20 times. Do 2 - 3 sets per day and work up to 50 heel raises per set with each leg.

b) Heel walking - Walk on your heels, pulling your toes toward your shin as far as possible. Walk about 10 - 20 steps and do 2 - 3 sets per day.

c) Towel gathering exercise - Set the balls of both feet on a towel. Flex the toes to gather the towel under the feet. The heel remains in contact with the floor, and stationary. Progress to doing this exercise 10 times and add a light weight to the towel for added resistance.

d) Marble pick up - Place a marble, or wadded piece of paper, on the floor. Pick it up with your toes. Repeat 10 - 25 times.

ARCH TAPING TECHNIQUES

Athletes suffering from shin splints may benefit from taping that supports the arch. Several of these techniques are described below.

Technique # 1 - Basic Arch Support

1. Cut a piece of ½ inch felt to fit the longitudinal arch. Bevel the edges so they do not irritate the foot.

2. Have the athlete hold the foot at approximately a 45-degree angle. Place the felt on the arch between the ball of the foot and the heel. Secure the felt with pre-wrap. Starting at the ball of the foot, place strips of tape around the foot pulling lightly up on the arch.

Technique # 2 - "X" Arch Taping

1. Have the athlete hold the foot at a 90-degree angle with the toes curled slightly downward.

2. Using 1-inch tape, lightly place an anchor strip around the ball of the foot. Use five one-inch strips of tape and start each strip at the base of a different toe. Each strip of tape starts and ends at the same toe. Finish by placing strips of tape around the foot lightly pulling up on the arch.

SHIN TAPING TECHNIQUES

Athletes suffering from shin splints may also benefit from taping that pulls the muscle closer to the shins. The most common technique is described below.

Technique # 1 - Basic Shin Taping

1. Place the foot at a 45-degree angle. Starting near the ankle, place strips of tape around the lower leg. Go around the outside of the leg first and finish by pulling across the inside of the leg. The tape should be slightly taut, but not too tight.

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