Shin splints (M.T.S.S -Medial Tibial Stress Syndrome)
Many athletes get shin split, also called sore shins or medial tibial stress syndrome, at one time or another. Whether you jog daily or just sprint to catch a bus one day, you can get shin splints. While they often heal on their own, severe shin splints can be a problem.
Shin splints aren’t really a single medical condition. Instead, they’re just a symptom of an underlying problem. They might be caused by:
- Irritated and swollen muscles, often caused by overuse.
- Stress fractures, which are tiny, hairline breaks in the lower leg bones.
- Over-pronation or ”flat feet”, which is when the impact of a step causes the arch of your foot to collapse, stretching the muscles and tendons.
Shin splints are very common. They are the cause of 13% of all running injuries. Runners might get them after increasing the intensity of their running or changing the surface they run on from a relatively soft surface to a hard surface. Shin splints are also common in dancers.
What do shin splints feel like?
Shin splints tend to cause dull, aching pain in the front of the lower leg. Some people feel this pain only when they are exercising while others feel it when they stop exercising. Sometimes the pain is constant. And can be severe with areas of intense tenderness. This might imply underlying stress fractures.
Depending on the exact cause, the pain may be located along either side of the shinbone or in the muscles. The area may be painful to the touch. Swollen muscles can sometimes irritate the nerves in the feet, causing them to tingle or feel numb.
To relieve the pain caused by MTSS, ice massage and Achilles tendon stretching are performed 3 to 4 times a day. Nonsteroidal anti-inflammatories such as aspirin are recommended to relieve inflammation and pain. Gentle stretching of the leg muscles that includes the calf, heel cord, and hamstring is essential before and after exercising to treat MTSS. Any anatomic foot variation, such as a pronated (a foot with a low arch) flat foot, should be corrected with a foot orthosis . Runners should use a running shoe that provides shock absorption and has a firm heel support. Gentle flexibility and strengthening exercises for the muscles involved should also be added to the workout.
The key treatment for MTSS is rest from the activity that causes the pain. Once the pain has subsided, less stressful exercise can begin. For example, for the first week, biking and swimming can be substituted for running. Then the patient can start training again at about half the previous level of intensity (half the distance or pace). The exercise intensity should be gradually increased to the desired level over 3 to 6 weeks. Recurrence of pain is a signal that the level of activity has been resumed too fast.
Active individuals who have recurring MTSS need not stop exercising or running. They should first correct predisposing factors, such as wearing worn-out shoes, running on hard surfaces and pavement, or increasing training too quickly.
MTSS can be painful but is usually easily resolved. If you experience pain in your shin, thoroughly stretch before exercising, reduce your activity level, and check your shoe wear. If you run on a hard surface, find softer ground.
Iliotibial Band Sydrome
What is Iliotibial Band Syndrome?
The IT (Iliotibial) band is a tough band of fibrous tissue that runs down the outside of the thigh. The upper fibers of the IT band start at the hip and the lower fibers insert below the knee on the outside of the tibia (shin bone). It works with the surrounding muscles to assist in flexion and stabilization of the knee. It also assists with hip movements out to the side and internal rotation. IT band syndrome is an irritation of this tissue due to excessive tightening or shortening of the band. It is commonly felt as localized pain on the lower thigh or outside of the knee where the IT band inserts. It may also be painful at any point along its length. A tight IT band is often the cause of greater trochanteric bursitis (at the prominent knob of the hip bone). Pain can be aggravated by activities such as running, climbing and descending stairs or getting out of a car. Pain is usually worse during activity and can lessen during rest. This is because activity tends to promote more tightening of the band and more friction over the bony prominences the band crosses.
How did I get Iliotibial Band Syndrome?
There are many anatomical factors that can contribute to the development of this condition. People with bowed legs, excessive internal rotation of the lower leg, pelvic muscle imbalances and leg length differences may be prone to developing this problem. This is a repetitive stress injury so excessive training, or always running on the same side of a curved road is thought to contribute to IT band syndrome. Biomechanical problems in the feet are also a major contributor to the development of this syndrome. Specifically, excessive pronation or flattening of thearches can lead to extra stresses on the outside of your thigh. When the feet flatten, the lower leg is turned inwards (internal rotation). This moves up the chain to rotate your thigh inwards. This creates a bowing of the knee and added strain on the outside of the knee. When you are running or moving on flattened arches, the tightened IT band may rub over bones in the hip or knee or just get irritable from the tightness, triggering inflammation and pain.
Exercise: Stretching exercises are directed at lengthening the IT band and the muscles of the outside of your hip, to try and relieve some of the tightness. Strengthening exercises can be directed at your gluteal region to stabilize the pelvis and try to prevent pulling of the IT band at the knee. Remember, the IT band is not a muscle, but a thick band of fibrous tissue (think of a tough piece of leather) so it is very resistant to being stretched.
Anti-Inflammatory Agents: These may include ice and oral anti-inflammatory medications. Ice can be applied directly to the site of pain to decrease the inflammatory response. These may provide some temporary relief from the pain of inflammation, but are not helpful in addressing the underlying cause of your condition.
Rest and/or Training modification: Rest is often recommended to reduce inflammation. You may be advised to decrease your training time or distance. You may also be advised to avoid activities such as running and try biking or swimming. Altered or reduced training schedules may be suggested in combination with running form advice. Shortening your stride and avoiding hills may be part of your strategy. It is important to remember that although rest by itself may decrease your pain temporarily, it does not address the reason why you have developed this problem in the first place.
Steroid Injections: A local cortisone injection to the side of inflammation can help temporarily reduce the pain of IT Band syndrome. This is a last resort and only done when all other treatments have failed.
Foot Orthotics: The proper foot orthotics can go a long way to taking the stress off of your IT band. The right custom made, biomechanical orthotics can address the underlying cause of your knee dysfunction. Abnormal joint positions can be reversed, thereby allowing function to be restored and tissues to heal. A foot orthotic, unlike typical custom orthotics, is designed to completely support the corrected position of your foot. They are also designed with your weight and specific activity level in mind creating true biomechanical shock absorption. This restoration of correct mechanical function takes the abnormal stress off the outside of your knee and allows the IT band to heal.