Shin splints
The term "shin splints" is the name used for pain at the front of the lower leg. The most common cause is inflammation of the periosteum (the fibrous bone covering) where muscle fibres are attached to it. Sometimes the pain of "shin splints" may be due to stress fractures of the tibia, usually two or three inches above the bony part of the ankle. Shin splints are usually an overuse injury, caused by repeated pounding on hard surfaces that occurs in sports like running, basketball and indoor football.
What are the symptoms?
Pain and sometimes swelling in the shin area are the typical signs of shin splints. Sometimes you may notice bumps over the shinbone. If this pain is ongoing, you may be suffering from a stress fracture, so it is important to get your leg checked out by a GP or a sports injury specialist. It is worth noting that X-rays do not show stress fractures at the time of injury. However, four weeks later, healing bone may be seen at the site of the fracture.
How should it be treated?
Visit your doctor if you suspect shin splints - it may be that you are suffering from a stress fracture. If it is found that you do have shin splints, the following treatments options are:
- taking time off from the sport or lowering your participation. Normally you will need to rest from the activity for a significant length of time - often two weeks to two months
- taking an anti-inflammatory medication such as ibuprofen
- applying ice-packs, warm soaks, or a protective wrap to the skin to reduce swelling. Don't apply ice directly to the skin, always use an ice pack wrapped in soft material
- changing to another, low-impact exercise such as swimming to maintain fitness while the shin splints heal
Compartment syndrome
All muscles are surrounded by a protective sheath and sometimes, due to overtraining or injury, the muscle becomes too big for its sheath. The resulting increased pressure in the sheath causes pain and swelling around the muscle. When this happens, it is called compartment syndrome. A common compartment syndrome to occur in footballers is that of the tibalis anterior - the big muscle on the outside of the shin. This injury is known as anterior compartment syndrome.
Two types of contusion injury can occur:
Acute anterior compartment syndrome- syndrome is usually caused by a muscle tear or an impact. This causes bleeding and swelling inside the muscle compartment. The syndrome can also be caused by overuse of the muscle.
Chronic anterior compartment syndrome- may occur as the result of overuse and overdevelopment of the muscle during training, or the over-expansion of the blood vessels during exercise, which causes the muscle to swell and put pressure on the surrounding sheath.
What are the symptoms?
Acute injury
- Severe pain in the muscle on the outside of the lower leg, which worsens on movement
- Weakness when trying to pull the foot upwards against resistance
- Swelling and tenderness, particularly after exercise
- Pain when the foot and toes are bent downwards
Chronic injury
- Pain goes after a short rest but comes back again during exercise
- Difficulty in lifting the toes and foot up
- Pain when pulling the toes and foot downwards
How should it be treated?
Acute injury
- Rest until the pain has gone
- Your doctor may prescribe anti-inflammatory medication
- Your sports injury specialist may prescribe range-of-motion exercises to rehabilitate the area
- You will need to elevate the leg to heart level (but no higher)
- Your doctor may measure the pressure of your compartment syndrome
- You may need an operation called a fasciotomy. This involves cutting open the sheath to allow the muscle to expand
Chronic injury
- Rest until the pain has gone
- Your doctor may prescribe non-steroidal anti-inflammatory medication (NSAIDS)
- Your sports injury specialist may prescribe range-of-motion exercises to rehabilitate the area
- In the longer term, you'll need to modify your activity levels - perhaps cross-training to use different muscles
- You may need special footwear/orthotics
- Sports massage may be advised
- Occasionally you may need a fasciotomy
Sources
The following sources were used to write this feature
- Healthwise knowledge base - Knee Problems and Injuries, Toe Foot and Ankle injuries
- Virtual Sports Injury Clinic - Football injuries
- The Physician and Sports Medicine online
- MD Advice
