Dealing with shin splints after jumping back into exercise

No one doubts that spring is a great time. Once we can get outside consistently, all many of us can think of is hitting the pitch and playing, or hitting the road for a nice long run.

Forget the fact that for the last 4 to 8+ weeks, the most activity some of us got was jumping up and down during the NCAA basketball tournament. It's time to PLAY, so let's just get back into it as though we last played a day or two ago.

Stepping right back into play might not be the wisest thing to do, and we realize that by the amount of pain we feel during and after exercise.

Pain can be instructive and telling. Is there pain at rest, or just during exercise, or both? Does it go away after exercise starts? Did the pain come all at once or gradually? Where is the pain located?

One source of pain is one of the most troubling problems in sports: the pain in the lower leg, especially shin splints.

The aching pain in the lower leg can happen to athletes who are unaccustomed to exercise, or the running surface, as well as to the experienced athlete who increases their exercise intensity, changes to different shoes, or moves to harder surfaces.

The pain comes with exercise, especially when running on roads or tracks with tight turns, and is usually felt on the medial (middle) aspect of the lower leg. This pain may linger even after exercise.

Shin splints are a problem in figure skaters and gymnasts, as they don't have the freedom to select training shoes with lots of support and cushioning features that runners have. Shin splints can be fairly common on track teams because they train so much on a very hard surface.

The actual medical term for shin splints can be medial tibial stress syndrome or posterior tibial syndrome. All of the muscles of your lower leg have some attachment to the tibia or fibula. The common perception is that the change in exercise habits leads to a tearing of the muscles as they attach to the tibia. Some tendon involvement may be present.

The typical treatment for shin splints is:

  • Several weeks of relative rest (do something other than running).

  • Non-steroidal anti-inflammatory medications (e.g. ibuprofen).

  • Stretching and thorough warm-up before activity.

  • Ice massage for 15 minutes after exercise (use a bag of frozen peas, or fill a bunch of paper cups with water and keep them in the freezer. Just peel back the paper as the ice melts as the leg is iced).

  • Stretching exercises to improve flexibility of the calf and heel cord.

  • Work on strengthening lower leg muscles, with exercises such as:

    1. Lay a towel on the floor and put an object of some weight on the towel then use the toes to pull the towel/weight toward you.

    2. Loop a towel around the leg of a chair or table. Sit on the floor in front of the chair and put the foot in the looped towel then point the toes up to the ceiling trying to pull the chair across the floor.

    3. Sit high up enough up so that the foot is off the floor. Loop a towel over the toes and put something heavy (and unbreakable!) in the towel below the foot, then raise and lower the weight.

  • Slow, gradual return to running -- progress from water running to Stairmaster to treadmill to over-the-ground running.

    Also, make sure running shoes are of good quality. If there is access to an athletic trainer, there are some taping techniques that help.

    As soccer shoes are not noted for their cushioning, soccer players may have to train in running shoes for a while after returning to training. Orthotics may be prescribed.

    But don't just take these comments and self-treat any pain in the shins. See a sports medicine physician. Why? Unfortunately, there are more serious problems that also cause lower-leg pain and are mistakenly called shin splints; specifically, stress fractures and compartment syndromes (which require surgery).

    This is why simply shrugging off lower leg pain as "shin splints" is not a good idea, and why a sports medicine physician should be consulted.

    Copyright 2003 Donald T. Kirkendall

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