Like Being Kicked in the Shin

Senior year has brought a lot of changes to my routine: new teachers, new classes, college tours and filling out college applications. In my final year of varsity baseball, I also have a new head coach. In themidst of fall conditioning, I have learned one of the things coach likes us to do is run. Run before practice. Run after practice. Grueling “poles” and sprinting to the point of vomiting. Returning from practice one day, I felt sharp pains in my shins with every step I took, like little kicks to my shins. I had shin splints.

Medial tibial stress syndrome (MTSS), aka shin splints, causes pain along the inner side of your shin (tibial bone). Shin splints usually are related to vigorous activity or exercise including running. MTSS is seen in 13.2 to 17.3 % of all running injures (Yates 2004 American Journal of Sports Medicine). Shin splints can commonly be seen in runners and dancers. While typically not a serious condition, it can cause temporary discomfort and if left untreated, can lead to stress fractures in the tibia bone. As the name implies, this condition is related to overworking or stressing the muscles around the tibia leading to inflammation of the anterior tibialis muscle. The exact mechanism is unclear but a few theories try to explain why MTSS occurs like repetitive traction on the tibial periosteum (Devas 1958 Journal of Bone

and Joint Surgery).

In general, shin splints will be associated with beginning of an exercise program or an increase in intensity of exercising or activity. However, certain conditions can increase the change of developing this uncomfortable pain in your leg. Having “flat” feet or low arched feet and using poor fitting or worn out shoes can lead to MTSS (orthoinfo.aaos.org).

Aside from examination, MRI can be used to aid in diagnosis of MTSS as well as look for associated conditions such as stress fractures or tendinitis. Treatment is usually conservative and surgery is rare to treat MTSS. Rest, ice and pain control with NSAIDS if necessary are key components to recovery.

Prevention can be just as important in resolving shin splints. Gradually implementing an exercise regimen or cross training with lesser body impact exercises like swimming or biking can help reduce the incidence of splints. As mentioned before, proper shoe fit and quality can aid in prevention as well.

Orthotics can be used if anatomical predisposition like low arched feet exist to help stabilize the foot and ankle in movement. Some believe that barefoot running can prevent or even alleviate shin splints (Beierle 2019 International Journal of Exercise Science).

Figure from https://www.wdhospital.org/wdh/services-and-specialties/orthopedic-care/blog/prevention-and-treatment-shin-splints