Getting back to a sports season (or starting one for the first time) can be a very exciting time for both kids and their parents. So it’s always unfortunate if a painful problem such as shin splits gets in the way.
The term “shin splints” can feel a bit vague, though. About all many people know about it is it causes pain in the lower leg and sounds sporty. And while these notions are valid, there is always more to the story.
So what are “shin splints” exactly, and how do we address such causes of lower leg pain in kids and adults? School is in session!
What Are Shin Splints?
The term “shin splints” is typically reserved for pain occurring in the lower leg. This generally occurs due to increased activity, starting new activities, or changing activities of focus.
What we most commonly call shin splints can arise from two different problems. The areas where these problems can occur are within 2 inches of each other but are still, medically speaking, in two different neighborhoods.
Shin Splints A
The first type of shin splints is the result of muscle strain in the leg.
Although there are many muscles in the lower leg, most of them are very small. The job of these smaller muscles are to stabilize you. Only two big muscles below the knee actually move your leg forward and upward.
The smaller, stabilizing muscles are still very important, but they do not need to be incredibly strong to do their job. There’s a classic party trick that shows how lacking these muscles can be when you are called upon to use them in certain ways.
But if those muscles are in the right position and able to do the jobs they’re made to do, things are fine.
However, what happens when there is a tug-of-war between a large muscle and a small muscle? You can guess who wins.
When those two big muscles, attached to the Achilles tendon, are tight, they will make those smaller muscles work harder. This can lead to strain and damage. Pain will typically occur next to the outside (lateral) portion of middle-to-upper third of the lower leg (tibia). The area will become sensitive to the touch and especially painful when you flex your foot upward.
Shin Splints B
The other type of shin splints happens in the mid-to-lower third of the tibia. This time it will also be on the inside (medial) area.
This pain occurs from the stretching of the posterior tibial tendon due to pronation (your foot rolling too far inward as you walk). As the foot collapses inward during motion, the tendon is forced to stretch longer. Posterior tibial tendinitis tends to the best starting result, and ultimately the tendon can become stretched enough to tear or detach.
The condition can present differently in different age groups. In younger patients, the tendon is usually stronger and the damage occurs closer to where the tendon attaches to bone (“shin splint”). In older patients, the tendon is often weaker, and full posterior tibial tendinitis develops.
Who Has a Higher Risk of Shin Splints?
Those with the highest risks of shin splints tend to have at least one of the following:
- Tight Achilles tendons (equinus)
- Overpronation, often from flat feet
Such conditions can be seen at just about any age, from children to adults. Add an increased rate of activity, increasing intensity too quickly, or increased weight or force in the area, and injury is likely to occur.
Typically, cases will become present when someone begins an activity while their muscles are not yet accustomed to that exertion (think starting training for a new sport, for example). You don’t need to be a rookie, though. Even relatively seasoned athletes can still develop pain if they are putting their all into an activity they’re not fully adjusted to.
How Do We Treat Shin Splints?
Shin splints are not something to try and ignore. Both versions of shin splints can lead to stress fractures or compartment syndrome if not properly addressed.
There are many suggestions for treating shin splints that often have good intentions, but miss on addressing the actual causes of the problem. They only treat the symptoms. Let’s review some of these first.
What Doesn’t Work
- Muscle strengthening. Strengthening the muscles will not help the problem because it does not overcome the constant strain being placed on them. Even when you’re strong, you can still only endure constant force for so long, as this video shows.
- Massage. Moving a damaged muscle increases blood flow and feels good. But if the source of the problem isn’t addressed, the problem will come back the next day, week, or month.
- New shoes or shock-absorbing insoles. Softer shoes can actually increase pronation, which can worsen the condition.
- Rest, ice, medications, etc. Again, we’re addressing just the symptoms here. These can, however, help shorten recovery time if we also address the original cause.
- Stopping activity. What happens when you start again?
What Does Work
To overcome shin splints, we must address the “tug-of-war” happening within: either stronger muscles pulling too hard against weaker muscles, or overpronation straining the tendons.
For the first version of shin splints (muscles), physical therapy tends to work well. By conditioning the body to place less stress and strain on the muscles and restoring further balance, the tug-of-war can effectively end.
Physical therapy is not as effective in the second version (tendons), but the aid of custom orthotics is. By controlling overpronation using orthotics, we can stop the excess strain on the tibial tendon.
The above treatments under “What Doesn’t Work” may certainly be used to help a patient feel better or accelerate initial recovery, but without hitting the sources of the shin splints, those measures can’t be permanently effective.
A bonus of finding and addressing conditions such as overpronation in children is that we can often do more to directly help the issue while your child’s foot structure is still somewhat malleable.
Tell Shin Splints to Split
Persistent lower leg pain is not a matter to ignore. If your child or anyone else in your family may have shin splints or any other form of consistent discomfort, schedule an appointment at our Indianapolis office. Give us a call or fill out our online contact form.