Thursday, September 25, 2014

Shin Splints or Stress Fracture?

This is a common question that comes up with athletes who are training in any sport.  Shin splints can affect anyone who does a lot of running, from marathoners to soccer players, and it is one of the most common ailments I see in my office.

Shin splints are known by many names, but the correct terminology is medial tibial stress syndrome, or MTSS.  As the name implies, the condition involves stress or overload of the inner, or medial, border of the shin bone—the tibia.

We usually see MTSS when someone abruptly changes their training routine.  The bone is overstressed and begins to remodel.  It also develops a tiny amount of fluid between the main layer of bone and the outer jacket, called the periosteum.

On examination, the inside of the leg is very tender, especially along the bone.  X-rays usually don’t show any abnormalities. And bone scans and MRIs, while helpful to confirm the diagnosis, are usually unnecessary and expensive.

So what do you do about shin splints if you have them?  The answer is simple, but is one that athletes don’t like to hear.  REST!!  That doesn’t mean sitting on the couch all day and resting, but rather changing the exercise to a cross-training activity like swimming or biking to maintain cardiovascular fitness while allowing the bone to heal.

Other things that may help include anti-inflammatory medicines, ice, compression sleeves, and arch supports.  However, there is no clear evidence that any of these things work.  Generally, rest is key!

It’s usually just better to avoid getting shin splints.  The most important way to do that is to increase training gradually, allowing for plenty of time to reach your goals.  A high quality shoe and limiting running on really hard surfaces also helps.

If you suspect you have shin splints, try giving it some time to rest.  But if there is one small area on the shin that is a lot more tender than the surrounding bone or if your pain is not improving over time, it may indicate a stress fracture, and you should have your doctor take a look.