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Shin splints

MagazineApril 2009 (Vol. 20 Issue 1)Shin splints

Q) I recently started running in an effort to lose weight but, as a result, I've developed shin splints, and now even walking is painful

Q) I recently started running in an effort to lose weight but, as a result, I've developed shin splints, and now even walking is painful. My doctor's prescribed plenty of rest, but I'm keen to get back to my fitness programme as quickly as possible. Is there anything I can do to speed up the healing process? And how can I prevent the injury from happening again?-D.S., Leeds

A) Shin splints-or, as your doctor would say, 'medial tibial stress syndrome'-is the result of damage to the muscles and/or shinbone (tibia) in the lower leg, usually due to stress put on the bone and connective tissues during weight-bearing activities such as running, dancing, aerobics, gymnastics, football and even just walking.

Several factors, including muscle weakness, non-supportive shoes, poor running technique and over-training on hard surfaces, can lead to shin splints. In your case, the sudden increase in physical activity may well have caused the condition.

Treatment options

Treating shin splints usually involves the RICE method:

- Rest. Take a break from the aggravating activity and avoid any other activities that cause pain, swelling or discomfort. While healing, try low-impact exercise such as swimming, bicycling or running in water.

- Ice. Apply ice packs or an icy towel to the affected area for 15-minute periods over the first 24 hours after injury, and for several days afterwards if neces-sary, to reduce pain, inflammation and swelling.

- Compression. Wrap the lower leg in an elastic bandage to limit swelling and provide support for the shin muscles and connective tissues.

- Elevation. Keep the injured leg above the level of your heart for the first 24 hours, even while sleeping. If there is localized swelling, this may help that, too.

In addition, the following treatments may help to allevi-ate the pain and facilitate healing:

- Massage. Shin splints are related to muscle overuse, so massage is often effective (Lowe W. Orthopedic Mass-age: Theory and Practice. St Louis, MO: Mosby, 2003: 82). Try massaging the affected leg for 10 minutes twice a day, or visit a trained massage therapist.

- Homeopathy. According to one podiatry expert, Ruta Grav is the number-one remedy for shin splints at a potency of 6X, 12X, 15X or 30X, four times a day for two weeks. After two weeks, take Calc Phos as a single 1M dose (Subotnick SI. Sports and Exercise Injuries: Convention-al, Homeopathic and Alternative Treatments. Berkeley, CA: North Atlantic Books, 1991: 218).

Also, the popular remedy Traumeel, which includes Arnica, Echinacea and Calendula, may be worth trying. In one study, Traumeel proved to be as effective as conventional medicine for a variety of musculoskeletal injuries (Complement Ther Med, 2008; 16: 22-7).

- Acupuncture. When 40 athletes with shin splints were treated with either acupuncture, acupuncture plus sports medicine or sports medicine, those treated with either acupuncture alone or combined with sports medicine experienced the most pain relief (J Chin Med, 2002; 70: 54-7).

Prevention

Although no single preventative method has proved to be consistently effective against shin splints, any of the following may help:

- Suitable footwear. Choose footwear that suits your activity. If you're a runner, replace your shoes every 300 to 600 miles or so (J Athl Train, 2008; 43: 316-8).

- Shock-absorbing insoles. In four trials evaluating the use of shock-absorbing insoles vs controls, fewer tibial stress injuries occurred with shock-absorbent insoles (Cochrane Database Syst Rev, 2005; 2: CD000450).

- Arch supports. If you have low or flat arches, your feet may roll too far inwards (pronation) when running, which can contribute to shin splints. Insoles or special orthotics that offer arch support can help to correct the problem (J Athl Train, 2008; 43: 316-8).

- Graduated exercise. Following injury, allow an adequate rest period (usually several weeks) and resume exercise slowly. Remember to increase the frequency, intensity and duration of exercise gradually. You may also wish to consider cross-training with a low-impact sport such as swimming

or cycling.

- Strength training. Strengthen the leg muscles by walking on the outer edges of the feet and on your toes. Also, try hamstring-stretching exercises such

as wall pushups, as these will also stretch the calf muscles.

- Correct posture. A poor running/walking technique can contribute to shin splints. Make sure your weight is centred over your hips, and don't lean forward or overstride. Also, try to walk or run on a soft surface such as grass or dirt (Subotnick SI. Sports and Exercise Injuries: Conventional, Homeopathic and Alternative Treatments. Berkeley, CA: North Atlantic Books, 1991: 218).

Shin splints or stress fracture?

Shin splints can sometimes present with the same signs and symptoms as a stress fracture of the tibia. It is also thought that shin splints can progress to stress fractures if they're not treated properly. So, if you think you have shin splints and they're not responding to either rest or treatment, have a healthcare professional look at them. If you do end up with a stress fracture, it will probably take a minimum of six weeks to heal.


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