Chiropractor Chandler AZ
Shin splints are very common condition affecting active individuals, especially younger athletes. Our lower legs absorb a tremendous amount of force when we run or jump, especially on hard surfaces. Shin splints are one of the injuries that affect almost every sport, especially gymnastics, track, basketball, cross-country, football, or tennis. It also affects all age groups. Younger individuals are especially at risk in explosive or pounding sports. However adults and older athletes also experience shin pain as they increase their activity levels. Shin splints is also called medial tibial stress syndrome and is especially common when someone is trying to get back in shape and they’re exercising much more than they had in the previous months.
The lower leg bones are made up of the larger and more weight-bearing tibia in the middle. The smaller fibula bone runs on the outside or lateral aspect of the leg. The femur comes to sit on top of the tibia at the knee. Crossing the knee are several large muscles coming from the upper leg including the quadriceps, biceps femoris, and the gastrocnemius muscles. The gastrocnemius starts above the knee and crosses down to the Achilles tendon. The gastrocnemius is a larger muscle seen on the back of the calf that appears to be a big bump, and underneath it is solely a muscle that also performs plantar flexion. On the lateral side of leg is the fibularis longus and and fibularis brevis muscles that help stabilize the lower ankle. On the medial side of the leg is a posterior tibialis muscle that runs directly behind the tibia and its tendon extends behind the medial malleolus and onto the bottom of the foot. On the anterior side of the tibia starts the tibialis anterior muscle that runs from the knee down towards the ankle and foot.
Shin splints are very commonly a stress or strain to the muscles and tendon as they attach onto the tibia. Both the tibialis anterior and tibialis posterior muscle have a broad attachment on to the periosteum of the tibial bone. The periosteum is a thinly wrapped layer of connective tissue around the bone. The muscle tendons attach to the periosteum all the way down the tibia. Overuse or chronic pulling of the muscle can irritate either the tendon or the periosteum on the bone. Pain localized to the posterior aspect of the tibia is affecting the posterior tibialis muscle. Pain in front of and to the lateral side of the tibia is from injuries to the tibialis anterior muscle. Whenever the muscles are contracting to stabilize the lower ankle or knee there is a tug through the muscle. This tug and force is distributed throughout the muscle and any injury to the tendon is feeling that pull and causing further injury and pain. The body is in a constant battle to lay down more strengthening connective tissue fibers on that tendon as you are increasing the pounding forces to the lower leg muscles.
This is why running or jumping on harder surfaces causes greater injury to the lower leg muscles. Landing on a hard surface produces more of the impact force that those muscles have to absorb. Meanwhile, landing on a softer surface causes less impact and less force needs to be absorbed by all of the muscles in the lower leg.
At home, the first and most effective treatment for decreasing any type of chronic repetitive stress injury is rest and ice. Resting allows the muscle a chance to recover and heal without further trauma to the tissue. Ice helps decrease the pain and inflammation. Inflammation in excessive amounts can slow the healing process, in addition the inflammatory molecules increase sensitivity to pain and discomfort.
Over-the-counter anti-inflammatory medication can be utilized to decrease pain and inflammation. It can be taken as recommended by your primary care physician. Cortisone injections are not usually prescribed for shin splints because the pain is distributed throughout multiple locations on the tendon. Cortisone injections tend to work better in very specific injury areas, such as IT band tendinitis or supraspinatus tendinosis, where a single tendon or rope-like structure is attaching onto the bone. Pain medication or prescription anti-inflammatory medications are not usually given unless the pain and injuries are severe.
Conservative and alternative treatments for decreasing pain and inflammation of chronic repetitive injuries involves reducing the stress and strain to the muscles. Rest gives the muscles and tendons a chance to heal and recover. Therapeutic treatments are designed to increase blood flow and enhance the muscle fiber and tendon repair. Ice, heat, electric, ultrasound, light stretching, and strengthening exercises are common physical therapy modalities and treatments.
Acupuncture is also another alternative treatment for shin splint pain. Acupuncture helps relieve pain and muscle spasms, and increase blood flow for healing. Many patients respond very well to the treatments even though it seems significantly different than the type of therapies they are accustomed to. Massage therapy, Graston neck technique, and active release technique are muscle therapies that help decrease the muscle spasms, scar tissue and fascial adhesions that are contributing to the muscle and tendon injuries. Graston technique utilizes stainless steel instruments to slide along the skin and help break up scar tissue by pulling one muscle layer across to another. Graston technique is excellent on large muscle groups, as well as where the muscle becomes tendon for attaching onto the bone. In conditions such as shin splints, much of the pain can be focused along the tendon junction where it meets the periosteum and bone. The shape of the instruments makes it ideal for working of the long muscle insertion of bone. Active release technique is a specialized sports muscle therapy that helps relieve fascial adhesions in the larger muscle groups. It is very common to have an active release provider on staff in many sports therapy clinics, university athletics, and sports team programs. ART is also a treatment very popular with runners and triathletes, especially at the Kona world championship Ironman.
Class IV cold laser is a very effective treatment for decreasing pain and inflammation in large muscles and in the smaller tendons. Specific wavelengths and frequencies help block pain and inflammatory molecules. By reducing the amount of inflammation, the injury becomes less painful to the touch and responds better to the active therapies and treatments. In addition, different wavelengths help accelerate repair and the regeneration processes within the muscle and tendons. The wavelength stimulate fibroblasts to help lay down more collagen fibers for support and to increase tissue strength. Increased fibers allow the muscles and tendons to absorb more force, especially when people return to their previous exercise levels and begin straining the leg muscles.
Class IV cold lasers are the newest and most popular low-level laser therapy treatments. The class IV laser has multiple wavelengths and treatment protocols for each region of the body. The leg muscles require different settings then the large muscles and the low back. These lasers also have greater depth of penetration and can produce more energy per minute than the older class III. The class III lasers emit approximately 6 J of energy per minute. Meanwhile the class IV cold lasers can produce several hundred joules of energy per minute.
There are multiple therapies and treatments for shin splints. Initial treatment involves decreasing pain, inflammation, and muscle spasms. Home treatments involve rest and ice to reduce the stress and strain allowing the soft tissue heal. Anti-inflammatories and pain medication can be used as needed. Conservative treatment is very effective at accelerating recovery and healing for active individuals with muscle and tendon pain. Heat, ice, electric, ultrasound, stretching, exercise, Graston technique, active release technique, and massage therapy are excellent treatments for medial tibial stress syndrome.