Shin Splints is a common term for shin pain during running. One of the most common shin conditions is Medial Tibial Stress syndrome, an overuse injury usually caused by kicking and running. The condition is characterized by pain and tenderness in the lower leg, usually along the front edge of the shin.

Mechanism of Injury

There are many different opinions as to the specific cause of tibial stress, including:

• changing training techniques
• overuse (from not allowing enough time to recover)
• training too hard, too fast or for too long
• suddenly increasing the intensity or duration of exercise
• problematic soccer cleats or turf shoes
• the shape and structure of the leg
• pes planus (flat feet) or pronated foot position (a lowered arch during running)
• training surface or change in training surface (i.e. hard or uneven surfaces)

Signs and Symptoms

• Pain and tenderness developing along the front edge of the shin where the muscles are attached. Pain can occur before, during, and/or after soccer practice or games.
• Symptoms can show up suddenly, but usually develop gradually (pain over the shin and soreness in heel walking are a few).
• Swelling and discolouration are seldom noted.

On-Site Management

P.R.I.C.E. PROTECT the area from further injury (i.e. shin sleeve). REST does not imply halting all soccer activity, and your injured athlete can be running in deep water, cycling, etc. to maintain and/or increase fitness. ICE the area 10-20 minutes to reduce inflammation. COMPRESS the area to move inflammation away. ELEVATE the area to increase circulation towards the heart, this can be done while icing.

Refer for a Correct Diagnosis. It is important, as with all overuse injuries, that a correct diagnosis be determined before the cycle of pain becomes established. A sport medicine practitioner will take a history of the injury, conduct a physical examination of the injured area, and undertake a biomechanical assessment of the soccer player's lower extremity (looking for anatomical abnormalities). If warranted, selected diagnostic tests may be ordered such as X-rays, bone scans, etc. Physicians will often prescribe anti-inflammatory medication and therapists can apply various electrical modalities that will assist in controlling inflammation and returning the area back to optimal function.

Rehabilitation

Promote Healing. Invariably with overuse injuries, when the soccer player's pain is relieved, s/he prematurely returns to playing soccer and is reinjured. Rest and anti-inflammatory medication alone do not heal. Healing occurs with a combination of progressive site-specific strength and conditioning exercises and overall body conditioning.

Soccer specific agility, speed and skill drills should be gradually incorporated into the athlete's program as healing progresses. Training of the calf muscle with plantar and dorsiflexsion movements are indicated.

Control Abuse. The potential for tissue overload must be adequately controlled prior to returning the player to soccer activity. Some effective methods for tibial stress include:

• supportive soccer cleats or turf shoes (may need orthotics)
• improving kicking and running technique
• addressing any training errors (frequency, intensity, duration)
• paying attention to playing or training surfaces
• taping can sometimes be helpful

Return to Activity. A very gradual return to soccer program must be adhered to once stretching and strengthening exercises have been undertaken. Generally soccer players are allowed to return to limited activity when the injured extremity shows 80% to 90% of the strength of the uninjured extremity. In severe or prolonged cases, the athlete should not return until pain-free and receives a doctor's OK.

Prevention

• Adequate warm-up, including stretching, before soccer practice and games.
• Pre-season soccer specific strengthening and stretching.
• Appropriate soccer footwear (cleats and turf shoes).

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