Often incorrectly described as "shin splints", tibial stress syndrome is an overuse injury usually caused by running. The condition is characterized by pain and tenderness in the lower leg, usually along the front edge of the shin. There are many different opinions as to the specific cause of tibial stress, including:

• changing training techniques
• overuse
• problematic footwear
• the shape and structure of the leg
• training surface (or change in training surface).

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 exercise.
• 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 activity, and the injured athlete can be running in deep water, cycling, etc. to maintain and/or increase fitness. ICE the area to reduce inflammation. COMPRESS the area to move inflammation away. ELEVATE the area to increase circulation towards the heart.

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 athlete'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 athlete's pain is relieved, s/he prematurely returns to activity 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.

Sport 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 athlete to activity. Some effective methods for tibial stress include: supportive footwear, improving running technique,addressing any training errors (frequency, intensity, duration), and paying attention to playing or training surfaces. Taping can sometimes be helpful.

Return to Activity. A very gradual return to running program must be adhered to once stretching and strengthening exercises have been undertaken. Generally athletes 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 activity.
• Pre-season strengthening and stretching.
• Appropriate footwear

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