Shin Splints

Aka: Shin Splints, Medial Tibial Stress Syndrome

1. See Also
   1. Running Injury
2. Pathophysiology
   1. Injury to Tibialis Posterior and Soleus Muscles
3. Risk Factors
   1. Poor flexibility
   2. Over-pronation or increased internal tibial rotation
   3. Worn or improper shoes
   4. Running on Hard surfaces
   5. Early season hill training
   6. Increased training intensity, pace or distance
   7. Miserable Malalignment Syndrome
4. Symptoms and Signs
   1. Localized pain at distal third of medial tibia
   2. Pes planus associated with over pronation
5. Differential Diagnosis
   1. Tibia Stress Fracture
   2. Exertional Compartment Syndrome
6. Management
   1. Alphabet writing range of motion Exercises with foot
   2. Ice massage
   3. Transverse friction massage (TFM)
   4. Cushioned anti-pronation inserts (CAPI)
   5. Local Ultrasound with Phonophoresis
   6. Sleeve, strapping, brace
   7. Decrease training and avoid hills
   8. Consider cross training activities
   9. NSAIDs
   10. Limit activity to soft surfaces
7. Management: Algorithm based on severity
   1. Mild Shin Splints
      1. Implement above measures
   2. Moderate Shin Splints
      1. Implement above measures
      2. Replace Running with non-provocative activity
      3. Consider evaluation for Tibial Stress Fracture
   3. Severe Shin Splints
      1. Implement above measures
      2. Long air cast
      3. Evaluate for Tibial Stress Fracture
      4. No weight bearing sports until
         1. Two weeks of rest and
         2. Negative Hop Test