Chiropractors see a lot of running injuries. Shin splints are among the most common and persistent types of injury among them.
A recent study found that medial tibial stress syndrome (MTSS) can sideline a new runner for 70 days or more.1
The diagnosis is usually uncomplicated, but chiropractors should also rule out other causes. Occasionally, a painful shinbone may be a sign of a more serious problem. “Shin splints, stress fractures, and anterior compartment syndrome can look alike,” says Jason Hare, DC, who owns Pure Chiropractic in Nanaimo, BC, Canada. “All three injuries are easily confused.”
Recognizing the difference is vital for ensuring proper treatment and recovery. While shin splints often heal with rest, the other two conditions require more extensive treatment―and sometimes even surgery.
Pinpointing the problem
Medial tibial stress syndrome (shin splints) is an overuse injury caused by repetitive impact. The repeated stress on the lower leg causes inflammation of the muscles, tendons, and bone tissue. If it persists, the irritation can worsen and may even result in a fracture.
“Shin splints appear to be on a continuum of mild to severe problems, with fractures at the severe end,” says Debbie Craig, PhD, LAT, of Northern Arizona University, who has studied the prevention of MTSS in athletes.2 Stress fractures are not always preceded by shin splints, though.
The characteristic throbbing ache felt along the inner side of the tibia typically occurs after a sudden increase in physical activity. Shin splints tend to affect new runners, but anyone who participates in high-impact sports can get them.
The main differential is a stress fracture. Though the pain may be similar, the size of the affected site may help identify the injury. With a fracture, the pain tends to be concentrated in one spot. If the cause is shin splints, the soreness usually involves a more general region. Morning pain is also typical of shin splints, Craig says.
The other important diagnosis to rule out is anterior compartment syndrome (ACS). The reason that compartment syndromes develop is related to the anatomy of the lower leg, which is divided into four compartments by dense walls of fascia. In some people, one of the compartments is tight (often the anterior one). During exercise, the muscles swell slightly within the enclosed compartment, cutting off the flow of blood to and from the tissues and causing severe pain.
One sign of ACS is its sudden onset. “With anterior compartment syndrome, people get a sharp pain after running for five to 10 minutes,” Hare says. “If they stop and rest, the pain goes away.” He also notes that ACS generally affects the front outer part of the leg and there is no bony pain. A thorough examination and careful diagnosis are essential. All three conditions are caused by similar factors, but they must be treated differently. The long-term consequences of ACS are serious, and although rare, include surgical release of the compartment.
Treating the cause
After ruling out other injuries, the treatment of shin splints is generally unproblematic. The underlying factors that increase the risk of shin splints vary, however. Yet because chiropractic focuses on the causes of a condition, as a chiropractor you are uniquely positioned to offer individually tailored care.
A peak time for shin splints is during a sudden increase in the intensity of physical activity, such as early in the running season or before a race. Jogging on slopes or hard surfaces may also contribute to the condition. Other factors include tightness in the calf muscles or a short Achilles tendon.
Some research has also linked supination or pronation to shin splints, suggesting that rolling over the foot places stress on the muscles along the shinbone, which must work harder to stabilize the feet and ankles.3 Though studies are inconclusive, overpronation and wearing worn-out shoes are among the most common probable causes, Craig says.
It is important to check your patients’ shoes or refer them to a running specialist. “People with a history of shin splints need new shoes that are antipronation and absorb shock,” Craig says. The usefulness of wearing inserts during sports is unclear, though. “A lot of orthotics are hard,” Hare says, “which is not what a runner needs.”
Gradually increasing the intensity and duration of physical activity may also help prevent shin splints. A good rule of thumb to stay injury-free is to increase mileage by no more than 10 percent per week. Taking time to warm-up properly and cool down after any workout is another key to prevention.
Hare also emphasizes the importance of days off. “Recovery days are just as important as running days,” he says. Alternating running with low-impact activities such as swimming, biking, or walking can help avoid overuse injuries.
Treatment of shin splints does not generally require professional care, but recovery times vary. Using kinesiology tape, wearing compression socks, and icing for a few days can provide relief during recovery. As with any overuse injury, the best treatment for shin splints is rest. Some people may need to take a few days or weeks off.
After a longer break, patients should ease back into training. If the pain lasts more than two weeks, Hare advises putting the patient in touch with a physician.
Patients with recurrent pain may need to undergo further tests. “The difficulty is that by the time symptoms appear the damage has already been done,” Craig says. If a fracture is suspected, a leg X-ray should be obtained. A crack in the bone is not always visible, though, especially if the injury is recent. The final diagnosis may require a bone scan.
Fortunately, most cases of shin splints are self-limiting. With prompt treatment and prevention, you can help your patients recover faster and get back to up to speed.
Stephanie Kramer is a freelance writer and translator. Her writing on health, wellness, and the performing arts has appeared in Dermatology News and other publications.
1 Nielson RO, et al. A Prospective Study on Time to Recovery in 254 Injured Novice Runners. PLOS One. 2014;9(6):e99877.
2 Craig DI. Medial tibial stress syndrome: evidence-based prevention. Journal of Athletic Training. 2008;43(3):316-18.
3 Neal BS. Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis. Journal of Foot and Ankle Research. 2014;7(1):55.