Thursday, May 4

Shin splints

Maybe one of your resolutions this spring is to finally get in shape. You'll dust off your jogging suit and slip on your running shoes and this time you'll stick with it. Starting out easy and building a baseline of fitness, soon you'll be running five miles a day!

Then one morning, you'll get out of bed and the pain in your lower legs will stop you in your tracks. You're a victim of the dreaded condition known as shin splints -- an affliction that seems to affect most recreational athletes at one time or another. " The primary causes of shin splints are overuse and training errors,' says Dr. David Schmidt, a member of theAssociation of Professional Team Physicians (PTP) and team physician for the San Antonio Spurs. "People just do too much, too quickly."

Join Dr. Schmidt as he reviews the basic condition and summarizes the most effective prevention measures.

What exactly are shin splints?

Dr. Schmidt: Shin splints are a general term for any pain that exists between the knee and the ankle. Over the years, there have been a whole host of things that have been called shin splints, but primarily when someone has pain anywhere below the knee and above the ankle they will have what are commonly called shin splints. The classic cause of shin splints is periostitis, an inflammation of the layer of tissue over the shin bone to which the muscle attaches. The constant pull of the muscle on the periostium, or bone skin, causes it to get inflamed. The classic symptom is the familiar pain along the inside of the tibia about halfway down the leg.

There are other things that can cause this pain though -- tendinitis, for example. Shin splints or shin pain can also be the result of a stress reaction or stress fracture. In addition, there can be what's called "compartment syndrome" where the muscle gets swollen and too big for the area or compartment it is lying in, and that can be very painful.

How can you get shin splints?

Dr. Schmidt: Usually, it is a pure overuse syndrome. But remember, overuse is in the eye of the beholder. If I am used to running 30 miles a week and you are used to walking for exercise, you may see what I'm doing as overuse but that is relative to what you are used to. But if we have an 18-year-old who just got recruited for the military who never did any marching in his life and now he's marching five miles a day, that is overuse relative to what he was accustomed to. So overuse is relative to the baseline as well. That is the primary cause of shin splints. There are also training errors -- the same amount of effort that uses the extremity of the lower leg in a different way. So I still may be running 30 miles a week, but now I've added sprint or hill training to my regimen. Also a change in your athletic footwear can cause pain in the leg area.

How are shin splints treated?

Dr. Schmidt: Probably the best treatment is prevention and rest. Make sure to do a comprehensive lower-extremity stretching program before and after your activity. Bob Anderson's book "Stretching" is a great resource for illustrating different stretches for different activities. If you do start to get a little leg pain, try some activity modification or cross-training; get on the bike or a cross-country skiing machine or an eccentric walker. If the pain persists with activity modification, try some non-steroidal anti-inflammatory medication such as ibuprofen. If symptoms persist, icing after activities is very important as well.


Q: What's a good pre-game meal, and how soon before the game should I eat? I play soccer recreationally. Thanks!
David Martinez, San Jose, CA

A: From Dr. Phillip Zinni, PTP member physician:
"The ideal pre-game meal should consist of complex carbohydrates (the types, pending the time of day the meal is consumed): cereal, whole grain pasta, long grain brown rice, etc.; fruits and vegetables [60-70%] , proteins (the types, pending the time of day the meal is consumed): non-fat dairy, lean low-fat chicken, turkey [25-15%] and if needed for cooking monounsaturated fats: olive, canola and peanut oil. 16- 32 ounces of clear fluid. Foods that are usual and customary to the person. Generally avoid spicy, fried preparations; heavy or rich sauces and gravies. The meal should be consumed 3 - 4 hours prior to the event."

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The biggest mistake I think people make is training errors. They want to get fit, so they go out and run three miles a day and they feel good. The next week they want to run four miles a day and the week after that they want to go five miles a day. That's too rapid an increase. Too much, too quickly. A good rule of thumb is to increase your activity time by 10 to 15 percent per week. So if you're running 20 minutes a day, the next week go to 22 minutes, not 30.

Are shin splints a type of stress fracture?

Dr. Schmidt: Most shin splints are not stress fractures, but this is something that the recreational athlete needs to pay attention to. If there is persistent pain, pain that doesn't go away through the efforts we talked about, then you need to be a little concerned. The other thing I tell patients to do is cross their legs in a figure-four position. The doctor palpates or feels the tibia on the place where the bone is right under the skin, and if there is a lot of tenderness there -- not along the back edge -- then you need to be concerned. Shin splints are usually in the back where the muscle is near the edge of the bone.

The tibia is a triangular-shaped bone. The peak or crest of the tibia is in the front of the leg and the back edge of the triangle is where you feel shin splints. But if you feel subcutaneous tenderness right under the skin, on the front of the tibia, then you should think about the possibility of a stress fracture. You should probably get an X-ray, albeit with the understanding that stress fractures will not show up on X-rays for the first two or three weeks. So if you're out running and you get tibia pain and it bothers you for a week and it remains painful and you go to the doctor and he takes an X-ray and it's negative, you may still have a stress fracture. If you rest it and then go out and exercise and the pain returns, I might order a bone scan, which is a nuclear-medicine study where a stress fracture will show up within two or three days.

Dr. David R. Schmidt , a member of theAssociation of Professional Team Physicians (PTP), is team physician for the San Antonio Spurs. Dr. Schmidt received his medical degree from the University of Texas Medical School at San Antonio and completed his residency there. He also completed a fellowship in sports medicine and knee surgery at the North Sydney Orthopaedic and Sports Medicine Center in Sydney, Australia. Currently, Dr. Schmidt practices out of the Orthopaedic Surgery Associates of San Antonio.

The information, including opinions and recommendations, contained in this website is for educational purposes only. Such information is not intended to be a substitute for professional medical advice, diagnosis or treatment. No one should act upon any information provided in this website without first seeking medical advice from a qualified medical physician.

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