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Sunday, August 9, 2020

Shin Splint Discussion: Part III

This is Part III of a discussion on Shin Splints. The links to Part I and II are attached. Here we will talk about treatments when the pain is all in the leg. Even though this discussion is geared for the podiatrist, patients can get a favor of what is important in their treatment.

Common Mechanical Changes for Shin Splints

  1. Strengthening of Involved Muscle Group

  2. Stretching of the Involved Muscle Group

  3. Reducing the Suspected Pronation or Supination Tendencies

  4. Stretching the Achilles Complex

  5. Strengthening the Achilles Complex

  6. Custom Orthotic Devices particularly for Forefoot to Rearfoot Alignment Issues Involved

  7. Training Decisions

  8. Consideration of Bone Involvement

Strengthening of Involved Muscle Group is crucial in all 4 types of Shin Splints.

What is important is good muscle testing principles and you will need to learn

how to differentiate the muscles in each group. It is well taught how to

differentiate testing of the gastrocnemius (knee straight) and soleus

(knee bent) in the posterior group with the other groups *equally

challenging. It is important to know if it is the posterior tibial,

flexor hallucis longus,or flexor digitorum longus giving the medial ankle

pain. Or, if it is the peroneus longus or brevis that hurts when testing against

resistance the lateral compartment. Or, if it is the anterior tibial or another

one of the extensors producing the anterior shin splint. 

Stretching of the Involved Muscle Group is typically only done for the

anterior or posterior muscle/tendon groups. You should know the general

rules for stretching,but remember stretching should never hurt or the tightness

actually gets worse. I recommend stretching an involved group 3 times a day

so I can get to 100 stretches within a month for my next followup visit

generally. It typically takes stretching 3 times a day to gain.

Reducing the Suspected Pronation or Supination Tendencies with varus

or valgus wedges, taping, arch supports, shoe changes, custom orthotics,

and strengthening exercises occurs when youthink the pronation or supination

observed in gait or activity is related to the type of shin splint. 

Stretching the Achilles Complex is vital to most sports injuries when

there is equinus forces. However, it is so important to be able to reliably

measure for this equinus because over stretching a normal or hyper flexible

achilles tendon will do more harm than good. Tight achilles has been known

to be involved in all 4 shin splint types. 

Strengthening the Achilles Complex is vital when the achilles is weak.

The acid test for normal achilles strength is 25 single leg heel raises with

the knee straight (gastrocnemius) and 12 single leg heel raises with the knee

bent (soleus). These are typically done in the evening. 

Custom Orthotic Devices particularly for Forefoot to Rearfoot Alignment

Issues Involved is your classic Root design. Doctors not trained in Root

biomechanics tend to use more metatarsal pads and anterior orthotic bars and

posts, and combinations of all may be needed. Not only is forefoot support great

for the correction of pronation or supination tendencies, the metatarsal support

provided can be crucial for long flexor or extensor produced medial or anterior

shin splints. 

Training Decisions for shin splints is universally to lighten the load on the

injured tissue. And for those athletes who seek treatment, the chance of a

stress fracture is high. The runner must cross train with biking as the

mainstay alternative. Since both hill work and speed work are more stressful,

slow distance training is the first goal to accomplish. Each sport involved

will have different strategies at lightening the stress first, and then

gradually re-introducing these same stresses. 

Consideration of Bone Involvement is very important in shin splints.

There are yearly reported cases of compound fractures in runners ignoring

the shin splint symptoms only to have the stress fracture become a through

and through fracture. I have had 27 year olds with shin splints have the bone

density of 80 year olds. It is important to remember Shin Splints can be bone

pain primarily, and verifying the patient has good bone health is crucial. 

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.