Medial tibial stress syndrome (shin splints) is a condition commonly experienced by runners, triggered by muscular irritation.
Typical sensations are (cramp-like) pains along the inside of the tibia when just starting to run, usually towards the center of the shin.
The pain should not be ignored, as continuing to train without treatment can lead to stress fractures.
Underlying causes can be excessive training, incorrect running technique, and wearing the wrong running shoes.
Depending on the causes and extent of the symptoms, therapy can include taking a break from or adjusting the training plan, changing running shoes, cryotherapy, physiotherapy, and ongoing stretching of the calf muscles.
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Shin splint syndrome is often called shin splints and is a common overexertion syndrome in runners (but also in aerobic trainers and dancers). These symptoms have also been labelled "Medial Tibial Stress Syndrome" (MTSS) in specialist literature. Up to 20% of all training casualties amongst runners are attributed to shin splints.
Cramp-like pain on the medial side of the tibia at the beginning of training is typical, often halfway up the tibia. The pain may also run from the ankle to the Knee Most runners report that their pain occurs at the beginning of the run in the initial stages of their symptoms, but can disappear during the course of the run. The pain then recurs on the next run. The longer the shin splints persist, the longer the phases of pain last.
Runners who overpronate when rolling are at risk.
Shin splints are caused by irritation of the musculature attachment (predominantly the posterior tibial muscle and the soleus muscle) due to overstraining. The posterior tibial muscle is very important for tensioning of the arch of the foot. You must therefore react to pain by resting the foot, otherwise the muscle can fail, with increasing formation of a flat foot. An additional risk when ignoring pain is the possibility of a fatigue fracture - the symptoms must therefore be investigated by an experienced sports physician and a break in training must ensue.
The pain itself occurs because the attachment of the musculature to the skin on the leg is overstimulated (= tendinitis of the area of attachment of the tendon). As a result of this inflammatory stimulus, muscle cells can often also harden and myofascial trigger points form, which are painful at the location but can also cause radiating pain (e.g. into the Achilles tendon, the heel, and also the knee joint).
Shin splints more rarely occur due to excessive supination in the forefoot (if the runner pushes off over the little toes). In these cases, the long toe flexor muscles are overloaded and the tibial periosteum is irritated.
Inexperienced long-distance runners who have just commenced endurance training, have corresponding deficits in their running technique, often also have unsuitable shoes and do not observe adequate rest times and days are particularly frequently affected.
TIP: By choosing the correct running shoes using a treadmill analysis, you can often avoid the occurrence of overexertion problems.
TIP: The enforced break in training can be used sensibly to consider your training plan, possibly book a running technique seminar, and have your running style and running shoes checked.
Treatment depends on the extent of the symptoms:
- In the case of moderate pain, running training should be reduced and no running down mountains carried out.
- In the event of severe pain, running training must be stopped and switched to ergometer or racing bike and swimming training.
- Cryotherapy (= ice pack) and cold compresses help a lot in the initial stage of shin splints.
- Physiotherapeutic treatments often have better success than medication, however treatment must be carried out by an experienced physiotherapist who is skilled in treating trigger points. Manual therapy of the irritated skin on the leg must, however, be avoided.
TIP: If the symptoms occur shortly before a competition, your doctor can apply a tape dressing that prevents excessive pronation. In the event of long-term pain, a tape dressing is generally applied to relieve the musculature.
For severe pain in the area of attachment, anti-inflammatory medication can be prescribed by your doctor (Diclofenac, Ibuprofen).
Consistent exercises to stretch the calf musculature before and after running help to prevent problems. If the symptoms are already present, you should stretch several times daily.
Kräftigungsübungen der Wadenmuskulatur nach Abklingen der Beschwerden dienen der Vorbeugung. Hilfreich sind auch Koordinationsübungen am MFT Brett. Man kann sich aber auch selber ein Kippelbrett basteln. Empfohlen sind auch Barfussläufe – wobei Univ.Prof. Dr. Christian Gäbler persönlich dazu rät, solche Läufe vorsichtig anzugehen, da das Fussgewölbe keine Unterstützung hat – und auch Sandläufe am Strand sind anfangs nicht ungefährlich, da man die Muskulatur sehr rasch überbeanspruchen kann.
After the acute symptoms have disappeared, treatment with heat prior to training is useful.
In the event of persistent pain, a stress fracture (fatigue fracture) of the tibia and chronic compartment syndrome must be ruled out.
TIP: Prevention is better than cure, as applies to all sport. Consistent exercises to stretch the calf musculature even in long-distance runners are strongly advised.
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