Shin Splints Pain: Symptoms, Causes, Risk Factors, Healing Cycle & Treatment

What is Shin Splints?

Shin splint, also known as medial tibial stress syndrome is described as an overuse injury of the lower limb seen in military personnel and athletes. This exercise-induced pain occurs over the anterior aspect of the tibia. The overload injury in the shin splint is also associated with periostitis. In athletes such as runners, the incidence of medial tibial stress syndrome is 13.6%-20%. In military personnel, this incidence increases to 35%. [1] This article describes the symptoms, causes, and risk factors of shin splints with associated pain as well as elaborates normal healing cycle and treatments for alleviation of shin splint pain. 

Symptoms of Shin Splints Pain 

Following are the symptoms of shin splints pain.

  1. Painful shin upon touch
  2. Shin splints pain relief upon rest
  3. Sharp or dull throbbing pain of the shin during and after exercise 

Causes and Risk Factors of Shin Splints Pain 

Following are the causes and risk factors of shin splints pain.

  1. Bad shoes 
  2. Bad gait pattern
  3. Military training
  4. High arches
  5. Running on an uneven terrain
  6. Pronated posture of the foot 

Normal Healing Cycle and Chronic Conditions 

There are a total of four stages of the healing cycle. The description of each stage of healing cycle along with the underlying mechanisms is described as follows. 

  1. The first stage is known as hemostasis. The characteristic mechanisms of this phase of healing cycle are vasoconstriction of the blood vessels, and changes in the platelets including aggregation, degranulation, and blood clot formation. The primary goal of this phase of the healing cycle is to limit blood loss.
  2. The second stage of the healing cycle is the inflammation stage. Inflammation is a response to injurious stimuli. It is characterized by the recruitment of inflammatory and immune cells at the site of injury. The inflammation phase is mediated by different cytokines and inflammatory mediators released by these cells. The cardinal signs of inflammation include loss of function, warmth, redness, pain, and swelling. 
  3. The third stage of the healing cycle is known as the proliferation phase. During this phase, new blood vessels form at the site of injury by a process called angiogenesis, the extracellular matrix is synthesized, re-epithelization occurs, and collagen is produced at the injured site. In the case of chronic conditions, the persistence of the proliferation stage of the healing cycle is associated with the formation of fascia restrictions, trigger points, scar tissue, and muscle spasm.
  4. The fourth and last stage of the healing cycle is the maturation stage, which marks the resolution of the healing cycle. 

In the case of chronic conditions, the healing cycle moves back and forth between the two stages – inflammation and proliferation. Persistence of both these stages in chronic conditions leads to failure of the healing cycle to progress to the resolution stage. In order to normalize the healing cycle, it is important to adopt measures involved in the resolution of the inflammation and proliferation stages of the healing cycle. (2, 3)

Ineffective Treatments of Shin Splints Pain

Individuals usually adapt different traditional therapeutic strategies for relieving shin splint pain. These therapeutic measures are common yet ineffective. Following is a list of treatments that are ineffective for relieving shin splint pain.

  1. Application of heat and ice
  2. Electrical stimulation of the site of pain or injury
  3. Use of foam roller and massaging on the site of pain or injury
  4. Stretching of the shin 
  5. Mobilization of the shin 
  6. Strength exercises during the inflammatory stage of the wound healing cycle 

Effective Treatments of Shin Splints Pain

In contrast to the above-mentioned therapeutic strategies, effective treatment measures act on the inflammation and proliferation stages of the healing cycle in order to treat shin splint pain. The effective treatment measures are given in the table below. 

Table 1 Effective Treatments of Shin Splints Pain

Resolution of the Inflammation Stage of the Healing Cycle

The application of magnetic fields in magnetic therapy is useful for the treatment of shin splint pain. Magnetic therapy modulates angiogenesis and mechanisms related to proteoglycans and collagen. MagnaHeal is a useful device that employs magnetic fields of the neodymium magnet and anti-inflammatory substances to treat shin splint pain. (4, 5)

  1. MagnaHeal 1 is characterized by a magnetic force length of 2 inches making it useful for mild inflammation.
  2. MagnaHeal 2 is characterized by a magnetic force length of 3 inches making it useful for severe inflammation. 
Adequate rest is also useful for the alleviation of shin splints pain. 
Anti-inflammatory modulates and reduces inflammation as opposed to the pro-inflammatory diet which further aggravates inflammation in the body. Components of an anti-inflammatory diet include unsaturated fats, fruits, vegetables, whole grains, and fish. (6)
The deficiency of different micronutrients including minerals and vitamins contributes to the persistence of the inflammatory stage of the healing cycle in chronic conditions. AskASTR program is helpful for addressing nutrient deficiencies as it not only identifies the nutrients that are deficient but also recommends supplements to restore the nutrients in the body. 

Resolution of the Proliferation Stage of the Healing Cycle 

Resolution of the proliferation stage of the healing cycle focuses on releasing the fascia restrictions, muscle knots or trigger points, and scar tissue. 

  1. A1 Tool releases fascia restrictions in the superficial and aponeurotic fascia. 
  2. A3 Tool releases superficial scar tissue and muscle trigger points.
  3. A5 Tool is useful for releasing deep muscle trigger points and scar tissue. The tool is also useful for releasing fascia restrictions in endomysium, epimysium, and perimysium. 

Lifestyle Modifications and Postural Changes 

One shall maintain a normal gait while walking, wear good shoes, and correct high arch and pronated foot. 

Conclusion 

Shin splint or medial tibial stress syndrome is a significant and common occurrence in military personnel and athletes. Shin splint leads to pain upon touch and the shin splint pain increases upon exercising. This also occurs in people who wear bad shoes, run on uneven terrains, and do not maintain correct foot posture. For the treatment of shin splint pain, it is important to resolve the inflammation and proliferation stages of the healing cycle. This can be achieved by releasing fascia restrictions, muscle knots, and scar tissue as well as consuming an anti-inflammatory diet and using a MagnaHeal device.

References 

  1. McClure CJ, Oh R. Medial Tibial Stress Syndrome. [Updated 2021 Nov 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538479/
  2. Pahwa, R., Goyal, A., & Jialal, I. (2022). Chronic Inflammation. In StatPearls. StatPearls Publishing.
  3. Velnar, T., Bailey, T., & Smrkolj, V. (2009). The wound healing process: an overview of the cellular and molecular mechanisms. The Journal of international medical research37(5), 1528–1542. https://doi.org/10.1177/147323000903700531
  4. Yuksel, C., Ankarali, S., & Yuksel, N. A. (2018). The use of neodymium magnets in healthcare and their effects on health. Northern clinics of Istanbul5(3), 268–273. https://doi.org/10.14744/nci.2017.00483
  5. Arabloo, J., Hamouzadeh, P., Eftekharizadeh, F., Mobinizadeh, M., Olyaeemanesh, A., Nejati, M., & Doaee, S. (2017). Health technology assessment of magnet therapy for relieving pain. Medical journal of the Islamic Republic of Iran31, 31. https://doi.org/10.18869/mjiri.31.31 
  6. Stromsnes, K., Correas, A. G., Lehmann, J., Gambini, J., & Olaso-Gonzalez, G. (2021). Anti-Inflammatory Properties of Diet: Role in Healthy Aging. Biomedicines9(8), 922. https://doi.org/10.3390/biomedicines9080922