Tuesday, September 30, 2008

There is no such thing as shin splints

I had an incident occur at my school recently that is all too common. A visiting team coach calls me over to look at an athlete with "shin splints". The athlete was wearing two ankle stirrups to help alleviate bilateral medial tibia pain. I watched the player jump and land a few times, and it became obvious there were serious force reduction issues going on. It was particularly troubling because the fall season has just begun.


I wonder if that coach ever saw an athlete land from a routine jump and completely shatter their entire lower leg?


I have.


If you are a coach, don't think it can't happen to you. Get the blinders off- a shin splint is a stress reaction in the tibia. In other words, either a precursor to a stress fx, or a stress fx itself. Asking your ATC to tape the shin is a waste of time. If the athlete has a planus or cavus foot structure, an orthotic may help. But more often than not, it's a training progression issue. Don't think this is the A.T.'s responsibility alone. Sport appropriate axial loading exercises that increase bone density must be integrated into your workouts. If you're working with female athletes, it's even more important.


If your athlete presents with these symptoms, listen to your ATC. Rest accompanied by non weight bearing exercise (ie stationary bike, pool) is crucial to prevent further damage. Just because these symptoms appear does not mean the end of the season. Manipulation of work/rest and weight bearing/non weight bearing exercise can allow bone remodeling to take place. I will post more on this topic in the future.




5 comments:

sportsmedguy23 said...

Funny you bring this up today...We had three kids, one right after another, see our team physician during Athletic Training Room clinic this week because in their minds they had "shin splints"...It has always been one of our MDs pet peeves when people say "shin splints" for the same reason you list...they trully don't exist...it's either a stress reaction or a full on stress fracture...We see this every year with our freshman athletes, they get through 6-8 weeks of training and start breaking down...usually because they aren't use to the level of activity or the intensity. We've had good results from resting them for a few weeks, using alternate forms of conditioning and wearing long leg air stirups to transfer the stress from the bone to the braces, however, they are next to impossible to compete in...Can't wait to hear more of your ideas on this topic Joe...

You're doing a great job on the blog I've really enjoyed it...

KP said...

My most hated term. I tell our athletic training students that it's like hearing someone has a headache. All it means is they have pain and that you need to evaluate the athlete to find the underlying cause to their pain. Great post.

JH said...

When I worked for the USMC we saw many overuse injuries. When dealing with shin pain we actually saw a lot of success with transverse plane exercises such as transverse hopping, and agility.

Muscles said...

Joe,
Well said. I have a few kids I am working with (all girls) who have these issues. We are working on self myofascial release, calf stretching, SL balance w/ reach, exaggerated heal-toe walk, tube walks, and bridges. Progress has been made in both cases. I don't know about you but I often find the kids are in footwear (sandals/sneakers) with no arch supports all day long further reinforcing the falling arch. Do you see this as well?
www.trainbetterllc.com

Fredrick said...

Amen brother!!! Amen! I have tried to educate athletes, coaches, and parents for years to no avail. It's nice to hear someone finally speak the truth.