Pain in the shin is not necessarily a shin splint

From Tots to Teens

July 23, 1996|By Dr. Modena Wilson and Dr. Alain Joffe | Dr. Modena Wilson and Dr. Alain Joffe,SPECIAL TO THE SUN DTC

I ran track this past year at school and I still run during the summer. Toward the end of the season, I developed shin splints. I thought they would go away, but they are getting worse. What can I do?

Many people refer to any pain that occurs in the leg between the knee and the ankle as shin splints. We want to be more specific than that in answering your question because certain kinds of pain in this area of the leg can indicate serious conditions such as a stress fracture.

If you run your fingers along the front of your leg below the knee, you can feel a sharp-edged bone called the tibia. Many people refer to this bone as the shin bone; hence the name shin splints. People with shin splints typically have pain just to the midline of this bone along its length. The pain is caused by inflammation of the muscles and ligaments that attach the muscle to this bone. If your pain is not in this area or if it is much more localized, you may have a stress fracture. It is important to determine if you have a fracture because treatment for this condition is quite different from that for shin splints.

Teen-age girls who have stopped menstruating for a prolonged period of time but are still quite athletic are at particular risk for stress fractures.

Depending on how long you have had the pain, either a simple X-ray or a bone scan would help determine if you have a fracture.

Shin splints are what we refer to as an overuse injury. This is because they are typically caused by an individual trying to increase the level of activity too quickly. For example, an individual may try to suddenly increase distance or speed or switch to a harder surface without allowing the body time to adjust. Running with worn out shoes can also cause the problem. The resultant strain causes the inflammation that you experience as pain. Usually the pain occurs after running, but if an individual ignores the symptoms long enough, the pain may start to occur during running or, if the inflammation gets bad enough, during walking as well.

We suggest you consult your physician or a physical therapist to figure out if you truly have shin splints. If you do, you will need to cut back on whatever activities cause the pain. Taking nonsteroidal anti-inflammatory medications (such as ibuprofen) and applying ice to the affected area will also help your leg to heal. Stretching and strengthening exercises for the muscles in the lower half of the leg will also be of great value. Once the pain has subsided, you can gradually begin your running program again. It will be important to stretch before and after exercise. In addition, you should probably take some ibuprofen about an hour before you run and ice your leg immediately afterward. If you perform the stretching and strengthening exercises regularly, these other measures will eventually no longer be necessary. Of course, if your running shoes are old, they need to be replaced.

Dr. Wilson is director of general pediatrics at Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.

Pub Date: 7/23/96

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