We have been treating sports related injuries for nearly 20 years and now its time for us to unveil the long overdue blog series that we call “Stupid Medicine.”
“Stupid medicine” pays tribute to and dissects commonly practiced medical procedures that we hope to see eventually removed from the medical handbooks. This month we begin with shin splints.
HOW DO SHIN SPLINTS PRESENT?
Shin splints usually present as soreness or throbbing pain in or around the shinbones during and even after exercise. Some people may notice the pain towards the end of the day of routine, low-grade activity.
HOW DOES THE MEDICAL COMMUNITY TREAT SHIN SPLINTS?
If you go to WebMD you will read what has commonly been considered the treatment for shin splints.
- Anti-inflammatory medication
- Neoprene sleeve
- Physical Therapy
- Surgery in extreme situations
We’ll give WebMD 1½ stars for its advice: One star for the PT recommendation and a half star for the suggestion to consider using orthotics.
People who have experienced shin splints usually will report the pain returning immediately after using ice and/or after periods of rest. Anti-inflammatory medications will reduce pain temporarily but will not address the underlying causes. And surgery is usually crazy talk, wrapped around an admission of not fully understanding what causes shin splints in the first place.
NOTE: Anytime we discuss sports injuries, we will use ice and rest ONLY in the first 48-72 hours of healing. Beyond that, it is safe to assume the pain is a result of a biomechanical or movement deficits that must be addressed and corrected. We will deal with this below.
WHAT ARE SHIN SPLINTS?
Shin splints are an overuse injury of the muscles of the calf and shin. Look at the muscles of the shin and appreciate that these muscles are long and slender.
KEY POINT: Long and slender muscles are what we call “torque producers.” A torque producer is designed to produce movement. Long slender muscles of the lower leg move the ankle and foot and help us walk or run down the street.
The deep muscles of the foot are shorter and more square or rectangle in shape. These muscles are called “stabilizers.”
KEY POINT: Stabilizers help to keep us upright, assist with balance, and they control the motion of the foot. A stabilizer is not designed to produce torque or movement, and a torque producer is not designed to stabilize.
In people with shin splints, you will observe a lack of stability in the stabilizing muscles of the foot.
GIVE YOURSELF A TEST
To test if your foot lacks stability, first stand on one foot, then close your eyes. If you are unable to stand on one foot with your eyes closed for 20-30 seconds, you lack foot stability.
When the foot lacks stability, the torque producers attempt to assist with stability. Repeat: Torque producers are not designed to stabilize. The result is the muscles of the shin have to do two jobs — stabilization and torque production. As a result, they become overworked and the result is shin pain (shin splints).
Several factors need to be addressed in correcting shin splints:
- Lack of foot motion
- Scar tissue formation in the irritated soft tissue
- Lack of core stabilization
To properly treat shin splints, you have to:
- Improve joint motion in the foot with chiropractic and joint mobilization
- Improve stability of the muscles of the foot with functional rehabilitation
- Reduce scar tissue formation in the shin with Active Release Technique
- Improve core strength and stabilization
After correcting all of the above, orthotics may be considered, but it should be a last step, not the first.
If you are experiencing pain in the lower leg and shin, call the office to schedule a functional evaluation. You may have shin splints, but you don’t have to suffer weeks and months of pain.