When you have chronic and painful shin splints and nothing helped

You are a runner or an athlete, most likely a soccer player, that requires stamina and the ability to run up and down the field or court. You have an on-again, off-again problem with pain in the shin area. Your initial research online was “what do I do about this?” You got pretty much the same tips about resting, taking anti-inflammatories, ice, compression sleeves, and exercises and stretching from the websites you visited. You also found out that a lot of runners have your problem.

You did pretty well managing this problem on your own for a while, but now the pain is much more chronic and severe, you may be taking more anti-inflammatories and you are taking to icing on a more regular basis.

Finally, you went to the health care provider with your complaints and he/she recommended that you have “shin splints,” “Periostitis,” an inflammation of the soft tissue that surrounds the tibia (the main shin bone), or you have “Medial Tibial Stress Syndrome.” For the most part, they all mean Shin Splints.

You got your diagnosis and perhaps a prescription for a strong anti-inflammatory. You were probably advised to rest more often, continue with icing if that was helping and come back in a few weeks if this problem did not resolve.

A few weeks later, you went back to the health care practitioner to report little improvement

While some people do respond to rest, some people do not. This is probably you and why you are reading this article. You are now back at your practitioner’s office and you decide that you want to follow a more aggressive treatment plan. Physical therapy may be called for. The exploration of shoe inserts may be explored to distribute the impact of walking or running to different parts of your foot, ankle, and shin.

At least you feel that more is now being done. But will more work?

Understanding that your problem is much more than painful shins. This can end your ability to run.

As your problems progressed and you spent more time online researching, you started to discover that your problem may be more than just painful shins. You start to realize that there are reasons you cannot run or get better. Understanding of the causes of shin splints goes beyond “overdoing it” for people like you whose situation has become long-term.

Shin Splints Prolotherapy

The United States Army has a problem with chronic shin splints.

If you are in the military you know that shin splints are a problem for new inductees as they go through basic training. Long runs and carrying heavy back is a powerful formula for shin splints. So Army doctors teamed up with Indiana State University researchers and published a paper in the Journal of Athletic Training (1) as to what factors put physically active individuals at risk for the development of medial tibial stress syndrome (Chronic shin splints).

  • Body mass index (BMI). Increased BMI means increased pressure on your legs and joints as you run, which could lead to shin splints
  • Navicular bone drop. The instep or arch of the middle of the foot drops out of place as the foot-arch complex becomes unstable due to excessive pronation (tilt).
  • Ankle instability can cause a hyper plantar-flexion range of motion (increased ability to point your toes down). Simultaneously, it can cause increased difficulty dorsiflexing the foot (pointing toes up), which causes the muscles that dorsiflex the foot (anterior shin muscles) to be overactive and increase stress on the shin.
  • Quadriceps angle. Commonly called the “Q angle”, this is the measurement of the angle between your quadriceps muscles and patellar tendon. This angle helps us determine the alignment of your knee. Increased Q angles, more common in women, can contribute to the development of shin splints.
  • Hip instability This can cause a hyper plantar-flexion range of motion, similar to that which can be found with ankle instability. In addition, instability of the hip can increase forces on the tibia during activity or alter the Q angle, both of which increase torque on the lower leg and lead to shin splints.

An October 2020 study in the International journal of environmental research and public health, (2) reviewed eleven research papers seeking risks factors for Medial Tibial Stress Syndrome in new and recreational runners. are mainly intrinsic (the way someone’s body moves) and include higher pelvic tilt in the frontal plane (please see our article Treatments for adult spinal deformities, leg length discrepancy, and pelvic tilt), peak internal rotation of the hip, navicular drop and foot pronation (evaluation of the medial longitudinal arch, among others. Please see our article Adult acquired flatfoot deformity – fallen arches and flat feet treatments).

Treatment options

Since shin splints are felt as intense pain in the leg, traditional treatment usually involves rest. This is after other measures, such as taping the arches, using heal cups in the athletic shoes and applying topical creams to the sore muscles have failed to give relief. The problem with this approach is that resting the muscles and the periosteum, or the bone covering, will further weaken the already weak structures. It does not repair the weakened ligaments of the hip and ankle that may be contributing, nor does it repair or undo the stress done on the tibia and surrounding soft tissue.

Cortisone

There is not much evidence that cortisone helps shin splints.

Dutch doctors offered the cases of two patients in the Journal of sport rehabilitation (3) where the cortisone injections did not help, but further caused side-effects.

Here the case doctors presented 2 cases of women with Medial Tibial Stress Syndrome who showed atrophy and depigmentation of the skin after pretibial corticosteroid injections.

  • Case 1 is an 18-year-old woman with pain in her lower leg for a period of 12 months. No improvement was noticed after conservative treatment, so she received local injections with corticosteroids. Five months later physical examination showed tissue atrophy and depigmentation around the injection sites.
  • Case 2 is a 22-year-old woman who presented with pain in both lower legs for 24 months. Several conservative treatment options failed, so she received local injections with corticosteroids. Physical examination revealed tissue atrophy and depigmentation around the injection sites.

We are treating this patient today for shin splints. The patient is a runner, he runs everyday. The patient has tried many of the other recommended treatments like icing, new shoes and other things that did not seem to work for him.

The injections begin at 0:27 of the video.

I inject along the tender areas of the shin where the muscles meet up with the bone.

What happens in shin splints is that you can get these microtears in the muscle and you put ice on it or you’re rested it and it does not get better you mey need to find other options. In Prolotherapy we can treat those microtears and help them heal so we can alleviate the pain from the shin splits while repairing damage.

CASE REPORT:

29 y/o male with a history of shin splints presented to the office as a new patient. For the past 4 years, he has been suffering from shin splints when running, which he attributed to running in worn-out shoes for several years. He reported that his shins were in intense pain and “clicked” when running. He had tried rest, ice, ultrasound, stim, and chiropractic care for several years without any long term benefit.

On exam, no instability in his hips, knees, or ankles was noted. His shins were diffusely severely tender to touch along the tibia and surrounding musculature attachments. He underwent several dextrose Prolotherapy and Neural Prolotherapy treatments, all the meanwhile doing cross-training and walk/jog intervals as the tissue healed. After three treatments, he reported significant pain when running and his shins were no longer clicking. At that time, he started training for a half marathon. As his training increased, he came back for two more treatments to his shin and ended up running his half marathon in just over two hours.

References:

1 Winkelmann ZK, Anderson D, Games KE, Eberman LE. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J Athl Train. 2016 Nov 1. Indiana State University. [Google Scholar]
2 Menéndez C, Batalla L, Prieto A, Rodríguez MÁ, Crespo I, Olmedillas H. Medial Tibial Stress Syndrome in Novice and Recreational Runners: A Systematic Review. International Journal of Environmental Research and Public Health. 2020 Jan;17(20):7457. [Google Scholar]
3 Loopik MF, Winters M, Moen MH. Atrophy and depigmentation after pretibial corticosteroid injection for medial tibial stress syndrome: two case reports. Journal of sport rehabilitation. 2016 Dec 1;25(4):380-1. [Google Scholar]
5 Yagi S, Muneta T, Sekiya I. Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners. Knee Surg Sports Traumatol Arthrosc. 2013 Mar;21(3):556-63. doi: 10.1007/s00167-012-2160-x. Epub 2012 Aug 9. [Pubmed] [Google Scholar]
6 Steinberg N, Dar G, Dunlop M, Gaida JE. The relationship of hip muscle performance to leg, ankle and foot injuries: a systematic review. The Physician and sportsmedicine. 2017 Jan 2;45(1):49-63. [Pubmed] [Google Scholar]

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