March 8th, 2013

Health N' Sports: Runners and Injury

Staff Report

Health N' Sports: Runners and Injury
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Louisville Orthopaedic Clinic discusses shin splints

As a part of the Louisville Orthopaedic Clinic, the Sports Rehab Team physical therapists are knowledgeable and trained in the latest advancements and techniques available in sports rehabilitation.

On a weekly basis, the Health N’ Sports Update will give information on prevention, recovery, and include special offers, as well as general health tips that would be beneficial to all. If there is a specific topic you’d like to know or hear more about, email future suggestions to

Shin Splints, otherwise known as Medial Tibial Stress Syndrome (MTSS), is a very common condition amongst people that have taken up running as a form of exercise.  This should not be confused with other conditions such as stress fractures and compartment syndrome, which have similar symptoms located in the same region of the lower leg.  The exact mechanism behind this common and painful condition is unknown, but through imaging analysis, we’ve learned that it may have to do with a stress reaction of the tibia bone (1).  When the muscle attached to the tibia, the anterior tibialis, is stressed beyond its normal level of function, the bone onto which it’s attached breaks down, but adapts by laying down more bone at the attachment site.  The inability of this process to keep up, in which bony resorption outpaces bone formation (2) is the current mechanistic theory for MTSS.

Risk Factors

Susceptibility of this condition has been studied extensively and several risk factors have been linked to MTSS.  Several common risk factors found in the research includes high BMI, female sex, foot pronation (minimal arch), and hip rotation angles (1-4). 

Tips for Alleviating Symptoms

Studies have shown that rest is just as effective as intervention/treatment for MTSS (2).  The way to alleviate your symptoms from MTSS is to first evaluate your risk factors.  If you have a higher BMI, losing weight would be an effective treatment.  The challenge is accomplishing this while dealing with the symptoms of MTSS.  Nutrition is by far the most important factor when dealing with weight loss.   A good exercise routine only compliments a healthy eating lifestyle.  When it comes to exercising, cross training using a variety of methods can help while the symptoms persist.  For example, combine your running with elliptical or cycling workouts.  Step aerobics, Yoga, Barre inspired classes, and Pilates are also great ways to burn calories and avoid MTSS.  Eventually, work your way up to running 2-3 days a week and hopefully at a lower BMI, your previous symptoms of MTSS will no longer be present.

Things to Consider

If your foot pronates, you are dealing with a foot arch deficiency.  This can be diagnosed by your local orthopedist or therapist. You should start by exercising, using a shoe insert/orthotic, that is made to cushion the arch.  These may be purchased at any local running store and can be a quick inexpensive way to deal with painful running.  Because runners hip angles, strength, and range of motion have been linked to MTSS, make sure that you practice a good stretching and strength routine for your hips.  These exercises are quick and easy and can be shown to you by a Physical Therapist.  A deficiency in hip involvement during running requires other muscles to compensate.  When dealing with something as repetitious as running, you must make sure that every involved joint and muscle is conditioned just as equally.  If these conservative methods of treatment don’t seem to work and/or you do not have any of the risk factors mentioned, running calf sleeves may provide relief.  The compression around the lower leg can provide relief through fluid/inflammation management during running and muscular mechanical aid. Options such as massage therapy or kineseo® taping may also be recommended.

-Jordan Tinnell, BS Exercise Science, DME Manage- (also an avid runner)

Tips by Holy Cross High School Lad Dillard:

“I have kids that complain about shin splints (usually in the beginning of the year). We have them ice the injury after practice everyday. Also there are special stretches that they perform to help heal it up. Also, depending on how bad it is, we have them run in the grass during some workouts (they may use the softer surface to make it easier to run instead of the hard pounding of the pavement). I think rotating shoes and also having the proper shoes help prevent shin splints. Ice, rest and stretching can also help the athletes. Cross trainers are good because they give good support to the feet which also help prevent from getting shin splints.”

Louisville Orthopaedic Clinic & Sports Rehab Center

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Physical Therapy: 502-897-1790


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Medial Tibial Stress Syndrome.  Reshef, N., Guelich, DR.  Journal of Clinical Sports Medicine.  April 2012.  31(2):  273-290.

Meidal Tibial Stress Syndrome:  A Critical Review.  Moen, M.H., Tol, J.L., Weir, A., Steunebrink, M., De Winter, T.C.  Journal of Sports Medicine.  2009.  39(7):  523-546.

Incidence and Risk Factors for Medial Tibial Stress Syndrome and Tibial Stress Fracture in High School Runners.  Yagi, S., Muneta, T., Sekiya, I.  Knee Surgery and Sports Traumatology Arthroscopy.  March 2013. Vol. 21, Issue 3, pg. 556-563.

Lower Extremity Kinematics in Running Athletes with and without a History of Medial Shin Pain.  Loudon, J.K., Reiman, M.P.  International Journal of Sports Physical Therapy.  August 2012.  7(4):  356-364  


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