Athletes competing in many different sports can suffer from lower leg pain. Although commonly referred to as “shin splints” by most athletes, lower leg pain must first be thoroughly evaluated to diagnose the specific injury. Once more serious acute injuries have been ruled out (acute compartment syndrome, fracture), the focus can be on differentiating between the chronic injuries.
Pain in the lower leg can actually be caused by several different injuries. Intense and potentially serious lower leg pain can be caused by of a tibial stress fracture. An individual with a tibial stress fracture typically experiences pain directly on the shaft of the tibial bone. The pain can sharpen at night and result in a “throbbing” type of pain in the evening when the individual has slowed down. An individual with these symptoms need to be referred to a physician for a possible bone scan.
Defining Medial Tibial Stress Syndrome
The most common cause of pain in the lower leg is from medial tibial stress syndrome. This type of pain is caused by periostitis (inflammation of the outer layer of the bone, the periosteum) along the posteromedial (inside back portion) tibial border. It is now believed (Foundations of Athletic Training, 2009) that the pain is related to periostitis of the soleus muscle (deep muscle that lies beneath the gastrocnemius).
Athletes will complain of pain along the lower inside border of their tibia that increases with activity and decreases with rest. A number of factors can contribute to this condition including prolonged pronation (weightbearing on the inside portion of the foot) and changes in any of the following:
- Running surface
- Running distance
- Running speed
- Training terrain (flat versus hills)
- Footwear
Initially, the individual will experience pain only during activity. As the condition progresses, the individual may experience pain before, during, and after activity.
The focus at the onset of pain is to try to discover the cause of the pain. Reviewing the above factors is a good place to start.
If pronation is the underlying problem, the individual can invest in either over-the-counter orthotics or custom orthotics. The orthotic realigns the foot laterally taking the pressure of the mass of the individual off of the inside of the foot.
Because athletes typically do not want to take time off from training, various treatments have been used to reduce pain from medial tibial stress syndrome.
Ice Massage Treatment
Ice massage is one treatment to reduce pain from medial stress syndrome. An ice cup can be made by filling a styrofoam cup ¾ full with water and placing the cup in the freezer. Once the water is frozen, the ice cup can be removed. Tear off the top portion of the cup, and gently rub the exposed ice in the palm of the hand. This will melt off any rough edges prior to proceeding with the treatment.
The treatment then consists of massaging the painful area before and after activity. Position the ice cup at the distal end of the tibia. Gently apply pressure and slowly move the ice cup up the leg. This procedure is repeated making sure that the entire area is massaged. The treatment typically lasts 10 minutes.
Athletic Tape Job for Medial Tibial Stress Syndrome
Athletes also report relief through the application of athletic tape to the painful area. Athletic tape can be applied starting at the distal end of the painful area. Circular strips can be applied starting on the outside of the leg and pulling towards the inside. Each strip needs to be applied separately so as not to make the tape too tight.
Care should also be taken not to apply athletic tape too high so as to constrict the belly of the gastrocnemius. This can cause the muscle to cramp.
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