Ask the Lab: Shin Splints

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From: James H., Los Angeles, CA: What, other than rest, can I do to heal and prevent my shin splints?  I suffer from this ailment and it directly impacts my ability to play my best during both practice and matches.  Is there some secret formula to solving this issue forever?

Dr. George C. Branche III: Dear James, I thank you for your interest in the rather perplexing problem of shin splints.  I would like to take the time to review the definition of shin splints to confirm your diagnosis, discuss causes and treatment, and to also provide some strategies for prevention.  As I am sure, you well know, shin splints is a disorder involving the lower leg that occurs in repetitive activities usually centered around weight-bearing sports.

It involves an irritation of the posterior or rear part of the tibia, the large bone in the lower leg. There is a layer of connective tissue between the muscle and the bone, referred to as the periosteum that is thought to be the source of the irritation in this disorder. The pain is usually aggravated by weight-bearing activity and relieved by rest.  When considering this diagnosis, it is important to rule out other problems that can present in a similar fashion. Among them are stress fractures, which involve a fatigue failure of the bone in a localized position as a result of repeated stress. 

Marcos Baghdatis
Patients who have persistent shin splints should be checked for stress fractures with such studies as x-rays, bone scans, and possible MRI images.  Another diagnosis that is often associated with shin splints is compartment syndrome.  Compartment syndrome involves an increase in the pressure of muscles due to activity.  These symptoms are also relieved with rest.  This diagnosis is sometimes difficult to confirm.  However, it usually involves the measurement of compartment pressures after exercise.

Before treating a condition such as shin splints or periostitis, it is important to identify causes of this condition.  Overtraining involving excessive weight-bearing activity can sometimes create an environment for this disorder to develop.  Making a drastic change in the frequency and duration of play, particularly after an absence can also lead to this disorder.  It is important to review the condition of one’s footwear, since as tennis shoes wear out they lose their cushioning ability. This can, in turn, transmit more shock and forces up to the leg.  Flexibility has also been shown to play an important part in helping prevent lower extremity problems such as shin splints.

In situations where shin splints are a chronic disorder, it is also very important to have the alignment of your legs checked properly.  People who have excess foot pronation (flattening of the arch) or eversion (sole of the foot moving outwards) sometimes put more stress on the inner muscles of the leg, thus leading to shin splints.

Proper treatment and elimination of the symptoms of shin splints relies on identifying what specific causes of this disorder apply to you.  A good program of stretching to regain flexibility of the lower leg musculature is important.  Modalities such as heat to warm up and ice after activities help both improve blood supply and reduce circulation. 

Athletes with this disorder often respond very well to anti-inflammatory medications surrounding their times of activity.  It is also important to carefully review your training regimen and to determine whether adding more low-impact loading fitness activities to your routine may ease some of the stress on your lower legs.  If an alignment problem such as pronation is detected, very often orthotics, which are inserts that can be placed in your tennis shoe, can help align the leg better and reduce the stress on the inner part of your legs.

Hopefully, after successful treatment of shin splints, you will be able to maintain a good prevention program.  This includes proper warm-up and cool-down activities, proper assessment of your footwear with timely replacement, and hopefully continuing to enjoy the wonderful sport of tennis.  If the symptoms have not been adequately relieved with these suggestions, it is important to seek the consultation of a trained healthcare professional well versed in sports-related injuries of the lower extremity to get a full diagnostic workup.

Listed below are three common exercises that are used to help develop the muscles around the ankle and the lower leg. These can be performed with elastic tubing. Also, please see the USTA strength and conditioning website for more information about strengthening the lower body to help reduce the likelihood of injury in the future.   

Toe-Out (Eversion) Exercise

Ask the Lab shin tubing toe out start

Ask the Lab shin tubing toe out finish




Toe-In (Inversion) Exercise
 

Ask the Lab shin tubing toe in start

ask the lab shin tubing toe in finish




Toe Up (Dorsiflexion) Exercise
 

Ask the Lab dorsiflexion start

Ask the lab dorsiflexion finish





 

Dr. George Branche
About the Author
As an orthopedic surgeon specializing in sports medicine, Dr. George C. Branche III draws on personal experience as both a tennis and basketball player. He graduated from Princeton University and Howard University College of Medicine. Post graduate training involved a general surgery internship at Harlem Hospital in New York City and an orthopedic surgery residency at Howard University. He joined Anderson Orthopedic Clinic located in Arlington, Virginia in 1989. The surgical aspect of his practice is dedicated to arthroscopy of the knee and shoulder. Dr. Branche has served as a medical staff member for Davis Cup, ATP tournaments, and USTA tournaments for the last 18 years.



 

 
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