As warmer weather calls runners outdoors, Dr. Richard Bremner, a podiatrist with Wheaton Franciscan Healthcare Covenant Clinic in Cedar Falls, says he tends to see more stress fractures in his patients.
“The cause,” he said, “is typically from either an abnormal force to bone over a long time period where the bone is unable to repair itself, such as in long distance runners, or it can be from a normal force on an abnormal bone such as those patients who have osteoporosis (a disease of progressive bone loss) or osteopenia (low bone density).”
Of all sports, distance runners have the highest risk of stress fractures, which occur mostly in the tibia (inner shinbone) or small bones of the feet. Females are more prone to stress fractures in running sports because of smaller and less dense bones.
“Young women who exercise vigorously may develop menstrual irregularities reflecting hormonal imbalance which can lead to osteoporosis. These women have a high risk of more serious and multiple stress fractures,” said Dr. Stephen Taylor, an orthopedic surgeon from West Des Moines specializing in sports medicine. Eating disorders also can increase risk.
The term “shin splints” refers to stress fractures, microfractures and other overuse conditions that may share the same initial symptoms (A Patient’s Guide to Shin Splints): muscle spasm, compartment syndrome (swelling shuts off blood supply requiring immediate surgery), adhesions or inflammation of the connective tissue or of the membrane covering the bone as muscles pull away from it. Any shin pain that worsens should be checked out.
Symptoms begin with a gradual tenderness and dull, aching pain upon exercise and increases with continued activity. Rest lessens the pain, but resumed activity will worsen a stress fracture sooner into the workout until any running is intolerable.
Causes
People who take up a new activity, especially with quick starts and stops and downhill running, those who don’t usually run but go for a long jog, those who run on the balls of their feet, or have shoes with poor shock absorption, tend to affect the front of the tibia. Shin splints on the back of the tibia are from imbalances in the muscles or feet, such as tight calf muscles or flat arches.
Adjustment time needs to be allowed as people move exercise and sports outdoors, says Dana Foster, Fitness Instructional Coordinator at the University of Northern Iowa’s Wellness and Recreation Services. In the change from softer, predictable indoor surfaces to hard pavement, angled surfaces or uneven terrain, different small muscle groups are used. If an athlete is not conditioned properly, injuries are more apt to occur with sudden changes in training, longer distances or faster speeds, such as the condensed high school track season.
Diagnosis and Treatment
Upon examination and taking history, physicians may address underlying causes of shin splints with the help of a chiropractor on alignment issues or a physical therapist with treatments and techniques that can reduce inflammation and prevent further injury. A stress fracture won’t appear on a standard x-ray until at least four to six weeks after it begins, but an MRI or bone scan can find it sooner, when the bone cells are attempting healing.
Ron Ragsdale, DPT with Taylor Physical Therapy at Waverly Health Center, recommends a thorough biomechanical assessment so that treatment “focuses on the cause of the problem and not just the symptoms.”
Structural issues can include the angles and alignment from the waist down as well as abnormal lumbar (lower spine) mechanics, according to Dr. John Schutz, Certified Chiropractic Sports Physician at Waverly Chiropractic.
Treatment can involve:
• First, REST and elimination of the aggravating sport or exercise
• Cold packs, anti-inflammatory medications and special taping techniques may be used to help heal, but not as a way to continue using the injured area
• A cast, in higher risk areas or in people at higher risk of resuming activity
• Crutches, to keep from bearing weight if pain persists
• Surgery, only in rare cases of certain foot and hip stress fractures
• New shoes, shock-absorbing insoles, or orthotic inserts for structural abnormality.
Owners of the Runner’s Flat, Sarah and Scott Gall, see poorly fitted or worn-out running shoes as factors in repetitive stress injuries. Their store in downtown Cedar Falls features a video camera and treadmill device that captures an individual’s gait to determine the most effective shoe.
Recovery and therapy can be from three to 10 weeks. Only after all symptoms are gone, any fracture is healed and risk-causing issues are addressed can workouts resume, starting with non-impact activities such as swimming or cycling. A personal trainer can help one pace and make corrections. Prevention is still the best medicine, so remember this old adage - don’t do “too much, too soon, too fast.”
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