Many, many Choate athletes, especially runners, and especially in the fall, come to the sports medicine folks with pain in their lower legs.
Usually these are shin splints, but the pain may also be from stress fractures or even something completely different.
Why early in the year?
First, it is cross country season, and running is the greatest precipitator of shin splints. Second, many athletes are not prepared for the rigors of sport after a summer of sun and relaxation.
What are shin splints?
Also called medial tibial stress syndrome, shin splints are caused by a combination of rapidly increasing activity (running), with possible bio-mechanical stressors (flat feet are the most common), poor or improper footwear, and hard playing surfaces (running on roads, for example). Usually, they are caused medically by the "tibialis posterior" muscle which pulls the front of the foot down (plantar flex) and curls your foot inside (inversion). Therefore, when your foot hits the ground, if the foot pronates (pushes to the ground on the inside, flattening your arch), this pulls on that muscle, which originates on the medial (inside) side of the tibia (the big bone in your lower leg).
Signs and symptoms
Mild pain usually after activity or when starting up. The pain may disappear when warmed. Later, the pain persists to the extent that you might not even be able to run at all. The pain is usually in the lower half of your lower leg, on the inside back of the bone. The pain comes from inflammation of the periosteum (the thick fibrous membrane that surrounds bone).
Prevention
Start up a season very gradually. After an off season, or a season without running, a regimen should be increased very slowly. Wear good shoes with good arches. Ask your doctor about your foot arches during a visit, and if you have flat feet (pedis planus), get arch supports, either at Wal-Mart (cheap), the health center (better) or a podiatrist (custom, very expensive). Don't run on hard surfaces if possible, and stretch your lower legs before activity.
Treatment
Ice after running, limited ibuprofen before running, rest and physical therapy. Physical therapy may include massage, deep stimulation, exercises and stretches. Check your shoes, even the "flip flops" that you wear during the day (bad idea). If you can't run, swimming, pool running, cycling and elliptical training are good ways to stay in shape until you can return to the sport.
If they persist and don't get better with the treatments mentioned, usually evaluation for stress fractures is necessary. The next column will be about stress fractures.
Source: Shin Splints, Gloria C. Cohen, M.D., SportsMed (Conn. State Medical Society Committee on the Medical Aspects of Sport) December 2003
