What are shin splints?
Medial tibial stress syndrome, commonly called “shin splints”, is a stress reaction based on an abnormally high load on the shinbone (tibia). Stress reactions are classified from grade I to IV, with a grade IV stress reaction showing a crack of the bone (a stress fracture). Pain from shin splints is particularly felt in the middle to lower thirds of the inside (“medial side”) of the tibia.
How can it occur?
Shin splints are an overuse issue from intense ballet training and are most often related to a number of different functional problems. Their direct underlying cause is a failure of proper active leg stabilization. Muscle dysfunction can seriously affect leg stabilization and is an important contributing factor. The psoas muscle is probably the most important muscle involved with dance injuries and overuse issues. Psoas dysfunction leads to tightness of the rectus femoris muscle (a part of the quadriceps) and deactivation of the piriformis (one of the smaller pelvic muscles inserting on the sacrum). This causes pelvic torsion and functional leg length discrepancy.The increased amount of stabilization work needed to compensate for leg length discrepancy will overcharge different groups of muscles and active leg stabilization can thus be seriously affected.
Poor bone quality due to osteoporosis is another important contributing factor. It is referred to as bone insufficiency and is often related to eating disorders in dancers. With reduced bone density, the risk of a stress fracture is immensely elevated.
What are the typical symptoms of shin splints?
Shin splints usually develop gradually, but may also occur acutely if it comes to a sudden fracture. Pain often increases with weight-bearing activities especially jumping and diminishes with rest. The symptoms are typically located in the middle to lower third of the inside of the tibia. You may notice some swelling, tenderness and eventually bruising.
How can a medial tibial stress syndrome be diagnosed?
Your doctor will examine your legs and review your symptoms as well as your current training activities. Correct diagnosis of this issue demands a thorough functional clinical examination, including specific tests to identify joint and muscle dysfunction. Finding out the exact underlying causes of stress reactions is often challenging and your doctor may ask a specialist in manual medicine for his opinion. Stress fractures are difficult to see on X-rays until they have actually started to heal. Your doctor may therefore recommend a bone scan or MRI scan, that can detect stress reactions at an earlier stage.
This MRI scan of the lower leg shows some findings, typical with shin splints syndrome. You can see a fine white line along the backside of the tibia that refers to an inflammation of the periosteum – a fine tissue layer around the bone. If you look closely you can also spot the white areas which indicate an inflamation.
What treatment options are there?
If you have severe or constant shin pain, you should take a break from your ballet training immediately. Ignoring the pain can have serious consequences, as the situation will become increasingly complicated the longer you train with pain. Even if no fracture has occurred yet, this overuse issue will need time and rest to heal. You should not attend ballet training for at least 4-6 weeks, depending on the severity of the problem.
The RICE concept (rest, ice, compression and elevation) is an easy guideline that can be used to initially treat shin splints symptoms. Please read my “First Aid” post to obtain some background information that you will need to adapt this concept successfully and learn about the use of painkillers. Wearing the right kind of shoes is very important d uring rehabilitation. Outside the ballet studio, choose comfortable shoes that have a stable foot bed and a good support of the heel. Floppy shoes and all kinds of “natural running” shoes may worsen shin splints pain because they provide little to no stability to the foot. In order to handle a given overuse situation successfully, its underlying causes – namely muscle dysfunction and muscle dysbalance – have to be addressed specifically in the rehabilitation process. Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition) and the muscles affected have to be treated accordingly in the rehabilitation process. Some muscles will have to be stretched whereas others will rather have to be strengthened. A well-suited training program including corrective exercises as well as a general strengthening and endurance routine is the most effective way to deal with most overuse situations.
Manual medicine and especially deep myofascial release treatment is recommended to address present joint and myofascial dysfunction. Restriction of the fascia plays a key role in all overuse issues and can be addressed effectively with manual medicine.
Ensure that you follow your specific training routine after the rehabilitation is finished. Myofascial rollers (Blackroll, Triggerpoint Roll, etc.) as well as Lacrosse balls and resistance bands are easy to use in the studio and will help you remain balanced in the long run.
Do you have shin pain and want to have them sorted out? These are the next steps:
- See a doctor
Dancers seek help from various different kinds of therapists, many of whom may employ treatments that are outside of mainstream medicine. Before considering the use of such alternative medicine, you should see a doctor for an evaluation and diagnosis.
Finding a doctor who is familiar with the specific medical issues faced by dancers is often challenging and you may need to see several different specialists in order to get a full picture of your diagnosis. A good place to start is to ask your friends and fellow dancers for the names of their favorite doctors.
- Find a specialist in manual medicine
Doctors who specialize in manual medicine practice a whole-body approach. They will try to identify and specifically treat the underlying causes of your problem, rather than just the localized symptoms. This approach is important in addressing all aspects of the often very complex overuse problems that dancers experience. A specialist in manual medicine will perform a functional examination on every part of your body and will treat you according to these thorough findings.
To find a physician who specializes in this field, search for “Manual Medicine”, “Osteopathic Manipulative Medicine” or “Osteopathic Physician” on the internet.
- Start working on your problem
There is a lot that you can do to work on your problem after a proper diagnosis has been set. Ultimately, it often comes down to addressing the same fundamental issues. Here are some useful exercises that I recommend to my patients:
Flexibility training: Calf release, Foot release, Professional calf and foot release, Deep back release, Rectus femoris release, Psoas release, Piriformis release, Compex “DECONTRACTURE” program (peroneal muscles)
Please refer to your doctor to confirm that the exercises you choose to do are suited to your individual problem, and obtain supervision from a professional trainer to ensure that you are performing them correctly.
- Talk to your ballet master or dance teacher
Technical issues and faulty dance technique are important predisposing factors of overuse and injury in dancers. Amending dance techniques often plays a crucial role in the treatment and prevention of overuse and injury and you should not hesitate to address any issues, if necessary.