How can you help athletes prevent and treat shin splints?
A study of 97 US naval midshipmen who developed MTSS during summer training programs compared randomly assigned treatments of rest and ice to rest and ice plus anti-inflammatory medication (aspirin or phenylbutazone), rest and ice plus heel-cord stretching, or use of a short walking cast for 1 week.6 Subjects assigned to a treatment program of rest and ice alone lost significantly fewer days from running than the other treatment groups (P<.03).
A recent RCT of soldiers with MTSS compared treatment with a leg orthosis with no orthotic use; all subjects underwent icing and activity modification.7 No significant differences in outcome measures (days to completion of a 0.5-mile run, global rating of change, or number of treatment sessions) were noted between the treatment groups. Small sample size, high dropout rate, and small effect size limit the power of this study.
Fasciotomy can relieve symptoms but may not improve postop activity
Three case series reported on deep posterior compartment fasciotomy to treat MTSS in athletes.8-10 Surgery significantly reduced pain levels (P<.001) by an average of 72% on the visual analog pain scale for 46 patients who had failed conservative therapy for at least 12 months.8 However, only 41% returned to their pre-symptom level of sports activity. Another case series of mostly running athletes reported that 21 (78%) of 27 patients exhibited excellent or good healing after surgery.9 In a series of 9 patients with an average of 39 months of symptoms, 5 reported complete relief at follow-up (42±6 months), and 7 trained more than they had preoperatively.10
One case series of superficial posterior compartment fasciotomy for MTSS in 35 athletes reported that, among the 32 athletes available for follow-up, 72% (23) reported improved symptoms, but 69% (22) had a lower level of activity postoperatively.11
Recommendations
The American College of Sports Medicine (ACSM) recommends at least 7 to 10 days of rest from painful activities to treat MTSS.12 Running in a pool and cycling to maintain aerobic fitness during the rest period are considered safe activities. Stretching and strengthening exercises are not recommended while symptoms persist. Patients should return to running gradually. ACSM also suggests that orthotics are useful for preventing injury and treating some patients.
