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I've been told I have shin splints in both lower legs. What's the best way to treat this problem?

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Q: I've been told I have shin splints in both lower legs. What's the best way to treat this problem?

A: Shin splints" also known as medial tibial stress syndrome or MTSS is a common cause of lower leg pain in weightbearing athletes. Dancers and runners seem to be affected most often. Overuse in an athlete with flat feet, hip rotational imbalances, and hyperplantarflexion (toe pointing downward excessively) are the biggest risk factors. Being overweight seems to delay healing in anyone with this problem as well.

The first thing to do is determine the cause of this condition. A physiotherapist can help you with this. The therapist will examine you for potential biomechanical, postural, or anatomic causes of malalignment that could be contributing to the problem. Muscle tightness or weakness will be evaluated as potential features of your problem.

Sometimes a period of rest and nonweight-bearing using crutches is needed to take strain off the tissues and before healing can take place. This means backing off from any sports, dance, or other recreational activities involving the lower legs. Taping the lower leg may be helpful.

Shoe inserts (off-the-shelf or specially made for you) may be recommended. The therapist is also integral in guiding the athlete in selecting proper shoe wear and getting back into an appropriate and effective training schedule. Stretching and strengthening activities are often an important part of rehab and recovery.

With symptoms in both legs, there is always concern the condition will develop into a compartment syndrome. Tightness of the fascia (connective tissue) and thickening of the muscles from overtraining can lead to pressure on the blood vessels. In such cases, medical treatment (possibly surgery) is advised. If there is any danger of this, your therapist will refer you to a physician right away.

Most athletes with medial tibial stress syndrome (MTSS) or shin splints respond well to conservative (nonoperative) care. Once the cause of the problem has been addressed, the symptoms go away and the condition is resolved. Some people have a tendency toward developing the problem again but with careful monitoring and treatment, return of this condition can be prevented.

Reference: Rachel Biber Brewer, MD, and Andrew J. M.Gregory, MD. Chronic Lower Leg Pain in Athletes: A Guide for the Differential Diagnosis, Evaluation, and Treatment. In Sports Health. March/April 2012. Vol. 4. No. 2. Pp. 121-127.

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