Shin Splints – What are they really?

We love looking at other Chiropractors work. We can learn, give advice, or even just be reminded of techniques and ideas that we haven’t used in a while. Today we ran across a great article by a Dr. Daniel P. Bockmann, a fellow Chiropractor in Austin, TX.

In his article he talks about what causes shin splints and what kind of injury they are. Here are a few of our favorite points:

“…the term “shin splints” doesn’t refer to an actual condition”

“There are 4 general causes for that deep, achy pain you feel around your shin bone, and if you’re a runner it’s very important to know the difference between them.  Here are the 4 biggest causes:

1.    Medial Tibial Stress Syndrome (MTSS).  The most common cause of leg pain in athletes, period.  A deep, achy pain felt on the inside and sometimes around the back side of the tibia (or shin bone).  Caused by micro-tearing of the posterior tibialis muscle where it attaches to the back & inner part of the tibia.
2.    Tibial Periostitis.  An irritation or inflammation of the periosteum, the thin membrane surrounding the tibia.  Pain is felt directly on the front of the shin bone, usually near the ankle and extending part way up the leg.
3.    Anterior Compartment Syndrome.  The muscles on the front of your lower leg are encased in a thin, leathery sheath, or compartment.  Excessive swelling within that sheath can quickly compress nerves and blood vessels, causing pain on the front of the leg, outside the shin bone.
4.    Stress Fracture.  These are small, sometimes microscopic cracks in the shin bone that can quickly worsen if you continue running.  Caused by the repetitive impact of landing strides while running, the pain from a stress fracture is usually localized to a very specific area, rather than spread out across the bone like the other 3 conditions.  Early diagnosis and treatment is critical, as stress fractures can lead to COMPLETE fractures if left untreated.”

You can read all of Dr. Bockmann’s article on his website. HERE

Should I have epidural steroid injections?

This is the medical model for treating low back and leg pain that is caused by spinal stenosis (pictured, here) – a narrowing of the space that the spinal cord or nerve root passes through:

• Try exercises and physical therapy first.
• If you are still having more problems than you can deal with, try an epidural injection of steroids at the pain clinic.
• When that doesn’t help, surgery is then offered to open up the space.

A small study published in the February 2014 issue of the journal Spine suggests that the injections may do more harm than good!

The Spine Patient Outcomes Research Trial (SPORT) was a four year comprehensive study to look at different ways of treating low back and leg pain and how effective they were for patients, funded by the National Institutes of Health (NIH).  Some patients had surgery, others had non-surgical interventions, and the research published from the trial said, basically, that those who had surgery were, by and large, happier with their results one to four years later than those who didn’t.

Researchers with access to the SPORT database took a look at the results from a group of those non-surgical patients, specifically those patients with lumbar spinal stenosis, to see how the patients who received epidural steroid injection compared to those who didn’t.

There were 276 patients in the original SPORT study who had the diagnosis of lumbar spinal stenosis, and the data from this subgroup was analyzed to see how well the 69 who received the epidural steroid injections within the first 3 months of the study did, compared to the 207 who didn’t have the injections.

The conclusions? Pretty scary if you’ve already had the injections!

• Those patients who had epidural steroid injection were associated with significantly less improvement at 4 years among all patients with spinal stenosis in SPORT.
• Furthermore, for those who eventually had surgery, having epidural steroid injections were associated with longer duration of surgery and longer hospital stay.
• There was no improvement in outcome with epidural steroid injection whether patients were treated surgically or non-surgically.

In case you didn’t catch it:  At the end of four years, everyone who had the injections had significantly less improvement than those who didn’t have them (whether they ended up in surgery or not).

Okay.  Yes, this is a small study.  Yes, it only studied the people with one of the possible causes for low back/leg pain.  Do you really want to have such an injection IN CASE they find something different when they look at the rest of the population?

Should you have epidural steroid injections as part of the recommended course of treatment for your low back pain?  I think not.