Shin Splints

Shin splints or medial tibial stress syndrome (MTSS) is defined by the American Academy of Orthopedic Surgeons as pain along the inner edge of the tibia.  Shin splints injuries are specifically located in the middle to lower thirds of the medial side of the tibia. They are common injuries in athletes and military recruits who engage in running sports or other forms of physical activity, including running and jumping.  The pain associated with shin splints is caused from a disruption of strong fibers that connect the muscle through the connective tissue covering of the tibia where it inserts into the bone.  With repetitive stress, the impact forces fatigue the muscle and create recurrent tibial bending or bowing.  The impact is made worse by running uphill, downhill, on uneven terrain, on hard surfaces or improper footwear.

The hypothesis of the development of the syndrome is that the body adapts to loading stresses to the tibia which is exacerbated by pulling the muscle away from the bone.   Shin splints can be attributed to overloading the lower leg due to biomechanical irregularities and an increase in stress exerted on the tibia. A sudden increase in intensity or frequency in activity level fatigues the muscles, hindering proper shock absorption and forcing the tibia to absorb most of that shock.  Also muscle imbalances, including weak core muscles, inflexibility and tightness of lower leg muscles can increase the possibility of shin splints.  The most likely cause is repeated trauma to the connective muscle tissue surrounding the tibia.   While the exact cause is unknown, factors that are associated with the development of MTSS include: increased rotation of the hip, prior use of orthotics, previous history of MTSS, increased BMI, misaligned foot bones, excessively tight calf muscles engaging the shin muscle in excessive amounts of muscle activity, undertaking high-impact exercises on hard, noncompliant surfaces (ex: running on asphalt or concrete), smoking and low fitness levels.  A study showed that the position of the ankle joint upon movement was the most significant factor to contribute to the onset of MTSS.  This abnormal movement causes muscles to fatigue more quickly and they're unable to absorb any shock from the foot hitting the ground.

Treatment for shin splints is not always successful because the exact cause of shin splints is still unknown.  MTSS should be treated by restoring proper biomechanics and alignment to the foot and lower extremity through massage and adjustments.  The primary objective of treatment should be to enhance shock absorption to the lower extremity.  It is important to significantly reduce any pain or swelling before returning to activity and to decrease the activity level if any pain returns.  Individuals should consider running on other surfaces besides asphalt, such as grass, to decrease the amount of force the lower leg must absorb.  Orthotics and insoles help to offset biomechanical irregularities.  Surgery is only performed in extreme cases where more conservative options have been tried for at least a year.  However, surgery does not guarantee 100% recovery.



Moen MH, Tol JL, Weir A, Steunebrink N. De Winter TC. Medial Tibial Stress Syndrome a critical Review. Sports Med. 2009; 39(7): 523-543.

 Newman P, Witchalls J, Waddington G, Adams R. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. OA J Sports Med. 2013; 4: 1-14.

 Yuksel O, Ozgurbuz C, Ergun M, Islegen C, Taskiran E, Denerel N, Ertat A. Inversion/eversion strength dysbalance in patients with medial tibial stress syndrome. J Sport Med. 2011; 10: 737-742.

 Krenner B. Case report: comprehensive management of medial tibial stress syndrome. J Chiro Med. 2002; 1(3): 122-124.

Patients tell me "I'm fatigued," but… What Is Fatigue?

Asking what fatigue is probably sounds like a silly question to you. I know you know what fatigue feels like, but do you know that, at its core, fatigue is an energy problem? You feel fatigued when your body does not produce and/or store enough energy. So the solution to helping someone who suffers from fatigue is helping the body create and store energy.
The trick comes in figuring out what is causing the “energy” problem. There are lots of possibilities and every person is unique, even in the amount of energy the body requires. Unfortunately, the “remedies” that most people use actually exacerbate the problem over the long term:
• Strenuous exercise that requires more energy than it helps the body produce;
• Caffeine and other stimulants like Red Bull, Ritalin, or Wellbrutrin that stimulate the body even though the body is already exhausted;
• Eating sugar for the temporary surge in energy, and then eating more sugar to overcome the subsequent “crash.”
Here are the strategies that I recommend:
Make sure your body is properly hydrated. The amount of water you need varies from person to person, but the signs that you are not drinking enough water can include chronic pains in your joints and muscles, lower back pain, headaches, constipation, fatigue, and a strong odor to your urine.
Eat quality foods that produce energy. What you eat matters. Dead foods with empty calories can actually deplete energy by taking more energy to digest than they can generate. Highly processed foods are dead foods. Refined sugar is another dead food that plays a more significant role in managing energy than almost anything else. Glucose is fuel for the body. But, if the concentration gets too high it’s like putting too much fuel in an engine; this is typically called “running too rich.” Moreover, excessive amounts of refined sugar contribute to demineralization which interferes with hormone production, enzymatic activity, and energy production.
Get enough high quality sleep. This requires that the room be dark, that the temperature be comfortable, that your body be well fed, and that your body has enough energy stored from exercise to keep it going through the night.
Manage stress. Stress depletes energy. Exercise, sleep, having fun, and taking time for yourself can help you handle stress.
If you are doing all of these things, and still feel fatigued then we need to look deeper. Are you digesting the food that you eat? Is there an organ in your body that is short circuiting the flow of energy? Is your body full of toxins that are interfering with the energy production cycle? I have had tremendous success in helping people overcome fatigue. If you suffer from fatigue, I would love to work with you to help you get your health back.