Shin Splints, Stress Fractures, and Orthotic Support

By: Tim Maggs, DC

In athletes, shin splints and stress fractures are typically a result of repetitive motion injury in one or more supportive muscles in the lower leg. Very often these muscles work without ever fully recovering before being asked to perform again. All athletes use similar muscles as they participate in sport specific movements, and runners are subjected to this same scenario. Unfortunately, young runners seem to have lower leg problems more frequently than older runners—probably a result of growing and having a musculoskeletal system that is not yet fully developed.

Unfortunately, our sportsmedicine industry is not about prevention or pre-season examination. Tests and treatments can only occur once the injury is present. Coaches and athletes alike are aware that traditional healthcare is rather ineffective when looking at an athlete’s injuries. Most sports injuries are biomechanical, and yet it’s often the pathology-based doctors who are doing the exams and treatment recommendations. This leads to athletes not seeking medical attention, as they know the standard recommendation is to stop running, with little, if any, actual treatment.

Athletes should, at the very least, be evaluated biomechanically after an injury such as a shin splint or stress fracture. The ideal, however, is to have a Structural Fingerprint™ exam during the pre-season. An athlete whose biomechanics shows a predisposition to excessive lower leg stress can be properly tended to in a true preventive manner.

The Structural Fingerprint™ Exam

A thorough history should be taken to determine pre-existing conditions, prior traumas or any other influencing factors. The soles and heels of the shoes should be compared for even wear. Any shoe imbalance suggests a biomechanical defect somewhere in the structure. The examination and X-rays should isolate specific biomechanical defects in an individual. Heredity often will contribute to specific injuries in people, and should be considered at this time.

Fig. 1. Foot Levelers’ 3D BodyView imaging system.

Figure. 1. Foot Levelers’ 3D BodyView imaging system.

Either way, the ideal arch should allow some room under the medial arch and the two feet should be symmetrical with regard to the amount of space under each arch. Seldom, however, is this the case. The majority of Americans pronate, with a smaller percentage supinating. In many cases the right and left foot are different, adding to the imbalance. Digital scanning (Fig. 1) with color schematics (Fig. 2) can also show a difference in structural weightbearing.

The Q-angle should be evaluated at the same time as the medial arches, and the exam should check for ranges of motion, muscle tightness throughout the hips, and low back and leg length check. Measuring from the greater trochanter to the lateral malleolus is one means of determining leg length difference and ruling out any anatomical shortness.

Standing biomechanical X-rays should then be taken. This is a standard procedure on all patients, as biomechanical findings on the X-ray provide a wealth of information, and the beginning reference points when attempting to help balance a patient. The standard series consists of an A-P open mouth, a lateral cervical, an A-P L-S and a lateral L-S.

Interpretations

If an exam is done pre-season, before any injuries have occurred, then a balancing program to improve

Figure. 2. Colorized scan from 3D BodyView.

Figure. 2. Colorized scan from 3D BodyView.

the imbalances should be designed. Custom-made, functional orthotics from Foot Levelers are recommended to help balance the individual, as well as to provide shock absorption. Special material in the heel of the orthotic reduces the amount of stress transferred up the leg of the athlete, reducing the likelihood of injury to the muscles or joints.

The examiner will make note of any and all imbalances found during the exam or on the X-ray. The goal is always threefold for all athletes; improve the overall structural balance, improve joint mobility, and increase muscle flexibility. This is always a process, but one well worth working towards, as it reduces the likelihood of injury and increases the performance potential of an athlete.

Treatment

The first step is to put the athlete into custom-made, Foot Levelers orthotics. This will provide support and symmetry for the medial arches of the feet as well as shock absorption for the entire structure.

Ice treatments should be used 4–5 times per day, with a wrap around the involved area. The repetitive motion of the involved muscles has most likely produced a tight, non-compliant muscle, which has accumulated toxins and a deprived blood flow. The shortening of this muscle is the cause of the increased tension and slow recovery of the muscle after workouts. A deep pressure massage needs to be done multiple times per day to this involved muscle. Proper nutritional supplementation, to promote healing and reduce inflammation, is also a benefit.

The next goal is to buy shoes appropriate for the athlete’s foot type. If there is pronation, motion control shoes are needed. If the foot type is neutral, then stability shoes are indicated, and if the foot type is supinator, then cushioned shoes are recommended.

Finally, the Advanced Conditioning™ Program should be recommended to all athletes with shin splints. This will encourage full spine joint mobility, improved muscle flexibility and an improved overall balance of the structure, which will surely help to reduce the stress going through either lower leg.

Conclusion

During the prime growing years, we need to implement a better management of the biomechanics and muscular systems of our young runners. We should never wait for symptoms to initiate concern, as symptoms are a clear indication the envelope’s been pushed too far. With competition as fierce as it can be in junior and senior high school students, we should at least give these young athletes a clean bill of structural health before they attack the season.