Shin Splints is the common term for anterior or medial tibial stress syndrome. It is a common lower leg injury predominantly found in those who participate in running sports. The most common aggravating factors include an increase in training volume, speed work or hill training or a change to a harder training surface. In the non-running population walking on uneven ground for long periods or foot control issues may be aggravating factors. Shin Splints is an overuse injury involving strain and subsequent inflammation of the muscles of the lower leg (tibialis anterior and posterior, extensor digitorum longus and extensor hallucis longus) and their myotendinous insertions onto the tibia, the periosteum of the tibia may also be involved. Pain is usually felt shortly after the onset of activity and is easier with rest. Pain may last into non-training days once the irritation is more established.
In Medial Tibial Stress syndrome the pain is more predominant on the inner aspect of the tibia and involves the tibialis posterior muscle. It is more common in individuals who tend towards excessive pronation issues. In Anterior Tibial Stress syndrome it is the outer border of the tibia that gives the most pain and predominantly involves the tibialis anterior muscle. It occurs more frequently in individuals who have recently increased the level of hill work as the Tibialis Anterior is involved in both dorsiflexion of the foot and as a decelerator for plantar flexion.
In a study involving 40 athletes with shin splints, athletic trainers from the University of California who were certified in Sports Medicine Acupuncture performed acupuncture twice a week or 3 weeks to assess the benefit to their athletes. Athletes were divided into an acupuncture group, a standard care and acupuncture and standardized care group. Standardized care included modification of activity, ultra sound therapy, stretching and strengthening exercises in addition to ice therapy and symptomatic anti-inflammatory medication. In the acupuncture treatment groups local needling following modern sports medicine protocols targeting irritated tissue and hypertonic muscles combined with traditional acupuncture techniques targeting the affected acupuncture meridians were applied.
To assess effectiveness of the intervention the athletes answered questionnaires prior to initial treatment and after each week of treatment. Questionnaires took note of the intensity and duration of pain during and between exercise; in addition to the amount of anti-inflammatory medication the athletes required. The athletes involved in the study did not have compartment syndrome or stress fractures which would involve medical intervention. All athletes noted an improvement in their pain levels regardless of which treatment group they were in however the acupuncture group noted the highest level of effectiveness. The amount of anti-inflammatory
medication consumed during the treatment period stayed the same with the standard care group but decreased by 80% in the acupuncture group and 60% in the combined group. Less pain in sporting activities during the week was noted in 100% of acupuncture and combined treatment groups compared to only 31.3% in the standard care group. In light of this study and generally accepted guidelines for acupuncture treatment of sports injuries it is recommended that those who are interested in acupuncture for their shin pain start with 2 treatments per week for the first 3 weeks and if pain persists once weekly follow ups if necessary.