There are a number of separate conditions that are given the name shin splints. All are caused by exercise and give pain around the shin (tibia). It is common in a wide range of sports where running is a major feature and hockey is no exception.
This problem is also known as medial tibial stress syndrome. Pain is felt on the middle third of the shinbone, on the inside of the bone.
The pain usually begins at the start of the season, often the result of too much hard training too early. Playing on hard artificial surfaces is a risk factor in developing this injury.
The pain is first felt as an ache after training. As the condition worsens, the pain is felt when warming up but may appear to go away when playing only to come back after the game.
There will often be some early morning stiffness and pain, which disappears after being up for 15 to 30 minutes. There is usually no pain when in bed at night. (Pain felt in bed at night should always be checked out if it lasts for more than a couple of days). Pressing on the inside edge of the shin bone (tibia) will be painful and in severe cases will be slightly swollen.
What causes shin splints?
The problem is an injury to where the muscle attaches to the bone.
Some fairly large muscles are attached to the shinbone in this area. The job of these muscles is to control the way the foot lands when you are walking or running. The muscles then work to help propel the body forward. Both the landing and the push off puts a lot of strain on the shinbone.
Where the muscles attach to the bone they pull on the lining of the bone, firstly when the foot lands to control the landing and secondly on the push off to propel the body forward. The lining of the bone becomes stressed, as does the muscle where it attaches to the bone. The result is pain and swelling.
The shinbone itself can be involved. The bone actually bends a little when the foot lands, if this is excessive, the bone becomes thickened in this area in an attempt to stop the bending. The combination of the excessive training and the bone trying to heal itself leads to the area becoming inflamed and therefore painful. In some sports, such as running, this can lead to what is known as stress fractures.
Stress fractures are breaks in bone similar to stress fractures in metal. Try bending a paperclip a few times, eventually it breaks! The good news is these stress fractures are not that common in hockey, although if someone does a lot of running as well as hockey then a stress fracture must be considered.
Shin splints are overuse injuries, that is they occur over a period of time, not as the result of a single incident (like getting hit by the hockey ball). A series of micro-injuries add up to a significant and painful injury.
Some key factors to the causes of Shin Splints:
How hard you train
Like many lower leg injuries doing “too much too soon” is one of the main factors to developing this injury. If training sessions are too hard, too long and happen too frequently then the bodies own ability to recover will be beaten and injury results. Ideally training should be alternated between hard and lighter training sessions.
The way you are built
If you are flat footed then you are more likely to suffer this problem. On the other hand if you have very high arches, this too can make you more likely to have shin splints.
What you train on
Hard surfaces, such as artificial surfaces with little shock absorption, are a risk factor. Also hill running both uphill and downhill causes the muscle to do more work and increases the chance of developing shin splints.
Previous ankle injuries
Players who have had previous severe ankle sprains may also be at more risk. This can be due to the ankle having lost some of its flexibility and/ or the muscles around the ankle being weaker after the injury.
Sex
Well it’s not actually to do with sex but it is to do with gender. Females do tend to be slightly more prone to this problem. The reasons for this are not clear.
How to avoid Shin splints
Sensible Training
Resist the temptation to do “too much too soon”. If you are addicted to exercise, use cross training to get your fix without stressing your body too much. Swimming and cycling both maintain cardiovascular fitness without stressing the shin.
Shoes
Shin splints are a result of the body having to deal with too much shock absorption. Help your legs out and use suitable shoes. This is especially true if you are playing on hard artificial surfaces. If playing on these surfaces make sure the shoes are designed for this. Also if you have flat feet (technically known as over-pronation) make sure your shoes are designed to help control this.
Treatment
The first thing I would always suggest is that you get an accurate diagnosis. If your GP has an interest in sport (and some do), he or she will be able to give you advice, possibly drugs (anti-inflammatory) and may refer you for physio treatment (free on the NHS). Your local sports injury clinic will often give highly subsidised treatment especially if you are still at school or a student.
Don’t ignore pain; it’s usually there for a reason. Try to think why it is painful. Are you training more than you normally do? Have you changed your shoes? Try and address the cause of your problem.
Treatment includes:
- Reduction in training (reducing the running element of the training)
- Maintain heart-lung fitness by cycling, rowing or swimming
- Local physio treatment to the injured area may include ultrasound, laser, or deep friction massage.
- Special insoles (orthotic devices) may be used to control any abnormality of your foot. This may be provided by your physio or a chiropodist who specialises in this area.
So if you have pain as with all injuries remember the initial treatment is RICE:
- Rest - This does not mean complete rest but it is essential you avoid activities that make the problem worse.
- Ice Apply an ice pack, the sooner the better. Keep it on for about 10 minutes. You can reapply it when the skin colour returns to normal. Take care if you are taking frozen peas straight out the freezer as you can give yourself a ice burn.
- Compression In general gentle compression helps to reduce the swelling that occurs after injury. However, compression generally does not help shin splints much and may even make it more painful.
- Elevation Raising an injury helps to reduce the swelling after injury. This works better for one-off injuries and does not do so much for overuse injuries.
