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Shin splints is a non-specific term for an overuse syndrome that affects the lower leg in athletes. Poorly conditioned and novice runners are especially susceptible to this condition.

Usually shin-splint pain is found in the lower two-thirds of the tibia (shin). The pain is commonly attributed to tendinitis of the posterior tibialis tendon and/or other flexor muscle tendons along the tibia. Other conditions that can elicit pain in this area are irritation around the bones and stress fractures.

PREVENTION
To prevent or reduce the severity of this condition, the coach/trainer must have an understanding of the contributing factors, so that effective preventive measures can be included in athletes' overall training program.

1. Biomechanical: Has the physician or trainer checked the athlete for excessive foot rotation, excessive inward angle of the leg, and other foot conditions such as flat foot,fallen arch, or high arch or low arch?

2. Equipment: Does the athlete's shoe provide adequate support for the arch? Adequate heel control? Adequate shock-absorption qualities?

3. Muscular Strength and Flexibility: Is an appropriate strength-maintenance program part of the athlete's training regimen? Is attention given to maintaining similar degrees of flexibility for both left and right hamstrings?

4. Training Schedule and Program: Is the program designed to meet the physiological limitations of the athlete and enable the athlete to progress as a planned incremental rate? Is non-weightbearing training ­ swimming, cycling ­ for the shin splint-sensitive athlete a sufficient part of the program?

Consult a local sports medicine professional if you need counsel on assessing these conditions.

Here are the next steps in a shin-splint prevention program.

• Flexibility exercises for the low back, hamstring muscle group and Achilles tendon complex;
• Strengthening exercises for the knee extensors, abdominal muscles and anterior muscles of the lower leg;
• Instruction on proper running mechanics;
• Running activities on a grass surface whenever possible, rather than on cement or other unyielding surfaces;
• Proper fit and adequate support for the athlete's shoes;
• The utilization of non-weightbearing programs in the overall training program.
• Instruction on the proper method of pre-participation warm-up and post-participation cool-down, and
• Instruction on the initial signs of shin splints: (a) generalized pain in the lower medial shin after activity, and (b) pain in the medial arch region, which may be accompanied by a blister on the bottom of the foot.

REHABILITATION
After the condition has been properly diagnosed by a physician, rehabilitation should begin immediately.

The following factors should be considered:

1. Maintenance of the Athlete's Cardiovascular Endurance: Swimming pool activities and bicycle ergometer sessions could be utilized until the athlete is permitted to return to training by the physician.

2. Maintenance of Muscular Strength and Flexibility: The affected and surrounding areas must be regularly exercised, with low-intensity strength training and appropriate flexibility exercises.

3. Analysis of the Athlete's Running Style: If the condition becomes chronic and if gait analysis, rehabilitative exercise, and proper footwear do not correct the condition, some type of foot control may be recommended, such as orthotic inserts or special pads in the shoes.

4. Return to Training and Competition: The athlete's return must be planned and controlled by the members of the sports medicine team.

CONCLUSION
Shin splints is an overuse syndrome that causes pain in an athlete's lower leg. By incorporating strength and flexibility exercises, proper equipment, and a progressive training program, the coach/trainer may reduce the severity and incidence of this condition.