Children with Shin Splints.
If your child is complaining of pain in their shin then I’d take an educated guess that you have one Active human on your hands! Our children will generally experience shin splints pain related to excessive load. The change in load comes through sports with a heavy running and jumping component required of the child during training and competition. Shin pain is more common to the pre-teen and adolescent age group.
Most commonly, the pain in the shins will appear as Medial Tibial Stress Syndrome or “Shin Splints. This occurs as an inflammatory reaction in the periosteum lining ( I like to explain this as the glad wrap on the top of the bone) of the front of the tibia bone (Shin bone), the tibia bone itself and or the surrounding muscles groups.
The muscles that sit against the shin bone insert via their tendons into the midfoot. They have very specific functions to trigger movements of the foot and ankle when our kids run and walk. If the load against making these movements becomes too high that force will ultimately cause the muscles, the bones those muscle sit against and the periosteum lining of the bone to swell in response. At first, shin splint pain will occur just with the activity and settle within a few days of rest. As more activity is required of our kids, this repetition of load prevents the muscles and shin bone from recovering. This leads to pain at rest as well.
In more rare but severe cases Shin Pain can be diagnosed as Compartment syndrome, a Tibial stress fracture and there is also the possibility of Osteosarcoma (bone tumour). I always recommend diagnosis by an Allied health Professional when dealing with children’s Shin pain. This is to avoid the possibility of one of these more severe diagnosis being improperly managed as Shin Splints at home with the very best of intentions.
For today’s discussion, lets chat a bit more about the more common Medial tibial stress syndrome.
Medial Tibial Stress Syndrome
When asking your child about their shin pain they most commonly point to the middle third of their shin bone as the main pain site. This is a Posterior Medial shin splint. Secondary to this site will be the upper middle third known as an Anterior shin splint. Finding the main pain site helps us identify the source of muscles involved in creating the shin splint. Applying a light compression with your thumb to the bone and leg in either spot will cause a dramatic pain responses…..because it really hurts!
Rest for 24 hours; Ice for 20 minutes of 3 rounds with 10 minute breaks between; and some mild anti-inflammatories will help allow the shin pain to subside. Unfortunately, as soon as these kids get back into their much loved sports the pain will return. This is where managing their load becomes important so that they can maintain their activity! I’m all about keeping our kids engaged in the sports they love!
Our children’s bodies are still very much in a developmental stage right through to their early 20s. Their bones are not often ready to tolerate extreme load demands put on them by some sports. In Podiatry we help kids manage these extreme loads through.
Footwear - Depending on the sports they participate in there will be required footwear types. Where possible, make sure your child’s shoe has laces to tie the shoe tight to their foot. Its much harder to move around a “floppy” shoe on your foot than one that is secured. With footy boots especially, avoid any sock top shoes that don’t help the foot secure in the shoe. Asic’s footwear are one of the best at attempting to make sports specific shoes for this age group and they have the depth to allow orthotics to insert for any biomechanical considerations. We also see Mizuno entering this market with some great footwear options for specific sports.
Orthotics- Kids with medial tibial stress syndrome of the shin respond extremely well to orthotics with proximal correction. This means the main peak of the arch profile of the orthotic sits further towards their rearfoot. This type of correction helps control the vector arm which works through the talo-navicular joint and surrounding midtarsal join This is the area that our Posterior Tibial and Anterior Tibial muscle tendons insert into from behind and in front of the shin bone respectively. These muscles along with the shin bone itself will react to increased ground reaction forces that come with running and jumping movements. If we can limit the force acting back through that vector arm we reduce load in the muscles and bones of the shin…….in a nut shell, it’s all about the way the force is absorbed between foot ground contact and then back up into the foot, ankle and leg.
The Kidzoles have a proximal correction in them alongside our Strong Arch support Lifesoles for bigger feet as a prefabricated option for these kids.
Exercises- “Hang on a minute!” I hear you say. “You just told me load was the problem but now you want to load them more”…. Yes definitely, but in different muscles. Strengthening exercises for the glutes, soleous and hip flexors can help a bunch with kids experiencing shin pain. As the strength in these muscle groups develop the load placed upon the Posterior and Anterior Tibial muscle and therefore the shin bone decreases. We also want to stretch out those tight posterior muscles groups of the calf and hamstring. Your Physiotherapist or Podiatrist can develop a graduated program to manage Shin splints for your child.
Massage and Heat. Grab a heat cream and lightly massage the back of their legs. Ice is great when the immediate flare up occurs, but in order to repair symptoms we need blood flow. Heat will assist in drawing blood flow while you work out the little Knotty areas in the back of the calf muscle. Avoid massaging the bone. Simply place some heat cream but do not rub in. I’d recommend fisocrem, dencorub or deep heat.
It is so important to manage Shin Pain as soon as it begins. The more time you leave it the more trauma that occurs to the muscles and bones. With Shin Pain, there can be some nasty diagnoses in this area, with long term effects, that can mimic symptoms common to a normal shins splint. Always see a Physiotherapist or Podiatrist to ensure these are ruled out before commencing the management of Shin Pain. As always any questions or queries just shoot me an email through my contacts page. Stacey X