In some cases of periostitis there can be a progression to micro-fractures or stress fractures along the tibia. Generally there is not a sudden break of the bone but usually you will complain of a gradual increase in pain until it becomes quite severe.
There are a number other causes of lower leg pain that can mimic periostitis. They include: tendonitis, a partial muscle tear, growth plate inflammation, referred lower back pain, lower leg muscle imbalance, a leg length difference and compartment syndrome.
Compartment syndrome can occur in muscles originating from the tibia. Muscles are surrounded by fascia which allows for a separation between adjacent muscles. This fascia does not stretch. Pressure within the muscles can increase due to activity. The fascia does not allow the pressure to diminish. This can lead to muscle damage and pain.
If you have shin splints a proper diagnosis via a thorough history and physical exam is essential to rule out causes other than periostitis.
Treatment of Shin Splints
Conservative treatment for periosteal injuries usually consists of rest, ice, immobilization, compression and elevation, physical therapy, foot orthotics and footwear.
Rest or major modified activity
You need to dramatically reduce the frequency, intensity and time of your activity/exercise. This means you need to reduce the duration of your activity/exercise between 50 to 90 percent and doubling or tripling the time between your workouts. You can pursue cross training or try a different type of exercise such as swimming.
You cannot make the mistake of taking a few weeks off from you normal routine and then going right back to the same schedule without a reduction in training. If your activity is not modified your pain will return and it may become worse.
This is extremely useful for reducing the inflammation following a workout. You can apply ice for 10 to 15 minutes over the painful area as this will both decrease pain and increase healing time.
In some instances, if the pain in your legs does not respond to foot orthoses and physical therapy modalities immobilization will be required. Immobilization is accomplished with a removable or walking cast/boot or a non-removable fiberglass cast. The length of time of immobilization can vary between two to six weeks.
Compression bandages using Coban™ or Elastoplast™ taping prior to or following an athletic event or workout may be extremely beneficial. You can try a shin splint wraps such as a neoprene sleeve. Compression can help reduce recovery time.
Elevation of your lower extremities above your heart can help to reduce the flow of blood to the legs and will help to reduce the inflammatory process. This can help to reduce pain and healing time.
Non Steroidal anti-inflammatory drugs
Oral drugs such as Ibuprofen or Naprosyn are very useful for reducing pain and inflammation during the acute stages. However, one the down side anti-inflammatory drugs do have the potential to cause stomach irritation, ulcers or kidney problems. Therefore, you should limit the use of these medications to the acute phase of the injury.
Deep tissue massage
Deep tissue massage is useful technique for treating shin splints. You may be advised to seek deep tissue massage from a qualified physical or massage therapist. Deep tissue massage will be able to break down and smooth out knots in muscles or tight areas within the muscle. This will help reduce pain and prevent recurrence.
Custom foot orthotics
The stabilization of any abnormal foot and lower leg alignment is crucial. If this goes unaddressed, you will continue to experience a recurrence of periostitis. Custom foot orthotics will address help address the underlying cause of posterior or anterior shin splints.
Your choice of footwear is also important since different running shoes and cleats/turf shoes have different degrees of support and motion control. After about 450 miles running shoes typically lose 30 to 40 percent of the shock absorbing capabilities. The tread may look fine but the capacity to prevent injury is reduced. Uneven wear patterns from one shoe compared to the other may also be an indication of abnormal motion in one leg. (Please refer to “How to check to see if your running shoe needs to be replaced”)