Stress fracture is one cause of shin pain


DEAR DR. DONOHUE: I hope you can help me. I have a lot of pain in my shins – and only my shins – when I walk for exercise. I walk 1 1/2 to 2 miles a day. I would go farther, but the pain won’t let me. Doctors say they don’t know what’s wrong. Please help. – A.C.

Shin pain is often dismissed as “shin splints,” an unfortunate diagnosis, because it has little meaning and because it applies to so many different conditions. Let me give you a couple of examples of shin-pain causes. A doctor will have to determine which applies to you.

Stress fractures are one cause. They’re tiny breaks in the shin bone (the tibia) that come from subjecting the bone to repeated stress without giving it time to recuperate. Hopping on one leg greatly increases the pain of stress fractures. Pressing the tender area with a finger also intensifies the pain.

Early stress fractures do not show on X-rays. A bone scan reveals them. Rest is the cure, and rest can take six or more weeks.

Another common cause of shin pain is medial tibial stress syndrome. It, too, results from overuse. Almost always, the feet of a person with this syndrome turn too far inward when they hit the ground. That’s pronation. The inward rolling causes leg muscles to pull on the shin bone’s tough covering. That irritates the bone. Bend your ankles so that your toes point upward. If the shin pain gets worse, that’s good evidence of medial tibial stress syndrome. Examine your shoes. If the big-toe side of the shoe is more worn than the little-toe side, that’s confirmation that your feet roll inward too far upon striking the ground.

Rest is the cure for this condition too. Shoe inserts can cushion the feet and lessen the pull of leg muscles on the shin’s covering.

For all leg pain, rest is necessary. It’s also necessary to change your walking surface to a more giving one.

You can stay active by swimming or bike-riding, either a regular or stationary bike.

DEAR DR. DONOHUE: Some time ago, in one of your articles, you discussed how to strengthen stomach muscles. Can you help me do it correctly, since I didn’t save the article? I think I remember that you lie on the floor with hands clasped behind the head and raise your head off the floor. I don’t remember how long to hold the position. How many times do I repeat the exercise and how many times a day do I do it? – W.H.

A simple, effective sit-up is one done lying on your back with knees bent 90 degrees so that they’re pointing straight up. Your hands can be lightly grasped behind your head or you can rest them at your sides or on your chest. Raise the head, shoulder and shoulder blades off the floor. The head should not bend. Keep it straight. Hold the raised position for five seconds. Repeat five times. Gradually increase the number of repetitions until you hit 12, and increase the number of times you do the exercise to three sets of 12 repetitions. Do this twice or three times a day.

A different stomach-muscle exercise is done in the same position with knees bent as in the first exercise. Cross one foot over the other. Keep the sole of the uncrossed foot on the floor. Raise the legs off the floor, keeping the knees bent and drawing them toward your head. While you’re raising the legs, contract the stomach muscles and exhale. Inhale on your return to the starting position. Repeat five times. Gradually work to a goal of 20 consecutive repetitions done three times a day – that goal can take a year or more to reach.

DEAR DR. DONOHUE: I am 14 and would like to learn how to do the splits. Any tips? – B.

I wish I had some tips. I am one of the world’s most inflexible people and have been since I was a very young kid. I could not sit on the floor in kindergarten and have my knees touch the floor.

I’m counting on an expert telling us how to do this, B. When I get that information, I’ll pass it on and try it myself.

DEAR DR. DONOHUE: I am 58 and work at a computer for hours at a time. This past January I suffered a pulmonary embolus with a lung infarction. The pulmonary specialist said the clot was from a leg vein. How can a blood clot originating in a leg vein cause a lung infarction? Wouldn’t it have to be in a lung artery to do that? What is the primary difference between those who do and don’t survive this? What can I expect as far as heart enlargement or future problems from it? – C.W.

A pulmonary embolus is a piece of a blood clot that has traveled into a lung blood vessel from a distant site. Quite often, that distant site is a leg vein in which a large blood clot (a thrombus) has formed. When the embolus lodges in a lung artery, it cuts off the blood supply to the lung section served by that artery. The embolus IS in a lung artery. The lung arteries begin on the right side of the heart – the place where all vein blood empties. From the right side of the heart it travels in pulmonary (lung) arteries to the lungs, where it picks up oxygen. This is the only place in the body where blood without oxygen is in arteries. “Infarction” (in-FARK-shun) is a medical word meaning “death of tissue due to deprivation of blood supply.” In this case, it’s lung tissue. Pulmonary infarctions can be deadly.

Survival largely depends on the size of the embolus and how much lung tissue dies. In a deleted part of your letter, you outlined the exercise program you’ve followed since you were 18. Your body’s excellent condition was another huge factor in your survival. Age plays a major role in pulling a person through this medical catastrophe. The number of a person’s years has little to do with body age.

You are 58, but you have a much younger body.

Hearts don’t always enlarge from a pulmonary embolus. If they do, the enlargement often disappears when the person recovers. Doctors keep people who have had a pulmonary embolus on blood-thinning medicines for as long as they deem necessary to prevent any recurrence.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from