Save Yourself From Shin Splints
Shin splints, or medial tibial stress syndrome, are a lower leg overloading injury causing pain along the edge of the shin bone.
Whilst many people may be able to identify that they have developed shin splints, they can be difficult to self manage and often we hear people have tried various solutions to heal them to no avail. Shin splints can be incredibly frustrating and limiting to the active individual.
At best, shin splints can limit your activities for weeks or even months as the pain slowly dissipates. At worst, untreated shin splints can lead to a much more serious injury of a stress fracture, which then would usually involve a period of total rest and protection . We complete a comprehensive assessment and treatment to help identify the root cause of your shin splints, provide exercises and stretches to help alleviate the pain, and give you tips on how to prevent shin splints from happening again.
Study Shin Splint Anatomy
Shin splints are when there is inflammation of muscles, soft tissue and bone tissue around your tibia (shin bone). Pain typically occurs along the inner border of the tibia where muscles attach to the bone. The quality of movement of the joints at the ankle as well as the lower limb muscle’s strength and control are important in determining the particular cause of an individual’s development of shin splints. This allows treatment to adequately address the causative factors for long term resolution.
In the ankle, the subtalar joint can be considered the functional centre and is the articulation between the talus and calcaneus. The primary movements at this joint are inversion (inwards turning of the foot) and eversion (outwards turning of the foot). The talocrural ankle joint is formed from the distal tibia, distal fibula and talus, This joint allows dorsiflexion (lifting up of the foot) and plantar flexion (pointing downwards of the foot). These joints work together to create normal movement of the foot.
- Tibialis Anterior. Beginning at the upper tibia and inserting at the medial cuneiform and first metatarsal (in the foot), this muscle is vital in lifting the foot when walking. Tibialis anterior contracts to dorsiflex and invert the foot. It is also responsible for deceleration of the foot at heel strike.
- Gastrocnemius. Otherwise known as your calf muscle, gastrocnemius has medial and lateral heads that begin at the femoral condyles and combine with the soleus muscle to form the calcaneal (Achilles) tendon to attach into the calcaneus (heel bone). This muscle is a strong plantar flexor, involved with push off actions in running, jumping, hopping, etc.
- Soleus. The soleus muscle originates in the fibula and tibia and inserts with the Gastrocnemius into the Achilles tendon, attached to the posterior calcaneus. It lies directly underneath the gastrocnemius muscle and aids in plantarflexion in walking, running.
- Tibialis Posterior. Tibialis Posterior begins on the back surface of the tibia and fibula and the membrane between them and inserts on the cuneiforms, the cuboid, and three middle metatarsals. This muscle has multiple actions; plantarflexion and inversion of the foot and support of the medial arch.
A condition known as hypermobility, where the structures in the lower extremities fail to adequately control subtalar joint motion can lead to the development of shin splints if left untreated.
Causes
Typical Causes Of Shin Splints
Shin splints typically occur when the muscle and bone tissue (periosteum) in the leg become overworked, most commonly from a large spike in an individual’s loading.
Overloading through changes to activity include altering factors such as frequency of sessions in a week, intensity, duration/distance or changes to terrain ( hill running or sand dunes). Returning to high levels of activity after a break , e.g. after a holiday or a period of illness, without gradually easing into activity can also be a causative factor to develop shin splints.
Biomechanically, there can be factors to increase likelihood of developing shin splints. These include being flat footed, or having rigid arches. Lower limb muscle imbalances or reduced flexibility can lead to altered running mechanics, increasing strain on the tibia and surrounding tissues. Some newer runners may begin ‘overstriding’ while running, this results in higher levels of impact forces exerted upon the tibia.
Aside from training changes and biomechanical factors, poor choice in footwear can add strain to the lower limb and consequently the development of shin splints.
Common groups affected by shin splints are runners and dancers, but any individual with a jump in loading can present with this condition.
Common Symptoms Of Shin Splints
- A dull aching sensation on the anterior or front of the lower leg.
- Sharper pain on palpation of the shin bone (commonly the inside).
- Initially or in milder cases pain that is aggravated by high-impact exercise but settles with rest.
- In severe cases or after continued aggravation, pain may take days to settle after provocation and tenderness may be felt with walking.
- Tenderness on palpation of the muscles either side of the shin bone.
Treatments
Physiotherapy Treatments For Your Shin Splints
01.
Hydrotherapy
In severe cases where exercise on land is provocative, your physiotherapist may prescribe exercises to be completed in the pool. The use of the pool allows graduated loading to begin without provoking pain and inflammation.
02.
Sports Taping
In some cases, if biomechanical factors are considered to be contributing to your shin splints, taping of the foot or lower leg can assist in offloading structures to help with settling symptoms down.
03.
Ultrasound Treatment
04.
Heat/Ice Therapy
Heat can assist in managing tightness in overloaded muscle tissues that may be contributing to the shin splints.
Ice is used for symptomatic management post activity if shins are painful.
Frequently Asked Questions
FAQ's About Shin Splints
How do you avoid getting shin splints?
A proper progression of returning or beginning any exercise program is vital to avoid an overloading injury such as shin splints. Follow the guidelines and tips below to further reduce the risk:
- Regular stretching of your calf, hamstrings and other lower limb muscles, particularly if increasing your physical activities. Tight muscles can alter your running patterns, leading to excessive strain on your tibia and then consequently inflammation and injury.
- Do not increase physical activity suddenly. Find a running plan to follow based upon your prior experience that will guide a safe increase in loading. If you miss a week of training sessions you may continue your plan. If you miss more than a week, you may need to adjust planned sessions to ease back into the higher loads.
- If you are finding it difficult to manage increasing your load but want to continue your exercise, try cross training with forms of exercise with reduced impact such as swimming sessions or cycling.
- Make sure you have good, activity appropriate shoes for running and sports, and keep them in optimal condition by reserving use for only those activities.
- If you are planning to be completing high volume training (e.g. training for long distance races) consider a lower limb strength program to ensure you have adequate muscle capacity for the training. Muscles to strengthen include hip extensors and abductors, quadriceps, hamstrings, calf and feet muscles.
- Maintain a healthy weight as best you can, an increased BMI is a risk factor for shin splints
How do you avoid shin splints when walking?
Overuse is often the cause of shin pain. Cutting back on high impact exercises is the first step in preventing shin pain. Among your other options are:
- Ensure you have proper footwear with a good fit and support.
- Use orthotics to help with foot positioning and shock absorption.
- Make sure you warm-up and stretch before you exercise.
- Try to avoid hard surfaces, uneven terrain, or sloped surfaces.
- Keep any walking activity in the right ‘Zone’ of mild discomfort, or 4/10 pain maximum as any more may provoke symptoms and progress the condition.
