Shin splints is the common name given to the condition Medial Tibial Stress Syndrome. It presents as pain on the inside margin of the lower part of your shin bone. It can be very tender to touch along the bone itself as well as the softer tissues adjacent. Areas of muscle tightness, thickening or lumps may also be felt in the area of pain. In severe cases of shin splints, swelling, redness and warmth may also be present.
The pain experienced from shin splints is because of muscles and tendons that have become inflamed as well as the membrane (periosteum) around the bone where these lower leg muscles attach. The most frequently involved muscle is the tibialis posterior muscle, but the flexor digitorum longus [FDL] and flexor hallucis longus [FHL] muscles are also often involved.
Shin Splints is a repetitive stress (or overuse) injury which commonly affects athletes involved in running sports, such as athletics, triathlon, marathon running and football. It commonly starts after a sudden increase in training volume such as at the start of pre-season training.
What are the causes?
Shin splints most commonly occur due to repetitive or prolonged activities placing strain on the tenoperiosteum. The tenoperiosteum is the connective tissue responsible for attaching these muscles to the shin bone (tibia). This typically occurs due to excessive walking, running or jumping activities and is often seen in runners and footballers. The constant tugging experienced at the tenoperiosteum through the forceful contraction of the involved muscles is what creates the painful inflamed microtears that are shin splints.
It frequently occurs in association with calf muscle tightness or biomechanical abnormalities, such as flat feet (excessive pronation) or those with inappropriate footwear. Interestingly, I have never treated an individual with shin splints who did not have flat feet. Athletes more commonly develop this condition early in the season following a period of reduced activity (deconditioning) and when training surfaces are generally harder.
How can it be treated?
R.I.C.E PROTOCOL: (rest, ice, compression, elevation for first 48-72hrs) The nature of the occurrence of shin splints is through overuse, therefore the most obvious form of pain relief comes through appropriate rest. In more severe cases, icing will also assist in reducing the inflammation as will the use of a compression bandage. Keeping the leg elevated merely prevents unwanted inflammatory metabolites dwelling in the region of pain. The RICE protocol is not a complete solution however as theres no guarantee it will completely stay away on your return to training.
PHYSICAL THERAPY: There are a range of modalities that can speed the recovery of this condition. These include dry needling, cupping and Active Release Technique[ART]. These three manual therapies are all soft tissue techniques aimed at moving more blood into the tissues that will in turn provide the necessary nutrition essential for healing. Furthermore, ART removes any adhesions between adjacent tissues and thus improving the biomechanics of the functioning of the involved muscles and joints.
In addition to this, chiropractic treatment may also be of benefit. A chiropractor will be able to assess other areas of your body related to the functioning of the lower limb, specifically the feet and pelvis. It is not uncommon to find a significant joint restriction in one or both of these areas that may be resulting in muscles of the lower leg working excessively hard to compensate.
ORTHOTICS: As previously mentioned, shin splint sufferers are most often foot pronators. This means there is a tendency for the foot to roll in during gait, or demonstrate flat feet on standing. The effect activities like long distance running has on these individuals aside from shin splints are typically plantar fasciitis and general foot pain.
Essentailly, the functional relationship of the bones and muscles of the feet and lower leg have strayed so much from the anatomical norm that it results in a biomechanical disaster. In some individuals, their genetic disposition is such that no amount of physical therapy will change the way their feet function. For these people, an orthotic may be their only savior. Many runners have benefitted from a well designed custom orthotic and all shin splint sufferers should be properly assessed for this alternative.
EXERCISE PRESCRIPTION: Whilst under the care of your
chosen therapist, it is essential you be performing exercises in
between sessions to consolidate your treatment sessions. You should
start an exercise protocol 72hrs after injury.
Initially, keeping good length and blood flow in the tissues through
stretching can be advantageous. Additionally, you want to keep the
tissues strong through doing resistance (or strengthening exercises).
Phase 1 Exercises
Calf stretch with towel – 10 x 5sec hold
Resistance band calf strengthening – 10-20reps pain free
Phase 2 Exercises
Gastrocnemius stretch – 4 x 15sec hold
Heel raises off ground – 10-20reps pain free
Heel raises off step – up to 20reps pain free (NB progress to this
exercise only once 20reps pain free of previous exercise can be
achieved)
Single leg balance – 60secs eyes open then progress to eyes closed
Phase 3 Exercises
Soleus stretch – 4 x 15sec hold
Kneeling stretch – 4 x 15sec hold
Ball circles around leg (move ball using free leg around stance leg) – 60secs eyes open then progress to eyes closed.
Self massage
Foam roller calf release – 15-90sec rolling pain free then progress to legs crossed.
Massage ball calf release – 15-90sec rolling pain free or 15-60sec sustained pressure to tight spot. Progress to legs crossed.
If you are suffering shin splints, be sure to have them treated
sooner rather than later. Leaving shin splints to heal on their own is
more likely to lead to re-injury of the involved muscles. Rest alone is
not sufficient and they will need some other means of therapy to prevent
the condition becoming chronic.
*DISCLAIMER: This discussion does not provide medical advice. The
information, including but not limited to, text, graphics, images and
other material contained in this discussion are for informational
purposes only. The purpose of this discussion is to promote broad
consumer understanding and knowledge of various health topics. It is not
intended to be a substitute for professional medical advice, diagnosis
or treatment. Always seek the advice of your physician or other
qualified health care provider with any questions you may have regarding
a medical condition or treatment and before undertaking a new health
care regimen, and never disregard professional medical advice or delay
in seeking it because of something you have read in this blog.
