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Shin Splints

What are Shin Splints?

Shin splints is a common complaint, especially among participants of running sports. The term 'shin splints' is colloquially used to describe shin pain along the inside or front edges of the shin. Shin splints are the most common cause of painful shins.

There are two regions where you can suffer shin splints:

  • Anterior Shin Splints
  • Posterior Shin Splints

Anterior Shin Splints

Anterior shin splints are located on the front (or anterior) part of the shin bone and involve the tibialis anterior muscle. The tibialis anterior lifts and lowers your foot. It lifts your foot during the swing phase of a stride. Then, it slowly lowers your foot to prepare your foot for the support phase.

If your anterior shin pain increases when lifting your toes up while keeping heels on the ground – you are likely to suffer from anterior shin splints. Medically anterior shin splints can also be referred to as anterior tibial stress syndrome (ATSS).

Posterior Shin Splints

Posterior shin splints are located on the inside rear (or medial/posterior) part of the shin bone and involve the tibialis posterior muscle. The tibialis posterior lifts and controls the medial aspect of your foot arch during the weight bearing support phase. When your tibialis posterior is weak or lacks endurance your arch collapses (overpronation), which creates torsional shin bone stresses.

If you feel pain along the inside rear of your shin bone – you are likely to suffer from either posterior shin splints or tibia stress fractures. Medically, posterior shin splints and tibial stress fractures can also be referred to as medial tibial stress syndrome (MTSS).

What Causes Shin Splints?

Shin splints are caused by overstraining of your muscles where they attach to your shin.

The most common cause is overuse or overtraining associated with poor foot and leg biomechanics. Shin splints can be caused by a number of factors which are mainly biomechanical (abnormal movement patterns) and errors in training.

Some of the most common causes of shin splints include:

Overtraining / Overloading:

  • Increasing your training too quickly
  • Running on hard or angled surfaces

Insufficient rest between loads

Biomechanical:

  • Overpronation of your feet
  • Oversupination of your feet
  • Decreased flexibility at your ankle joint
  • Poor hip-knee-leg muscle control (dynamic alignment)
  • Poor buttock control at in the stance phase
  • Poor core stability
  • Tight calf muscles, hamstrings

Weak quadriceps, foot arch muscles

Equipment:

  • Inappropriate footwear
  • What Structures are Injured?

Generally shin pain arises from a combination of three structures:

  • Muscles
  • Tenoperiosteum
  • Shin bone (tibia)

Muscle

As a result of repeated overuse, one or more of your muscles in the lower leg may become injured through excessive loading stress. This can result in muscle tenderness, inflammation or knots.

The most common muscles that cause shin splints are tibialis anterior (anterior shin splints) and tibialis posterior (posterior shin splints).

Tenoperiosteum

All bones are covered in a 'shell', called periosteum. The tendons, which connect the muscle to the bone, attach on to this periosteum. This zone at which the tendon meets the bone is known as tenoperiosteum.

Almost all cases of 'shin splints' have some element of inflammation of the tenoperiosteum. Inflammation of different tendons leads to pain in different areas of the shin.

Bone

Damage to the shin bone usually concentrates in the lower one-third of the shin bone (tibia). The bone damage may be mild, such as a simple stress reaction, or may be a severe stress fracture. Except in the worst cases, bone damage is not visible on normal x-rays. A bone scan or MRI may be recommended if your physiotherapist or doctor need to exclude or confirm a bone injury.

What are the Symptoms of Shin Splints?

Shin splints cause dull, aching pain in the front of the lower leg.

Depending on the exact cause, the pain may be located along either side of the shinbone or in the muscles.

The area may be painful to the touch.

The Four Stages of an Overuse Injury:

Your physiotherapist will guide you with respect to how much exercise you can do. Here are some basic guidelines until you seek your physiotherapist's opinion:

Stage 1

  • Discomfort that disappears during warm-up.
  • Injury identification and treatment in stage one allows continuing activity as long as the injury does not worsen. Professional guidance is recommended to confirm your diagnosis and to implement treatment strategies to ensure that your condition does not deteriorate.

Stage 2

  • Discomfort that may disappear during warm-up but reappears at the end of activity.
  • At stage two, the activity may continue at a modified pain-free level while being treated. Professional assessment and treatment is highly recommended and must continue until you have completely resumed normal activity and training levels.

Stage 3

  • Discomfort that gets worse during the activity.
  • If the injury progresses to stage three, the activity must immediately cease. Professional guidance is very highly recommended to confirm diagnosis and ensure that the condition has not progressed into bone stress fractures. A thorough rehabilitation program is recommended to gradually return to your desired activity and exercise levels.

Stage 4

  • Pain or discomfort all the time.
  • All activity must immediately cease. Professional guidance is essential to exclude stress fractures or more significant tibia fractures. Potentially, you may need to be non-weight bear on crutches or in an air cast. Please book an appointment with your healthcare professional who has a special interest in shin pain to fully investigate and rehabilitate you based on their assessment.

How is Shin Splints Diagnosed?

Shin splints are usually diagnosed based on your medical history and a physical examination by your physiotherapist. In some cases, an X-ray or other imaging studies such as bone scans or MRI can help identify other possible causes for your pain, such as a stress fracture.

Treatment for Shin Splints

Phase 1 - Early Injury Protection: Pain Reduction & Anti-inflammatory Phase

As with most soft tissue injuries the initial treatment is - Rest, Ice and Protection.

In the early phase you may be unable to walk or run without pain, so your shin muscles and bones need some active rest from weight-bearing loads. Your physiotherapist will advise you on what they feel is best for you. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.

Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication. As you improve a kinesio style supportive taping will help to support the injured soft tissue and provide some stress reduction for your shin bone.

Phase 2: Regain Full Range of Motion

If you protect your injured shin muscles while they heal and strengthen. This may take several weeks. During this time period, you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that will re-tear in the future. It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches, neurodynamic mobilisations and specific exercises. Your physiotherapist will guide you.

Phase 3: Normalise Foot Biomechanics

Shin splints commonly occur from poor foot biomechanics eg flat foot. In order to prevent a recurrence, your foot will be assessed. In some instances, you may require a foot orthotic (shoe insert) or you may be a candidate for the Active Foot Posture Stabilisation program.

Your physiotherapist will happily discuss the pros and cons of both options to you.

Phase 4: Restore Muscle Strength

Your calf, shin, quadriceps, gluteal and other lower limb muscles may need strengthening to enable a safe resumption of sport or training.

Phase 5: Modified Training Program & Return to Sport

Most shin splints occur due to excessive training loads. Running sports place enormous forces on your body (contractile and non-contractile).

In order to prevent a recurrence as you return to your sport, your physiotherapist will guide you with training schedules and exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.

Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

Our physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.

What Results Should You Expect?

There is no specific time frame for when to progress from each stage to the next. Your shin splints rehabilitation status will be determined by many factors during your physiotherapist's clinical assessment.

You'll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.

It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.

The severity of your shin splints, your compliance with treatment and the workload that you need to return to will ultimately determine how long your injury takes to successfully rehabilitate.

Are Shin Splints Serious?

Left untreated and with continued overtraining, shin splints can progress into tibial stress fractures, which will require a minimum of six weeks resting on the couch. Less commonly, if your muscle sheaths become compressed by engorged muscles - muscle compartment syndrome can develop. Muscle compartment syndrome is a very serious shin complaint that often requires surgical intervention to prevent permanent muscle damage.

Strengthening exercises to prevent shin splints

Our physiotherapist will be able to provide you with a programme specific to your needs. Rehab must focus around calf strengthening ; bent leg calf raises, soleus squat and bridge and some more general exercises as below:

Single leg heel raise

  • Keep your pelvis level and take your weight onto one leg.
  • Press up onto tip toes keeping your knee straight. Repeat 15 times

Single leg sit to stand

  • Stand up from a chair on one leg, then squat slowly to lower yourself back down to the chair with control.
  • Repeat 10 times

Single leg bridge

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