Shin Splints

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Medial tibial stress syndrome.
Medial tibial stress syndrome.

The dreaded shins splints. Shin splints is a general term to describe pain at the front of the lower leg during or after exercise. The term encompasses many conditions so it is essential to have it checked out to determine what the cause is as the wrong management can see you suffering with pain for many months.

 

This post will be concentrating on the most common cause of shin splints – Medial Tibial Stress Syndrome (MTSS). This is when frequent or intensive exercise places excessive stress on the tibia (the shin bone). It is most common in long distance runners, but also occurs in other sports such as football, tennis and basketball. Running on hard ground such as pavement or tarmac can be a big causative factor. The pain is due to the tissue that surrounds the shin bone or the muscles attaching to the bone becoming inflamed. Too much impact, over training, overpronation (foot rolling in), and tight or weak calves can all lead to MTSS. It is important to rule out other causes of shin pain such as stress fractures, tibialis posterior tendonopathy and compartment syndrome

 

The pain is usually, although not always, felt in both shins and it can take several days or even weeks to subside once activity is ceased. In some cases it can be painfree during normal day to day activities and only come on during running. Pain over the shin is usually due to the connective tissue surrounding the the bone becoming inflamed. Pain just behind the shin bone is usually due to the soleus or tibialis posterior muscle becoming inflamed as they attach to the bone. The inside of the shin bone can be quite tender to the touch. If there is 1 small focal area of pain this could indicate a stress fracture. Pain that appears in the calf then subsides quickly when exercise ceases could be due to compartment syndrome rather than MTSS.

 

So, What can you do?

 

It is important to have an initial period of rest to allow the inflamed tissue to rest. Do not try to exercise through the pain as this will only make matters worse. Rest does not necessarily mean complete rest. Cross training is a good way of keeping your fitness and strength without irritating your symptoms and often cycling and swimming are painfree.  Ice packs can help ease the symptoms in the first few days. Apply these for periods of 10 minutes a few times a day. Poor running form may be responsible. If you have had your trainers for a while it may be worthwhile having a gait assessment.

Calf tightness is often implicated here so stretching both the gastrocnemius muscle and soles muscle is advisable but do not stretch too early on as this can aggravate your symptoms. General rule of thumb is to stretch pain free only. If you think you may have a stress fracture then an X-ray may be useful in identifying this. However, these types of fractures do not easy show up and tend to be easier to spot around 4 weeks after the onset of pain. It is important to understand that MTSS can take some time to settle. Mild cases may settle in around 6 weeks. More severe cases may take as much as 4-5 months.

 

How can physiotherapy help you? 

Weakness in certain muscles of the leg and foot can contribute to increased forces through the shin bone. A good level of Functional muscle strength is essential here. The connective tissue around the shin bone and muscles attaching to the bone respond very well to manual soft tissue release.

It is common for the cause to be due to poor lower limb alignment. This can stem from poor spinal posture, weak hip muscles or overpronated feet. A biomechanical assessment to see where the dysfunction lies is useful here. If the feet are the problem suitable orthotic insoles may be necessary and a treadmill video analysis would be beneficial when choosing trainers. Having said that my personal preference would be to strengthen the foot and lower leg muscles which will prevent overload of these tissues. This, however, does take a little time.

The physiotherapist can identify tight muscles that may be pulling on the shin bone and advise on specific stretches to help reduce this.

Sports tape is very useful in the early stages to offload the inflamed tissue therefore giving you some pain relief and helping the tissue settle down.

Ultrasound therapy can also be useful to aid resolution of acutely inflamed tissues thus aiding recovery.

Shin splints can be a very painful problem and often a period of rest will only result in the pain returning once you start training again. since shin pain can come from a variety of conditions it is always best to get this checked out by a professional since the wrong management can be disastrous.