WHAT ARE SHIN SPLINTS?
There are two types of shin pain:
- Anterior shin pain also known as anterior tibial stress syndrome (ATSS) is pain at the front of the shin and is most commonly felt when lifting your toes off the ground whilst your heel remains on the ground making it very hard to walk and run due to the pain.
- Posterior shin pain – even though posterior means behind – this pain is felt on the side when the posterior tibialis muscle that controls the middle part of your foot arch during the weight bearing phase is weak or lacks endurance and strength. This causes the arch to ‘collapse’ which creates torsional shin bone stress. Severe cases of this can result in tibia stress fractures.
CAUSES/ RISK FACTORS
There are many different factors that contribute to getting shin splints. Currently there are two main understandings, the first is that the tendons and muscles that run upwards next to the shin bone pull on the bone which in turn causes inflammation. However, in a more recent study it has been shown to be a stress reaction from the bone.
It often occurs at the start of a training program when the body isn’t ready for such an increase in activity. Other factors include;
- A sudden increase in the amount or intensity of exercise – exercising beyond your current fitness level.
- Sports that involve a high level of running causing overuse on the muscles
- The ankle joint rolling inwards too far as the running foot hits the ground.
- Muscular imbalances – tightening of the calf muscles and hamstrings.
- Running on sloping, uneven or hard surfaces.
- Using unsupportive or worn out, old footwear.
- Poor foot and leg biomechanics e.g. overpronation/over supination of your feet
- Decreased flexibility at the ankle joints, poor knee flexion alignment, weak glutes and core stability
- Flat feet – can pull at the shin tendons and cause slight tearing
- Dull, aching pain in the front of the lower leg or associated muscles – this will affect walking/running/weightbearing.
- Painful to touch the area around the shin bone and calf muscles.
- The overlying skin may be red or inflamed.
- Pain during, before and/or after running.
- Muscle tenderness, inflammation or knots.
- It is very important to warm up before exercise and cool down after exercise. This includes slow, sustained stretches held for at least 30 seconds targeted specifically at the calf muscles.
- Ensure your stretching program turns into a habit before and after exercise, activities and work.
- Choose flat, softer surfaces to run on e.g.; running tracks or grassy ovals as opposed to uneven concrete surfaces.
- Reduce the intensity of your training to decrease overload at the start of your programs.
- Strengthen the muscles in the leg doing specific exercises – can be given to you by a Myotherapist, Physiotherapist and Exercises Physiologist.
- Always ensure you replace your shoes before they wear out – good arch support.
- Mix up training with low impact activities such as cycling, swimming and walking.
There are four phases in the treatment phase
- Rest – this will reduce the pain and inflammation and give your shin time to remould strong scar tissue. It is important to know this can take several weeks and to ensure you don’t go back to exercise to early as the scar tissue may still be too weak and have a high incidence of re-tearing in the future. In this time, you can do techniques such as massage, muscle stretches, joint mobilisation and specific exercises which will al help for the best outcome. Kinesio style tape is a popular choice of treatment in this phase as it allows support to the injured soft tissue and provides some stress reduction from your shin bone as it decompresses the area to relive pain and swelling.
- Regain proper muscle strength to ensure you have a safe return to sport and exercise. It is essential to start of slow and in small amounts so you can easily measure how you are feeling so your shin muscles don’t flare up again.
- Foot biomechanics – if your shin splints stemmed from flat feet, worn out shoes and/or poor running technical its essential to correct this before returning to exercise e.g.; new shoes, orthotics, running assessment to change dysfunctions.
- Modification to you training program – ensuring you don’t go back straight into excessive training loads and re-do the injury. Your Myotherapist or Physiotherapist will give you a program based of prevention for reoccurrence and ways to improve your sporting performance in the future. This process takes time so be patient.
** If left untreated severe cases can progress into tibial stress fractures, which usually require a minimum of 6 weeks resting with no exercise. Another severe outcome can be muscle compartment syndrome – which is a result of your muscle sheaths becoming compressed by engorged muscles. This often requires surgery to prevent permanent muscle damage. Therefore, it is very important to listen to your body and what it is trying to tell you to ensure you take care and action as soon as possible.
- Tibialis Posterior/Anterior, Peroneals, Gastrocnemius, Soleus
CALF RAISES – strengthens and activates calf muscle (can also be done balancing on a step and dipping down and then coming back up to neutral)
GASTROC STRETCH – you should feel this stretch in your upper calf.
SOLEUS STRETCH – this stretch should be felt just above your Achilles.
TOE SCRUNCHES – help restrengthen the foot to prevent recurrence of shin splints
TRIGGER POINT BALL – rolling the base of your feet and arch on a TP ball encourages breaking up of the fascia in the feet to lessen the strain on the shin muscles.
BAND RESISTANCE – controlled, slow movements to move strengthen to shin muscles.
**If you are experiencing pain, discomfort or an injury you are unsure of please seek professional advice from a doctor or your Myo/Phyio as this is general advice and is not to be used in replacement of**