Shin Splints

Shin Splints

Article by John Miller

Shin Splints

What are Shin Splints?

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

There are two regions where you can suffer shin splints:

  1. Anterior Shin Splints
  2. Posterior Shin Splints

shin splints

Anterior Shin Splints

Anterior shin splints are located on the front (or anterior) part of the shinbone 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 while keeping heels on the ground, you will likely suffer from anterior shin splints. Medically anterior shin splints are also known as anterior tibial stress syndrome (ATSS).

Posterior Shin Splints

Posterior shin splints are located on the inside rear (or medial/posterior) part of the shinbone 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 muscle endurance, your foot arch collapses, creating torsional shin bone stresses.

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

Shin Splints Cause

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 inadequate foot and leg biomechanics. Shin splints can result from several mainly biomechanical factors (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
  • Over supination of your feet
  • Decreased flexibility at your ankle joint
  • Poor hip-knee-leg muscle control (dynamic alignment)
  • Poor buttock control 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
  • Shinbone (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 overload 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 have a hard ‘shell’, called the periosteum. The tendons, which connect the muscle to the bone, attach 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. Swelling of different tendons leads to pain in other 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 a severe stress fracture. Except in the worst cases, bone damage is not visible on standard x-rays. A bone scan or MRI may exclude or confirm a bone injury if your physiotherapist or doctor need to investigate further.

What are the Symptoms of Shin Splints?

  • Shin splints cause dull, aching pain in the front of the lower leg.
  • Depending upon the exact cause, you may experience shin pain along either side of the shinbone or within your muscles.
  • The area may be painful to the touch.

The Four Stages of an Overuse Injury:

Your physiotherapist will guide you concerning how much exercise you can do. Here are some basic guidelines until you seek your physiotherapist’s opinion:

Stage 1

  • Shin discomfort that disappears during warm-up.

Injury identification and treatment in stage one allows continuing activity as long as the injury does not worsen. We recommend professional guidance to confirm your diagnosis and implement treatment strategies to ensure that your condition does not deteriorate.

Stage 2

  • Shin discomfort may disappear during warm-up but reappears at the end of the 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 wholly resumed regular exercise and training levels.

Stage 3

  • Shin discomfort that gets worse during the activity.

If the injury progresses to stage three, the activity must immediately cease. Professional guidance will confirm the diagnosis and ensure that the condition has not deteriorated into bone stress fractures. We recommend a thorough rehabilitation program to return to your desired activity and exercise levels gradually.

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 bearing on crutches or mobilising in an air cast. Please book an appointment with your healthcare professional who has a particular interest in shin pain to investigate and rehabilitate you based on their assessment thoroughly.

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.

Shin Splints Treatment

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

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

You may be unable to walk or run without pain in the early phase, 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, e.g. arnica, may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the first 48 to 72 hours. Most people can tolerate paracetamol as pain-reducing medication. As you improve, a kinesio-style supportive taping will help 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 healing may take several weeks. During this 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, e.g. flat foot. To prevent a recurrence, you should have your foot thoroughly 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 with 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 activities place enormous forces on your body (contractile and non-contractile).

To prevent a recurrence as you return to your sport, your physiotherapist will guide you with training schedules and exercises to address these critical components of rehabilitation to avoid a repeat injury and improve your sporting performance.

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

Your PhysioWorks 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 thorough 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. Many factors will determine your shin splints rehabilitation status 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.

You should carefully monitor each activity and exercise-level progression. 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 rehabilitate successfully.

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 severe shin complaint that often requires surgical intervention to prevent permanent muscle damage.

More Info

Anterior Shin Splints

Posterior Shin Splints

FAQs about Shin Splints

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