Posterior Shin Splints

Posterior Shin Splints

Article by John Miller

Posterior Shin Splints

What are Posterior Shin Splints?

Posterior shin splints are a common complaint, especially among participants in running sports. The term ‘posterior shin splints’ is colloquially used to describe shin pain along the shin’s posterior (inside-rear) edge. Posterior shin splints are the most common cause of painful shin bones.

Anterior shin splints are similar, but the pain and injury experience is elsewhere.

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. Posterior shin splints can occur in combination with tibialis posterior tendinopathy.

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).

What Causes Posterior Shin Splints?

Posterior 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. Posterior shin splints can result from mainly biomechanical factors (abnormal movement patterns) and errors in training.

Some of the most common causes of posterior 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 muscle that causes posterior shin splints is the tibialis posterior.

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 ‘posterior shin splints’ has 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 Posterior Shin Splints?

Where Do Posterior Shin Splints Hurt?

posterior shin splints

  • Shin splints cause dull, aching pain in the inside-rear front of the lower leg (tibia).
  • Depending upon the exact cause, you may experience shin pain along the side of your shinbone or within your associated muscles.
  • The area may be tender 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 Posterior Shin Splints Diagnosed?

Posterior 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.

For specific advice regarding your shin pain, please consult your physiotherapist.

Treatment for Posterior Shin Splints

What is the fastest way to heal posterior 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, e.g. arnica, may help reduce your pain and swelling. Most people can take paracetamol as pain-reducing medication. However, it is best to avoid anti-inflammatory drugs during the first 48 to 72 hours to encourage additional bleeding. 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

Posterior 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 posterior 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 rehabilitation components to 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.

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.

How Long Does It Take For Posterior Shin Splints To Heal?

There is no specific time frame for when to progress from each stage to the next. Many factors will determine your posterior shin splints rehabilitation status during your physiotherapist’s clinical assessment.

In most cases, you’ll find that your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improve.

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

Are Posterior 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 to rest 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.

For specific advice regarding your situation, please consult your physiotherapist.

More info:

Shin Pain

Shin Splints

Anterior Shin Splints

Please seek the professional healthcare advice of your physiotherapist regarding your shin pain.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.