What are Shin Splints?
There is much debate into what shin splints actually is, some say it is small tears and inflammation in the muscles spanning down the tibia bone, or inflammation of the sheath of the bone. Now shin splints is a term applied to general shin pain, but one of the major areas that are assumed to be shin splints are down the inner edge of the tibia. Symptoms down the edge of the tibia is known medically as Medial Tibial Stress Syndrome (MTSS), this is the most common I have come across in the athletes I have treated.
Symptoms of MTSS…
The affected area may be tender and swollen, highlighting the inflammation in this area. You may notice your pain will come on as your start exercise and may ease off as you start to warm up and activity continues. However, you may then notice when you stop or towards the end of exercising the pain returns and may be worse than before. The pain you usually feel will often be described as a dull ache, or throb.
Why Do You Get Shin Splints?
The occurrence of shin splints is described as an overuse injury, which means you may notice it presents after you have recently increased your activity (especially running), or after prolonged, frequent high impact activity, such as road running.
The lower leg and ankle have to absorb a lot of force and if this force is repeated and of high intensity such as running on hard surfaces, some structures are having to absorb these high forces. This may then lead to micro-damage in the structures such as the muscles. If you continue to engage in your activity, the damage to these structures then doesn’t have time to heal and thus you get the reoccurring pain.
If this was the sole cause then everybody who ran would experience shin splints. However, not everybody does. But why?
There is usually a domino effect of altered mechanics that will lead to a dysfunction in lower leg movements.
One tell-tale sign you may notice is that your feet may flatten during a squat movement or when you run. This alters the pull of your Achilles tendon, alters muscle firing patterns, and also puts pressure on the function of the lower leg. This could be due to weakness of some of the ankle stabilisers such as the inner calf, the muscles surrounding the tibia (Tibialis Anterior and Posterior). This may be combined with a tightness of the outer-lower-leg muscles (Peroneals, Outer Calf). This combination will pull the foot flatter and the weakness will inhibit the
ability to resist and stabilise this.
Your knees may also cave in as you squat or run. This will only further contribute to flat feet and thus the pressure on the lower leg. This occurs usually because the outer Hamstring (Biceps Femoris) and Ilio-Tibial Band (ITB – tendinous tissue on the outer thigh) are tight. This will pull the tibia outwards causing the knee to cave in. This dominance of the outer muscles coincides with weaker inner muscles such as the inner Hamstrings (Semitendinosus and Semimembranosus) and the gluteal muscles.
As a general overview these two factors are the most noticeable, and the common things I have experienced. The simple solution to this is to release and stretch the tight, shortened tissues and activate and strengthen the weaker, long tissues. This will rectify the compensatory, altered function of the knee, lower leg and ankle. In turn this will help reduce the stress on the lower leg and therefore reduce the likelihood of shin splints.
How Do I Treat Shin Splints?
• Reduce your running/high impact exercise – swap for lower impact training such as cycling, or swimming. Refrain from painful activity. This may mean putting a rest day from running in between your normal running days.
• Apply ice to your shins after activity, and on a daily basis to reduce swelling and inflammation.
• Apply compression to the area – compression bandage or stockings whilst exercising and during recovery
• Invest in mouldable inserts for your running trainers.
• Self-Massage – rub along the edge of the shin bone, down the tender areas. This is uncomfortable but helps breakdown scar tissue.
Longer Term Fix/Management…
• Stretch short, overactive tissues:
o Peroneals (Outside of the lower leg down into the outer ankle)
o Outer Calf
o Outer Hamstring
• Activate/Strengthen longer, underactive tissues:
o Inner Calf
o Tibialis Anterior & Posterior
o Inner Hamtsrings
Example Rehab Programming…
1) Shin Stretch – Kneel down flat on your shins, then lean back and attempt to sit on your heels or as close as you can get. Ensure your shins and knees remain flat on the floor throughout. This can be done one leg at a time if you require a stronger stretch.
Perform 3 sets of 30 secs.
2) Wall Calf Stretch – place your hands against a wall, split stance your legs, keep you back foot flat and leg straight, lean your body forwards towards the wall stretching up the calf. The leading foot can be placed at an angle out to the side to target the outer calf.
Perform 3 sets of 30 secs on each leg.
3) Towel Hamstring Stretch – lie on your back, bring your leg up straight, wrap the towel around the lower leg, pull the leg back straight, you can then pull diagonally across the body to stretch the outer hamstring more.
Perform 3 sets of 30 secs on each leg.
4) Active Oblique Stretch – Lie on one side, keep bottom leg straight, bend the top leg to 90 degrees out in front of you. Place your top hand on the back of your head, with the elbow pointing to the ceiling. Grasp the underside of your top thigh with the other hand. Then try touch your top elbow to the floor by rotating body outwards and trying getting your shoulders flat.
Perform 3 sets of 30 secs on both sides.
1) Tibialis Anterior Activator – Sit down with legs straight out in front of you. Perform dorsiflexion repetitions (pointing and raising the foot). However, it is important when doing this that you keep your foot rolled outwards so your sole faces inside, and also keep your toes curled in as your raise your foot. This can be resisted with a resistance band.
Do 3 sets of 15-20 each foot.
2) Single Leg Gluteal Bridges – Lie on your back, bend your knees so your feet are flat, then raise one leg off the floor straight, then raise your hips up squeezing your buttocks, but keep your shoulders flat on the floor. Hold at the top for 2secs then lower.
Do 3 sets of 20 each leg.
3) Glute Clams – Lie on your side and place yours knees on a 45 degree angle. Keeping your feet together open your knees out rotating the hip, ensure your torso remains still and you are not twisting it to aid the hip movement.
Do 3 sets of 20 each side.
4) Pigeon Toe Calf Raises – Stand against a wall, rise up onto your toes, but as you do this pull your heels out.
Do 3 sets of 20 (can be done single leg once two foot is too easy).
5) Single Leg Step Up – Stabilise – Curl and Press – In standing keeping the core tight and spine neutral step up with one leg onto a stepper or box until the leg is straight, and bring the opposite thigh parallel to the floor. Ensure that the pelvis remains level and you don’t lean to one side. Your core and pelvis position should remain constant throughout. Once this can be achieved with the leg raise introduce and curl and press then return to the floor and repeat.
Do 3 sets of 12-15 each leg.
6) Heel Walks – In standing, raise the forefoot off the ground so you are stood on your heels, turn your foot outwards so the sole faces inwards and curl the toes in (as in the above exercise).Once in this position walk around in this position. It looks silly but this causes the underactive shin muscles to become reactive during walking which will help with better lower leg function.
Do 3 sets of 20-30 steps.