Chances are you’ve heard the term shin splints before… Over the past few weeks I have noticed a spike in the number of patients coming in to the clinic with what is most commonly known as ‘shin splints’. This could be due to the fact that we are coming to the end of the winter sport season or maybe because we are sitting in the middle of the running season!
In the physio world ‘shin splints’ is actually a broad term used for a number of conditions which fall under medial tibial stress syndrome (MTSS) and is any pain experienced in the front of the lower leg.
In this post I am going to give you a guide on how to identify this condition and give you 3 simple exercises to help reduce your symptoms and get you back on the track!
So what are they…?
Medial tibial stress syndrome could be caused by a number of tibial injuries including tendinopathy, inflammation of the periosteum (connective tissue surrounding bone), stress reaction of the bone and remodelling of the periosteum.
The most common complaint we hear in the clinic from someone suffering this condition is a general, dull ache in the mid-lower part of the shin bone and is most commonly associated with increasing activity. The diagram to the right displays the usual area of pain for this condition.
The condition commonly presents in both legs at the same time but the pain may be greater on one side. At first it may only present at the beginning of exercise and once the body is ‘warm’ the symptoms disappear but then return as the body ‘cools’ down. As the condition progresses, the pain tends to stay throughout the whole event, including afterwards. Like the name suggests, shin splints are a stress reaction to chronic, repetitive loads going through the tibial bone.
What increases my risk of getting shin splints?
- Females 2-3x more likely than males
- Sudden increases in training (frequency, duration, intensity)
- Running or playing sport on hard surfaces
- Recent change in footwear
- Fat fleet (Pes planus)
- Weak or inactive core muscles
- Biomechanical abnormalities and training errors
I think I’ve got shin splints… What can I do??
Most people will probably tell you to stretch or foam roll your calves if you’re suffering from shin splints… but this is only part of the answer.
Here we’ll look at 3 simple exercises which can help manage pain coming from the shin bone region. Remember this is a complex condition and ideally requires a physiotherapy assessment which is directly tailored to you and the causes of your tibial stress! If your symptoms aren’t improving or are getting worse, make an appointment with your trusted physio!
- Attack the source
Calf raises with eccentric focus
Studies show that weak calf muscles are more prone to muscle fatigue, leading to altered running mechanics and in turn extra strain on the tibia. This exercise is to start as soon as the acute painful stage has subsided and the exercise is tolerable.
- Attack contributing factors
The glutes are extremely important muscles which sit on the side/back of the hip and contribute to lower limb stability and alignment. Although this muscle is higher up the chain, weakness of the glute medius will result in torsion of the tibia and in turn greater stress on the bone!
It also allows you to start the rehab process early as these exercises do not cause excessive stress on the painful area of the shins.
- Attack poor foot biomechanics
When it comes to the lower limb, the inner foot muscles are extremely important in keeping the foot, in particular the arch, placed in an optimal position. These muscles often become weak or underactive leading to collapse or poor stability through the arch.
This exercise can be made easier and harder by performing in standing or on unstable surfaces.
What else could my pain be coming from…?
Stress Fracture: thought to be caused by similar processes to MTSS this is a more progressed condition in which small fractures start to appear in the tibial bone.
Chronic Exertional Compartment Syndrome: also occurs from repetitive loading or exertional activities. Can present with symptoms that indicate nerve involvement such as weakness or numbness in the lower leg. More commonly affects the outer region of the lower leg.
Galbraith, R. et al. (2009) Medial tibial stress syndrome: conservative treatment options. Current reviews in musculoskeletal medicine. Sep; 2(3) 127-133.