Shin splints are common in runners and can be really challenging to manage. Whether you’re a seasoned runner or just beginning, you may have been sidelined by this common (and frustrating) injury. Shin splints cause a nagging pain that is often felt in the front of your lower leg along your shinbone during or after exercise, or when you press on the bone itself. There are several muscles which attach onto the tibia. These include the soleus, the tibialis posterior and the flexor digitorum longus muscle. These attach onto the tibia via a structure called the periosteum. How these three muscles contribute to shin splints is explained below.
What causes shin splints?
There are many things that can contribute to shin splints, including poor running form, increasing your exercise frequency or intensity too quickly, running on hard surfaces and over-pronating when walking or running. This is when the arch in your foot collapses, causing a “flat foot”. Over-pronation can decrease shock absorption and can increase the impact pressure on the bone. Excessive pronation leads to chronic traction over the soleus, tibialis posterior and the flexor digitorum longus’ insertion onto the periosteum on the tibia, leading directly to shin splints. In most cases of shin splints, the cause can be traced back to excessive training with inadequate recovery, most commonly after a period of increased intensity or frequency.
Physiotherapy treatment
If you think you have shin splints, it’s important that you don’t push through the pain as this can only make matters worse. Initial Physiotherapy will involve symptomatic treatment with rest, ice and pain medications (if really needed). You will need to avoid the activities which are contributing to your symptoms, often being running. Switching to pain-free activities such as cycling or swimming will enable you to keep being active, without aggravating your condition. Cushioned orthotics with arch support may be helpful to reduce shock absorption and over-pronation of the feet. Your Physio may even try taping your foot to correct over-pronation.
While your pain is settling, exercises to focus on any biomechanical problems should begin.
- Tight muscles within the calf region should be addressed to manage shin splints. Calf stretches and foam rolling focussing of the calf muscles are easy to do at home. Your physio may also use massage techniques to release other tight muscles including the tibialis posterior, the flexor digitorum longus and soleus which are more difficult to release yourself.
- As discussed earlier, an over-pronated foot is one of the main causes of shin splints. Depending on your foot, you may be able to re-train the control of your arch as you walk with specific arch-correcting exercises.
- Strength exercises focussing on the muscles surrounding the ankle are particularly important. An easy and effective exercise to strengthen the calf is a calf raise. This can be performed on the floor, or off a step. It can be progressed by adding weight in the form of a dumbbell or even wearing a heavy backpack.
After around two to four weeks of rest if the pain has settled, your Physio will create a plan for graduated return to running. If the pain returns, it is likely you will require more time to rest.
References:
- Craig, D. I. (2009). Current developments concerning medial tibial stress syndrome. The Physician and Sportsmedicine, 37(4), 39-44.
- Bennett, J. E., Reinking, M. F., Pluemer, B., Pentel, A., Seaton, M., & Killian, C. (2001). Factors contributing to the development of medial tibial stress syndrome in high school runners. Journal of Orthopaedic & Sports Physical Therapy, 31(9), 504-510.
- Pell IV, R. F., Khanuja, H. S., & Cooley, R. G. (2004). Leg pain in the running athlete. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 12(6), 396-404.
