'Shin Splints'

When it comes to shin splints it’s more a question of who hasn’t had them, than who has.

Do you have pain in the front of your shins that just does not want to go away? Have you ben running a lot or playing a lot of sports that involve jumping? If so, you may have “shin splints”. This lower leg injury is often due to overuse and can be a difficult one to rehabilitate.

Shin splints, which is better known as ‘medial tibial stress syndrome’, is a common injury in endurance athletes such as runners, as well as athletes involved in jumping sports such as basketball, netball or volleyball, who are placing large amounts of stress with high volume through their legs.

KEY FEATURES:

· Shin splints is a common overuse sports injury.

· Most shin splints occur due to excessive training loads.

· Shin splints is most common with running and jumping athletes, especially with “overloading”.

· Shin splints can also be related to sudden or substantial changes in the training program, such as an increase in distance, intensity, and/or duration.

· The main symptom is dull pain at the lower region of the posteromedial tibial (shin) border.

· Pain often extends over at least 5 cm, is often bilateral and is tender to touch.

CONTRIBUTING FACTORS:

Shin splints are caused by overstraining of your muscles where they attach to your shin bone.

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) as well as errors in training.

Common causes of shin splints include:

Overtraining / Overloading:

• Too much, too soon

• Running on hard or angled surfaces.

• Insufficient rest between sessions

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 or inadequate footwear

WHAT ELSE COULD IT BE?

Other possible diagnoses include:

· Stress Fracture

· Compartmental Syndrome

· Sciatica

· Deep Vein Thrombosis (DVT)

· Popliteal Artery Entrapment

DO I NEED SCANS?

Imaging studies are not necessary to diagnose shin splints.

Shin splints are usually diagnosed based on your history and a thorough physical examination by one of our experienced physiotherapists.

In some cases, an X-ray or other imaging such as a CT scan or MRI may be recommended to rule out more serious causes for your pain, such as a stress fracture.

THE JOURNEY:

MTSS is a continuum, with different phases or stages of the pathology.

One of our physiotherapists will guide you through your rehabilitation based on what phase you’re at. This includes how much exercise you can do. Here are some basic guidelines until you see one of our physiotherapist’s:

Phase 1: Mild medial shin pain at the start of activity, improves during warm-up.

Early identification and treatment in phase 1 will result in the best prognosis and fastest return to sport/activity.

Phase 2: Medial shin pain, may disappear during warm-up, but reappears toward the end of activity.

Activity may continue at a modified level in conjunction with treatment.

Professional assessment and treatment is highly recommended and should continue until you have resumed regular exercise and training levels.

Phase 3: Shin pain that worsens during activity

If the injury progresses to phase three, the activity should immediately cease. An assessment by one of our physiotherapists will confirm the diagnosis and phase as well as ensuring that the condition has not deteriorated into bone stress fractures. We recommend a thorough rehabilitation program with gradual return to your exercise.

Phase 4: Pain or discomfort ALL THE TIME!

All activity must immediately cease. A thorough assessment by one of our experienced physiotherapists is crucial to exclude more significant pathology including stress fractures. Imaging may be requested to assist with diagnosis. You may require a period of immobilisation with crutches or a moonboot.

TREATMENT:

The first step in treating shin splints is easy, but not so easy. In most instances, simply reducing the amount of volume, duration, and/or frequency an individual is engaging in is half the battle!

This can be challenging for many of us as especially when training for a race or upcoming season. However, relative rest is important to allow the area to calm down before moving towards more progressive rehabilitation.

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

Taping and/or compression may also help by supporting the injured soft tissue and providing some load reduction for your shin bone.

Shin splints commonly occur in conjunction with poor foot biomechanics, e.g., flat foot. To prevent a recurrence, you should have your foot thoroughly assessed by one of our physiotherapists. In some instances, you may benefit from an orthotic.

Strengthening your calves, quadriceps, gluteal and other lower limb muscles will likely form part of rehabilitation program for a safe return to sport or training and to minimise recurrent episodes.

Your physiotherapist will guide you through training schedules and exercises to avoid a repeat injury and improve your sporting performance.

One of our Elite physiotherapists 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.

Joshua Tidswell

Sports & Exercise Physiotherapist