Shin splints is a common complaint, especially among participants of running sports. In this post, Physiotherapist Stefani Joannidis discusses the cause and management of this debilitating injury.
“Shin splints” or pain in the area of the shin, can be quite debilitating for an athlete, accounting for approximately 13-17% of all running related injuries. It primarily occurs due to overloading of the musculoskeletal structures that connect directly to your shin bone (tibia), caused by repetitive microtrauma over a long period of time. It is important to understand that not all shin pains are the same, and through the help of one of our physiotherapists, we can assist you with diagnosing and guiding you towards the best treatment suited for you.
So what exactly are Shin Splints?
Shin splints is a very vague yet common term for “Medial tibial stress syndrome” (MTSS). MTSS is a form of injury and inflammation of the connective tissue and muscles that attach to the shin bone. This inflammation causes increased pressure against the bone, which can cause quite some discomfort and pain.
Why do they occur?
Certain factors put you at greater risk of developing shin splints, with some things being much easier to alter compared to others. The most obvious things include:
- ~ excessive training loads, or more specifically, rapid increases in training loads (duration, type, intensity, frequency)
- ~ running on uneven or hard surfaces
- ~ running with inappropriate or worn out shoes
Other risk factors that are more specific to you and probably put you at most risk is to do with your bodys’ biomechanics. Abnormal biomechanics will predispose you to developing shin splints. Some examples include:
- ~ overpronated feet (flat feet)
- ~ tibial malalignment (eg bowed legs)
- ~ muscle imbalances or inadequate strength (specifically around the hip/knee/ankle)
How to know if you have shin splints?
Pain will be felt down the front or inside of your shin bone and the intensity can be quite diffuse and variable. Pain will decrease as you warm up and stretch, and most likely will be felt in the morning as well as both during and immediately after exercise. Often initial symptoms will be mild and cease quite quickly after exercise, which is why many athletes tend to continue pushing through their symptoms. Unfortunately overtime, the pain can intensify and take longer to go away after exercise until the point where pain will be coming on with such little exertion required. Over time, it can develop to quite an achey pain, specifically at night, putting you at risk of bone stress reactions or even stress fractures which will require a longer period of time of offloading and staying clear of sport to let the injury settle.
What else could be causing your shin pain?
There are other causes of shin pain which one of our physiotherapists can help differentiate and diagnose based on your presenting history and physical assessment in the clinic. Symptoms can often overlap, making a thorough examination and history essential for diagnosis and treatment.
MTSS is commonly seen, but if not managed appropriately, can progress to bone stress reactions or even stress fractures. Stress fractures of the lower extremity account for 80-95% of all stress fractures in the body, with majority of them involving the tibia. They can require periods of non-weightbearing and require a longer time to heal before return to sport.
Another common condition that can be causing your shin pain is chronic exertional compartment syndrome (CECS). Your muscles and neurovascular structures can be divided into ‘compartments’, which are bounded by fascia. Exercise can cause increases in pressure within these compartments, which causes pain. The anterior compartment (holding major muscles such as your tibialis anterior and extensor hallicus longus) is most commonly involved accounting for 45% of all compartment syndromes with 85-95% of the time being bilateral in both limbs.
Pain in the shin area can also come about due to vascular problems. Peripheral nerve entrapment presents as burning pain brought about by exercise and exacerbated with continued exercise. As neurological signs of weakness, loss of sensation or changes in reflexes aren’t always present, often diagnosis can be delayed. Trauma is often a primary cause of peripheral nerve entrapment.
Exercise-related arterial entrapment syndromes are relatively rare in the lower limb but most commonly will include popliteal artery entrapment syndrome. Often getting confused as CECS, compression of the popliteal artery by surrounding musculotendinous structures can also be a source of your pain.
Treatment
Treatment for MTSS, as well as how we progress your rehabilitation, is very individual dependant and crucial to help settle your symptoms quickly and get you back on track.
Immediate treatment will consist of the RICE principal – resting, icing, compressing and elevating as well as the use of anti-inflammatory medications. Our physiotherapists can help you with soft tissue techniques such as massage and deep tissue massage, help correct biomechanical issues, as well as prescribe you foam rolling and stretching exercises. Strengthening exercises can be prescribed when tolerated, and other forms of cardio such as stationary bike and swimming is encouraged to maintain fitness until running can commence.
Other forms of treatment can include dry needling/acupuncture, taping, orthotics and education.
Progression of rehab will take place each week until you are safe for return to sport or activity to minimise the risk of future reoccurrence and further injury.
If you have any questions regarding the management of shin related pain, consult with one of the Physiotherapists at Jubilee Sports Physiotherapy. Please contact our Caringbah practice on (02) 9540 9400 or our Kareela practice (02) 9528 2200.
