Last updated: 31-May-17
By Karina Teahan (Chartered Physiotherapist)
Shin Splints are the bane of many runners. That tell tale pain shooting down the front of your leg may feel like an annoyance rather than a game-over in the beginning. However, you ignore them at your peril.
Shin Splints are also known as medial tibial stress syndrome or medial tibial traction periostitis. But don’t worry, for ease of reading in this article we will stick with the more familiar “shin splints”.
Shin splints are common in high impact activities and so present not only in runners, but also in dancers, basketball players and military recruits. They are caused by repetitive stress and overload on the shin bone and the connective tissues that attach your muscles to the bone. Shin splints present as an intense achy pain with tender spots along the front and inner edge of the tibia (shin bone). This can sometimes be accompanied by swelling. Initially the pain may just bother you while running but as it worsens you may feel it even while walking and at rest.
Diagnosis
Shin splints can be diagnosed by your Chartered Physiotherapist through discussing the onset of your symptoms with you and examining the affected area. Beware there are some conditions that may mimic the symptoms of shin splints. These include: stress fracture of the tibia (small cracks in the shin bone), swelling of the muscles in the lower leg causing nerve compression and pain (compartment syndrome), nerve problem in the lower back referring pain to the shin (radiculopathy) or a local tendon injury. Your physiotherapist will work through a differential diagnosis and plan of treatment with you. An MRI may be necessary to rule out a stress fracture if your condition does not improve with treatment.
Risk Factors
- Foot type: overpronation (flat foot) or an excessively high arch will cause excessive stress on your lower leg
- Worn our running shoes
- Reduced muscle length around your calf/ankle
- Muscle dysfunction around your hip/knee/ankle
- Sudden increase in training load (volume/intensity or frequency)
- Excessive running on camber, track or road
- Lack of recovery days
Treatment
- Address your risk factors!
- Rest – yes unfortunately you do have to stop running!
- Ice: use an icepack & apply to the affected area x 15 minutes, 5-8 times/day (or as life allows) until symptoms subside. Aim 3-4 days icing.
- Cross train: swim, aqua jog, cycle (if no pain). Use a low easy gear on the bike initially, do not try to push big gears or big hills.
- Footwear: change your running shoes every 350-500 miles. Wear a running shoe that suits your foot biomechanics. It pays to get good advice on this in a specialised running store.
- Orthotics: ask your physiotherapist or podiatrist if you think you need an orthotic. Many orthotics are quite cheap and can be bought off the shelf but you need to make sure you are getting the correct one for your foot. An unsuitable orthotic may make your worse and add additional stresses to your legs.
- Aim to restore normal muscle length around your foot and ankle-this will be described below.
The following exercises will help you restore mobility and flexibility to the part of your leg affected by your shin splints.
1. Calf stretch (gastroc-upper calf & soleus-lower calf)
Hold each stretch for 30 seconds x 5 reps
1A. Upper calf stretch: stride standing, feet facing forwards, heels on the ground, keep your back knee straight and lean forwards from your hips. You should feel a stretch in your upper calf.
1B. As above but stretch with your back knee flexed so the lower part of your calf gets lengthened.
2. Tennis ball calf muscle release
This is a great way to give yourself a deep tissue massage. I feel it works better for my calf muscles than my foam roller. All you have to do is tape 2 tennis balls together with sports tape then roll your calf up and down on the two balls from your ankle to the back of your knee,
Tape 2 tennis balls together.
Plantar flexion stretch kneeling and sitting back on heels – Anterior Shin Stretch
This exercise will stretch out the tight muscles down the front of your shin bone. Just sit back on your heels and feel the stretch.
It is important to correct muscle imbalances or weaknesses around your core, hip, knee and ankle to avoid shin splints and prevent a recurrence. Below I will describe specific exercises for lower leg and foot strengthening.
Tib Post
Tie a Theraband (resistance band) around your ankle and fixed point such as the leg of a table. Stand on that leg and create the best foot arch you can while allowing your big toe to remain on the floor. You will feel your foot muscles working to maintain the arch. Step over the band and back with the opposite leg. Keep the standing leg slighted flexed. Repeat 10 times.
Foot muscles
Strengthen your foot muscles by trying to pick up a pen/marbles with your toes.
Back leg
Calf raises will really help build up the back of your legs. Start by raising up and down on your toes with both legs on the ground. Progress to doing a single leg calf raise. Start with 10 reps and aim to get to 10 x 4 sets over time.
Walking on heels
30 seconds x 5 reps – this will strengthen the muscles down the front of your shin bone.
Static gait push
Point both feet out to 45 degrees, push up off the back foot onto the front leg and slowly back down, repeat 30 times each leg. The aim of the exercise below is to improve the muscle control around your foot and ankle as well as elongating the calf as your heel drops back in a controlled manner.
Return to running slowly when
- You can push hard on the spots that were very painful and no longer are.
- Your affected leg is as flexible and strong as your other leg.
- You can jog, sprint and jump on the affected leg without pain.
Start off training at a much lower level to when you picked up the injury or else you will quickly get a recurrence. Keep an exercise diary so you can monitor your progress. As with all injuries do not increase your training load by more than 10% per week and allow the body to adapt to the increase in training gradually. If you get a set back and feel a niggle, ice the affected area and take a few days off training. Try to maintain 2-3 days strength work in your weekly training schedule. Even 20-30 minutes is productive and may be far more beneficial long term than those extra few miles! If you train a lot on camber try to run out and back on the same side of the road. If you train mostly on track remember to change direction to avoid over stressing the one side.
Best of luck!
Karina Teahan (BSc, MMT, MISCP)
Chartered Physiotherapist
All images Karina Teahan.
About the author: Karina Teahan (BSc, MMT, MISCP) is a chartered Physiotherapist and elite runner who graduated from University College Dublin in 2002. She did a Masters at the University of Western Australia and worked in Dublin, Manchester and New Zealand. Karina is now based in a Primary Care Centre in Cork, Ireland.
