Shin Splints Rehabilitation

The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any self treatment.

Aims of rehabilitation

• Reduce pain and inflammation.
• Identify any biomechanical (movement) disfunctions that may be causing the problem.
• Improve the flexibility and condition of surrounding muscles.
• Gradual return to full activity
• Injury prevention

The time scales needed for each stage will vary considerably depending on the severity of each individual case and also the commitment to treatment advice. The full rehabilitation process may take anywhere from 3 weeks to 12 weeks. Only move from one stage to the next when you can achieve all exercises and tasks free from pain.

Stage 1

• The main aim of this stage is to reduce pain and inflammation.
• Rest from activities that may cause pain. Stay off your feet as much as you can. Maintain fitness by swimming or cycling provided this is pain free.
• Apply ice or cold therapy. Cold therapy can be applied in a number of ways. There are a number of specialist cold therapy products available which can apply cold therapy and compression at the same time and are more convenient than ice. Cold should be applied along the shin and repeated every 3-4 hours or at least 3 times a day. The tissues along the shin are very superficial so ice should only be applied for only 10 minutes at a time. Continue this for at least 3 days.
• Taping the shin is a good way of helping the leg to rest if you cannot avoid being on your feet. It will support the muscle attachments at the sore spot on the shin taking some of the pressure and strain off the tissues.
• NSAID (Non steroidal anti-inflammatory drugs) e.g. ibuprofen may help in the early stages. Always check with a Doctor before taking any medication. Do not take Ibuprofen if you have asthma.
• Gentle stretching of the calf muscles at this stage can be very beneficial. Hold each stretch for 30 seconds at a time and repeat at least 3 times a day.
• After the first 3 days, sports massage to the calf and shin muscles can be used. This should initially be quite light around the painful shin, but can gradually become deeper over subsequent treatments as pain eases.

Biomechanical correction

In many cases of shin splints, the cause is often related to the way we move, especially our feet when we run. For this reason it is important to get your foot position assessed as early as possible when rehabilitating shin splints. If you ignore this potential cause, the pain will more than likely just keep returning.

• If your feet roll in or overpronate excessively then this can contribute to the strain on the lower leg.
• If the foot rolls in then the lower leg will also rotate inwards, making the surrounding muscles work harder than they normally would.
• In addition the bones of the ankle will not 'lock' properly during the running action, again causing the muscles to take the strain rather than the bones.
• This can be corrected by orthotic inserts preferably fitted by a sports injury professional or podiatrist. Off the shelf orthotic inserts and heat moldable inserts are also available and are suitable for most patients although it is best to check with a sports injury specialist or podiatrist first.
• The inserts should be worn at all times. Not just when training. Your feet are under tension even when standing.
• One way of telling if you over pronate is by looking at your footwear. If you tend to wear out the inside front of your shoes then this is a strong indication that something is not quite right.

Stage 2

• Once day to day activities are pain free, flexibility and strengthening exercises can begin.
• Stretching the calf muscles can become more vigorous, using the heel drop method.
• Stretching the shin muscles can also start, albeit very gently.
• Sports massage should continue regularly.
• Strengthening the muscles of the shin will help prevent shin splints recurring. Start off by performing toe raises, provided this is pain free.
• Don't be tempted to return to exercise too quickly! This mistake is easily made but the condition will just return if a full rehabilitation programme is not followed.

Stage 3

• At this stage you can start to increase the intensity of your strengthening exercises. Incorporate a resistance band and calf raise exercises.
• Continue with stretching and massage as before.
• Start to add walking to your exercise program. Very gradually increase the speed and duration of your walks before incorporating hills provided you remain pain-free. Remember to always warm-up and stretch before and after activity.

Stage 4

• Provided walking has been pain-free for 2 weeks, you can start to gradually return to running.
• Apply tape to the shin to support it for the first few runs.
• Ensure you have the correct shoes for your running style or sport.
• After every training session apply ice to the shin for about ten minutes.
• Ensure you stretch properly before each training session and after. Hold stretches for about 30 seconds and repeat 5 times.
• Use massage regularly as this will help prevent the muscles tightening up, hardening and putting strain back onto the lower leg again.

Below is an example of a gradual return to running programme. Begin each training session with a 5 minute walk followed by a stretch.

Continue increasing in this manner until you are confident enough to return to full training.

Prevention of shin splints

• Increase training gradually.
• Do not run too often on hard surfaces. You can do more training if you run off-road.
• Avoid running a lot on your toes. Not easy if you are a sprinter but varying the training surface can help.
• Ensure you have the correct footwear and that it is not too old. A pair of running shoes will have lost most of their cushioning after 400 miles. If you run few miles but your shoes are over 6 months old then they still may need replacing.
• Check you do not over pronate. See a podiatrist or Sports injury therapist / Physiotherapist that can assess this.
• Continue to stretch properly - especially the muscles at the back of the lower leg.
• Get a regular sports massage. This will help keep the muscles of the lower leg supple and in good condition.
• Apply ice to the shin after training. This may help keep inflammation down before it gets bad.
• Wear a shock absorbing insole.

Stretching exercises >>

Quick links:

• Assessment
• Stretching exercises
• Strengthening exercises
• Sports massage
• Shin taping
• Shin splints products

Rehabilitation - stretching the calf muscles

Sports massage to aid rehabilitation