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Shin splints is the common name often given to pain at the front of the lower leg. Usually symptoms occur at the front inside of the shin bone but can arise from a number of causes.
We explain the symptoms, treatment and rehabilitation of medial tibial stress syndrome to cure and prevent it recurring.
Symptoms often come on gradually and consist of pain over the inside lower part of the tibia or shin bone. There may be pain at the start of exercise which often eases as the session continues only to come back worse later in the training session or afterwards. Symptoms are often worse the next morning. Swelling or lumps and bumps felt along the inside of the bone. Pain may also be triggered when the toes and foot are bent downwards. Occasionally in severe cases reddening of the skin over the inside of the leg from inflammation may be seen.
Read more on assessment and diagnosis
Treatment for shin splints involves reducing pain and inflammation, identifying and correcting training and biomechanical problems and restoring muscles to their original condition.
Stage 1 - Relieve symptoms
PRICE - Protection, rest, ice and elevation. Apply a cold therapy and compression wrap to the painful area of the shin. Avoid running, jumping or any other activities which make symptoms worse. Switch to swimming, cycling, cross trainer, rowing machines, step machines and other non impact equipment. Apply ice or cold therapy for 10 minutes at a time every hour initially reducing frequency to 3 or 4 times per day as symptoms improve.
The tissues are very superficial so ice does not need to be applied for longer than 10 minutes. Do not apply ice directly to the skin as it may burn. Either wrap ice in a wet tea towel or use a commercially avaialble cold pack.
Taping - Shin splints taping can instantly relieve symptoms in most patients. The simple taping technique supports the muscles of the lower leg by pulling them towards the shin bone reducing traction forces at the most painful part.
Insoles & shoes - Wearing shock absorbing insoles in shoes particularly if you run or walk on hard surfaces in poorly cushioned shoes will help reduce the shock on the lower leg. Switch to wearing softer training shoes rather than hard leather work shoes if possible until symptoms go.
Medication - A doctor may prescribe anti-inflammatory medication e.g. ibuprofen to help reduce pain and inflammation. Although this should not be relied on as a long term solution or excuse not to rest. Asthmatics should not take Ibuprofen.
Stage 2 - Correcting risk factors
Simply resting until the pain goes is not usually enough and the injury is likely to occur once normal training is resumed. Whatever caused the shin pain in the first place needs to be addressed. This can include:
Tight calf muscles - if the muscles at the back of the shin bone are tight then this can cause increased traction forces on the bone causing inflammation. Stretching exercises and massage are important do avoid this.
Over training - this is probably the most common cause. Too much too soon, training on hard surfaces, or running up on your toes a lot can also make the chances of shin splints occuring increase. If running on the road then weekly mileage should be increased by no more than 10% per week.
Biomecanical factors - this is where the foot either over pronations (more common) or supinates when the athlete runs causing increased forces on the lower leg. This can be corrected with biomechancial or orthotic inserts into the shoes, not just during training but in day to day shoes worn all the time.
Exercises to stretch the muscles of the lower leg are important, in particular calf stretching exercises will stretch the tibialis posterior muscle which is often associated with shin splints. Calf stretching exercises should be done both with the knee straight and bent.
Calf stretch straight leg - To stretch the larger of the calf muscles lean against a wall with the back leg straight keeping the heel pushed into the floor. A stretch should be felt at the back of the lower leg. If a stretch cannot be felt then move the heel further back. Hold for 20 seconds then relax and repeat 3 times. If the athlete has particularly flexible calf muscles then a more advanced version of the calf stretch can be done on a step.
Calf stretch bent leg - To to stretch this muscle the knee must be bent to relax the overlying Gastrocnemius. The patient should stand facing a wall with the foot of the calf to be stretched at the back. The knee of the back leg should be bent towards the wall, keeping the heel on the floor. A stretch should be felt in the lower part of the back of the calf. hold this position for 30 seconds and repeat 3 times. A more advanced version of this stretching exercise is to place the forefoot or the front leg on the wall keeping the heel on the floor and gently push the front knee towards the wall.
Massage & myofascial release
Sports massage techniques to the deep muscles at the back of the lower leg may help by reducing the strain applied by tight muscles but avoid the inflamed periostium close to the bone. Any tight knots, lumps and bumps should be identified and gently manipulated with soft tissue massage techniques. Massage techniques should include sustained pressure along the lenth of the muscles as well as transverse frictions.
Play sports masage video
Applying heat and using a heat retainer or shin and calf support after the initial acute stage and particularly during training can provide support and compression to the lower leg helping to reduce the strain on the muscles. It will also retain the natural heat which causes blood vessels to dilate and increases the flow of blood to the tissues to aid healing. As a rule of thumb, heat to warm up before exercise and cold therapy after exercise to reduce pain and inflammation.
If you do have a biomechanical problem with the foot then a firmer orthotic type insole may be more beneficial. A professional practitioner or podiatrist can perform gait analysis to determine if you overpronate or oversupinate and prescribe orthotic inserts to correct any biomechanical problems. A cushioned three quarter length insert is often most appropriate.
If all conservative treatment fails then surgery is an option, although this is rare.
What is shin splints?
Shin splints is a common term which can include a number of diagnosis or causes and is not an actual injury or diagnosis in itself. It is the name athletes often give to pain along the inside of the shin bone.
Medial tibial stress syndrome or medial tibial traction periostitis is a more accurate description of what is going on as traction forces from the muscles of the lower leg pull on the periosteum or sheath surrounding the bone.
- Stress fracture is a hairline fracture of the tibia bone. Symptoms are similar but pain is often more acute or sharp along the inside of the shin and does not ease off with exercise but gets worse.
- Chronic compartment syndrome is where the muscles of the lower leg swell up too big for the sheath surrounding them. An aching type pain comes on gradually with exercise and is relieved with rest.
- Popliteal artery entrapment is more likely to feel like calf pain and gets worse with exercise and dimished when plantar flexing the foot (pointing the foot and toes down).
See more detail on shin pain diagnosis.
Over training or overuse is the most likely cause, however a number of factors can increase the likelihood of this occuring:
- Biomechanical factors such as overpronation and over supination of the feet. Overpronation occurs when the foot rolls inwards too much flattening the arch of the foot and causing the lower leg to rotate inwards. This in turn increases the stress on the soft tissues of the lower leg resulting in pain and inflammation. Over supination is where the foot rolls outwards too much during the time the foot is in contact with the ground. If you think you have suspected biomechanical issues then a professional can do gait analysis tests either with a treadmill or using force plates to determine this and whether corrective orthotic inserts for your shoes are needed.
- Inadequate footwear such as the wrong type of shoe for your running style or running shoes that are just too old and have lost their support and cushioning can cause injury. Over pronators may require a running shoe with a firmer midsole on the inside to reduce the amount of rolling in. Supinators usually require a neutral shoe with plenty of cushioning. A specialist running shop can advise.
- Increasing training too quickly, running on hard surfaces, on your toes as in sprinting and generally doing too much too soon will increase the risk of injury.
- Poor flexibility at the ankle can cause increased stress on the soft tissues, muscles and tendons of the lower leg when running.
- Neal Reynolds - professional football physiotherapist Neal Reynolds talks about preventing shin splints - play video
- Ian Sadler - podiatrist explains the biomechanics of shin pain - play video
See more about shin splints rehabilitation.
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