Shin Splints Treatment
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Shin splints type symptoms can be very difficult to treat, particularly if the injury is long term. The sooner it is treated the better.
Often, athletes will rest until symptoms go, only to find they return once normal training resumes. This is usually because the underlying causes have not been addressed and the muscles have not been restored to optimum condition.
Treatment is split into three elements; reducing pain and inflammation, identifying possible causes and restoring muscles back to optimal condition with a gradual return to full fitness. The full rehabilitation process may take anywhere from 3 weeks to 12 weeks.
Reduce pain and inflammation
PRICE - initial treatment for shin splints involves the PRICE principles of protection, rest, ice, compression and elevation. Apply a cold therapy and compression wrap around the lower leg for 10 minutes every hour initially for the first 24 to 48 hours reducing frequency to 3 or 4 times a 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 availble cold pack.
Rest is important and often overlooked. This means resting from any activity that makes the condition worse such as running, jumping and other high impact sports. Very severe shin splints may require complete rest for a few days but you should aim to maintain an exercise routine by switching to swimming, cycling, cross trainer, rowing machines, step machines and other non impact equipment.
Taping - as most people have to be on their feet during the day it may not be possible to rest the tissues of the lower leg as much as required. 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 and allowing the soft tissues (muscle, tendon etc) to rest.
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.
Stretching can begin as soon as pain allows with very gentle calf muscle stretches. Hold each stretch for 30 seconds at a time and repeat at least 3 times a day.
Massage & myofascial release - After the first 3 days, sports massage to the calf and shin muscles / deep calf muscles can be appllied. This should initially be quite light and avoid the inflamed periostium close to the bone. Gradually become deeper over subsequent treatments as pain eases. Massage techniques should include sustained pressure along the lenth of the muscles as well as transverse frictions. It is important the massage therapist avoids the bone as this can make symptoms worse.
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It is a common complaint that athletes will rest until their shin pain goes only for it to return once training resumes again. This is often because the unerlying causes are not addressed. In particular the condition of the lower leg muscles. If these muscle are tight or have lumps and bumps in then they will not function optimally and place more strain on the periostium surrounding the bone. Poor biomechanics can increase the load on the tissues. Failure to correct this is often a reason the injury recurs at a later date.
Read more on causes and prevention of shin splints.
Stretching & strengthening
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 which involves stretching off a step. Stretching the shin muscles can also start, albeit very gently.
Sports massage should continue regularly gradually getting deeper but still avoiding the surface of the bone. Strengthening the shin muscles may 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!
Start to add walking to your shin splints treatment 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.
Read more on shin splints exercises.
Returning to full fitness
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 and 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 program. Begin each training session with a 5 minute walk followed by a stretch.
Day 1: walk 4 minutes jog 2 minutes repeat 4 times
Day 2: rest
Day 3: walk 4 minutes jog 3 minutes repeat 3 times
Day 4: rest
Day 5: walk 3 minutes jog 4 minutes repeat 4 times
Day 6: rest
Day 7: walk 2 minutes jog 6 minutes repeat 4 times
Continue increasing in this manner until you are confident enough to return to full training.