09 Oct Shin splints and treatment by Physiotherapy
What are shin splints?
The term “shin splints” is used to describe shin pain along the inside or the front edges of the shin that can be caused by a wide range of injuries or conditions. There are two common regions:
- Anterior/Lateral shin splints
- Posterior/Medial shin splints
Anterior/Lateral Shin Splints
Located on the front/anterior part of the shin and involve the tibialis anterior muscle. The tibialis anterior dorsiflexes the foot (Pulls in up and slow it going down to prevent foot slap with running). Suffers often report an increase in symptoms when lifting toes up while keeping heels on the ground, symptoms are usually worst when commencing exercise but improve with warming up.
This form of shin splints is medically referred to as Anterior tibial stress syndrome (ATSS).
Posterior/Medial Shin Splints
Located on the inside rear or medial/posterior part of the shin and involves the tibialis posterior muscle, its tendon and attachment along the tibia (shin bone). The tibialis posterior lifts and controls the medial arch of the foot assisting supination and allowing correct foot motion when walking and running.
When tibialis posterior weakens or lacks endurance arch collapses causing over-pronation which creates torsional shin bone stress. This can have wide-ranging effects up the biomechanical chain causing other secondary injuries such as knee, hip, and low back pain. It should be noted that the reverse can also occur, and that weakness in the glutes allowing inward knee movement or bone formation causing increased pronation (rolling in at the ankle) can overload the tibialis posterior generating shin splints.
Referred to as medial tibial stress syndrome (MTSS), this is often the most common form seen in the physiotherapy clinic. While there are the correct medical terms for these conditions we often shorten them back to shin splits when discussing them as the full name is a mouthful.
Differential diagnoses – other things it could possibly be:
- Stress fractures: small microscopic breaks in the bone from small repetitive impacts and injuries.
- Bone stress reaction: the stage before a stress fracture when the bone is becoming inflamed and damaged
- Compartment syndrome: all your muscles are surrounded by fascia (sort of like a sausage). Sometimes pressure can build up within this fascia, eventually, this can damage the muscle and often requires surgical intervention.
Aetiology/What is actually happening:
- Overuse injury
- Likely caused by excessive repeated force origin of soleus
- Bone scans can show an internal stress reaction within the tibia
- Periosteum of the bone may be inflamed or disrupted
- Likened to tendinopathy due to misalignment upon remodeling
What causes shin splints
- Caused by overstraining the muscles that attach to the shin
- Most common cause is overuse or over training associated with poor foot and leg biomechanics
- Improper training schedule or too quick increase in training volume
Most common causes:
- Overpronation or oversupination of feet
- Inappropriate footwear
- Increase in training
- Running on hard or angled surfaces
- Decreased ROM in ankle joint
- Poor knee flexion alignment
- Decreased hip or core stability
- Tight calf and hamstring muscles
- Weak quads
- With subjective and objective examination
- Pain over an area >5cm of the medial tibial border
- Worsens upon plantarflexion (calf stretch) while weight-bearing
- Rapid onset of pain during exercise (can improve as exercises continues)
- Morning pain often present upon waking
- Palpation may reveal bumps on the medial tibial border
- MRI or CT may be used to eliminate alternative diagnosis
- Education regarding excessive exercise
- Limit large-scale changes in exercise regime
- Ensure correct equipment and environment for activities
- Modify exercise program to prevent impact and excess pressure
- Physio treatment: dry needling, ultrasound, massage, taping
- Custom orthotics to correct foot posture – BodyWorx offers free assessments
- Rest and ice to relieve acute symptoms
- Exercise program to correct biomechanics eg lengthen calves and strengthen muscles
If you think you are experiencing shin splints the team at BodyWorx Physiotherapy Newcastle can help assist to get you pain free and back to your normal routine. You can BOOK ONLINE in 2 minutes or give us a call on (02) 4952 7033.
We now have clinics in Newcastle, Nelson Bay, Kurri Kurri, and Tea Gardens.
Written by: Tamara Nash – Physiotherapist
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