Shin splints is a generic term used to describe several conditions of the lower leg such as:
– Medial tibial stress syndrome (MTSS)
– Stress Fractures
– Compartment Syndrome
Throughout this article will we discuss the signs & symptoms for each condition.
Anatomy
The function of the tibialis anterior muscle is to dorsiflex the foot (bringing your toes towards the shin). Not a lot of strength is required to perform this movement and as a result the TA tends to be quite small. As the muscle contracts to perform dorsiflexion, the plantarflexors relax to allow the foot to raise. Plantarflexors are muscles that create the opposing movement of the foot, meaning they bring your toes down towards the ground. If the plantarflexors fail to relax, then the TA needs to overcome both the weight of the foot and the intrinsic resistance of these antagonistic muscles. This extra effort causes overload on the TA, resulting pain and discomfort.
Medial tibial stress syndrome (MTSS)
MTSS is inflammation of the periosteum, usually occurring on the posterior and medial surfaces of the tibia. The inflammation results in scar tissue which can stick or ‘splint’ the affected muscles (gastrocnemius and soleus) to the bone, making it difficult for them to lengthen, which would allow the tibialis anterior (TA) muscle to function.
Symptoms
– Pain and discomfort in the front and medial side of the shin, especially when walking or running uphill since the ROM required increases.
– inflammation along tibia
– persistent discomfort during activity, increases with walking or uphill running
– limited dorsiflexion (tight calf musculature)
– pain on palpation of medial tibial border
– pain on full contraction or stretch
– foot in a pronated position
Causes
– Muscle imbalance
– Impact
– Change of stress (e.g: shoes, surfaces, intensity)
– Over pronation of the foot
Stress Fractures
Continued microtrauma caused by repetitive impact can lead to small cracks developing in the tibia. The fractures often occur on the anterior tibia where the impact force is focussed.
Symptoms
– Pain felt on anterior and posterior tibia
– Increased pain with activity (particularly impact)
– Pain on palpation on anterior tibia
– Nodules along anterior tibia may be felt in more chronic stages
Causes
– Muscle imbalance
– Poor posture
– Over pronation during walking, jogging or running gait
– Overuse and excessive repetition
– Too much too soon
Compartment Syndrome
Compartment syndrome results in an increase in pressure in any of the four compartments of the lower leg
Symptoms
Symptoms are similar to those of deep vein thrombosis (DVT), so the healthcare professional should be confident that DVT is not a possibility before progressing with any treatment.
– Pain and swelling of lower limb
– Pain and discomfort increasing with activity
– Symptoms relieved shortly after activity stops
– Pain on palpation of affected compartment
– Pain on contraction of affected muscles
– Reduced ROM relating to movements of the muscles in the affected compartment
– Neurological symptoms distal to the compartment (numbness, tingling)
– Reduced pulse quality of the affected foot
Causes
– Post-impact bleeding
– Rapid hypertrophy of compartment muscles
– Inflammation of tendons from repetitive movement or impact
– Reduced flexibility in an adjacent compartment
Diagnosis of Shin Splints
Shin splints are usually diagnosed from the patients’ medical history and a physical exam. In some cases, an X-ray or other imaging studies can help identify stress fractures.
Treatment
Rest – Avoid activities that cause pain or discomfort but don’t give up all physical activity. While you’re healing, perform low-impact exercises, such as swimming, bicycling or water running.
Ice – Apply ice packs to the affected shin for 15 to 20 minutes at a time, every 2-3 hours for several days. To protect your skin, wrap the ice packs in a thin towel.
Take an over-the-counter pain reliever. Try ibuprofen to reduce pain.
Resume usual activities gradually after your pain is gone.
Alternative therapies
As soft tissue specialists in some cases Shin Splints can be confused with a tightness in the Tibialis Anterior muscle and as such a sports massage or deep tissue massage can relieve the issue. That said even if you have shine splints, maintaining good blood flow to the area and keeping your muscles relaxed and the lymphatic fluid drained can also be achieved through hands on soft tissue massage and lymphatic drainage techniques. Other therapies like medical acupuncture has also shown to be effective in the management of pain and symptoms.
Exercises
Standing Gastrocnemius Stretch
Primary muscles stretched: Gastrocnemius (calf muscle)
- Starting Position: Stand facing a wall or sturdy object, about arm’s length away. Place your hands flat against the wall at shoulder height for support. Keep your feet hip-width apart and both feet flat on the ground.
- Step Back: Take a step back with one foot, keeping it flat on the ground and extending it behind you. Your back leg should be straight, with your heel firmly planted on the ground and your toes pointing directly forward.
- Bend Front Knee: Bend your front knee, shifting your weight slightly forward while keeping your back leg straight. You should feel a gentle stretch in the calf muscle of your back leg.
- Adjust Position: If you don’t feel a stretch, you can adjust your stance by stepping farther back or bending your front knee slightly more. Ensure that your back heel remains in contact with the ground throughout the stretch.
- Hold and Breathe: Hold the stretch for 20-30 seconds, focusing on deep, steady breaths. Relax into the stretch, allowing the tension in your calf muscle to gradually release.
- Switch Sides: After holding the stretch on one side, release and switch legs, stepping back with the opposite foot. Repeat the stretch on the other side, following the same steps.
- Repeat: Perform the stretch 2-3 times on each leg, aiming to deepen the stretch slightly with each repetition. Listen to your body and avoid pushing into pain or discomfort.
Soleus Stretch
Primary muscles stretched: Soleus (calf muscle)
- Starting Position: Sit on the floor with your legs extended in front of you. Keep your back straight and your feet flexed, pointing towards the ceiling.
- Bend Knee: Bend one knee and cross it over the opposite leg, placing your foot flat on the floor on the outside of your opposite knee. Your bent knee should be pointing towards the ceiling.
- Foot Positioning: Keep your foot on the floor relaxed, with your toes pointing slightly outward and the sole of your foot in contact with the ground.
- Lean Back: Slowly lean back, using your hands for support behind you. Keep your back straight and your chest lifted as you lower your upper body towards the floor.
- Feel the Stretch: You should feel a gentle stretch in the calf muscle of your extended leg. This stretch primarily targets the soleus muscle, located deeper within the calf.
- Hold and Breathe: Hold the stretch for 20-30 seconds, focusing on deep, steady breaths. Relax into the stretch, allowing the tension in your calf muscle to gradually release.
- Switch Sides: Release the stretch and switch legs, crossing the opposite knee over the other leg and repeating the stretch on the opposite side.
- Repeat: Perform the stretch 2-3 times on each leg, aiming to deepen the stretch slightly with each repetition. Listen to your body and avoid pushing into pain or discomfort.
Tibialis Anterior Stretch
Primary muscles stretched: Tibialis anterior (front of shin)
- Starting Position: Sit on the floor with your legs extended in front of you. Keep your back straight and your feet flexed, pointing towards the ceiling.
- Cross Ankle: Cross one ankle over the opposite knee, placing your foot flat on the floor beside your opposite knee. Your crossed leg should form a figure-four shape.
- Lean Back: Slowly lean back, using your hands for support behind you. Keep your back straight and your chest lifted as you lower your upper body towards the floor.
- Point Toes: Point your toes of the crossed leg towards the ceiling. This movement will target the tibialis anterior muscle, located on the front of your shin.
- Feel the Stretch: You should feel a gentle stretch along the front of your shin and ankle of the crossed leg.
- Hold and Breathe: Hold the stretch for 20-30 seconds, focusing on deep, steady breaths. Relax into the stretch, allowing the tension in your tibialis anterior muscle to gradually release.
- Switch Sides: Release the stretch and switch legs, crossing the opposite ankle over the other knee and repeating the stretch on the opposite side.
- Repeat: Perform the stretch 2-3 times on each leg, aiming to deepen the stretch slightly with each repetition. Listen to your body and avoid pushing into pain or discomfort.
Calf Raises
Muscles targeted: Gastrocnemius (calf muscle), Soleus
- Starting Position: Stand tall with your feet hip-width apart, ensuring your weight is evenly distributed between both feet. Keep your shoulders relaxed and your abdominal muscles engaged for stability.
- Lift: Slowly rise up onto the balls of your feet by lifting your heels off the ground. Focus on using your calf muscles to initiate the movement. Keep your core tight to maintain balance.
- Peak Contraction: Once you’ve reached the highest point of the movement where you feel a strong contraction in your calf muscles, pause briefly. Ensure that you maintain control throughout the exercise to prevent any jerky movements.
- Lowering Phase: Slowly lower your heels back down to the starting position, allowing your heels to gently touch the ground. Resist the urge to drop your heels quickly, as this reduces the effectiveness of the exercise.
- Repeat: Perform the desired number of repetitions, aiming for 10-15 repetitions to start with. As you become more comfortable with the exercise, you can gradually increase the number of repetitions or add additional resistance by holding onto dumbbells or using a calf raise machine.
Resisted Dorsiflexion
Muscles targeted: Tibialis anterior
- Starting Position: Sit on a chair or bench with your feet flat on the floor, hip-width apart. Place a resistance band around the top of your foot, securing the other end to a stable object in front of you, such as a table leg or heavy piece of furniture.
- Ankle Positioning: Sit up straight with your shoulders relaxed and your abdominal muscles engaged. Your knees should be bent at a 90-degree angle, with your thighs parallel to the ground. Ensure that the resistance band is positioned securely around the top of your foot, just below your toes.
- Dorsiflexion: Keeping your heel planted firmly on the ground, slowly pull your toes towards your shins against the resistance of the band. Focus on contracting the muscles on the front of your shin (tibialis anterior) to lift your foot upwards, bringing your toes closer to your body.
- Peak Contraction: Hold the top position for a moment, feeling the muscles on the front of your shin working hard. Maintain control throughout the movement to maximize muscle engagement and prevent any jerky motions.
- Lowering Phase: Slowly release the tension on the resistance band as you lower your foot back down to the starting position, allowing your toes to point away from your body. Avoid letting the resistance band snap back quickly, as this can strain your ankle joint.
- Repeat: Perform the desired number of repetitions, aiming for 10-15 repetitions to start with. As you become more familiar with the exercise and your strength improves, you can gradually increase the number of repetitions or adjust the resistance level of the band.
If you believe you have shin splints and would like to have an evaluation done and possibly some treatment by some of our physiotherapists or sports therapists, then please contact us or alternatively make a booking online.
