'Shin Splints' is a common complaint that comes through our doors at our Woolloongabba and Spring Hill Remedial Massage clinics. Yet what exactly are they? The name suggests splinters of bone being pulled away from your lower leg bone, known as your Tibia. To clarify, that is not the case!
Shin Splints is the layman's term for a condition called Medial Tibial Stress Syndrome. This is a condition that causes pain on the inside of your shin. It is caused by a variety of factors and results in irritation of the bone's outer most layer, called the periosteum and/or your tibia (your shin bone) itself.
In this article we talk identification, treatment and management of Shin Splints. We want to give you the skills tools and information you need to help get on you on the road to recovery as quickly as possible.
What are Shin Splints?
Shin Splints, or Medial Tibial Stress Syndrome refers to pain along the inside of shin. It is common in runners, dances and military recruits. The condition is associated with overuse and is often caused by a combination of muscle tightness, poor lower limb biomechanics and/ or sudden increases in duration, frequency and/or intensity of training. It can also involve poor technique and inadequate equipment such as inappropriate shoes.
The result is tenderness, soreness and/or pain on the inside of your lower leg.
How do Shin Splints Occur?
Understanding the mechanism behind Shin Splints can help you understand what aspects of your body and lifestyle you need to be looking at to resolve them long term.
Shin Splints can involve the muscles of your lower legs, the connective tissue between the tendons of your muscles and the bone and/or your shin bone the tibia itself.
Muscles - Tight muscles can lead to 'shin-splint-like pain.' When we overtrain we do not give our body enough time to recover between training sessions. This can cause muscle tissue to become tight, irritated and sore. This is not necessarily shin splits however it can be a contributing factor. The form of exercise, your techniques and your joint biomechanics will determine which muscles tighten up. The most common are your Tibialis Anterior (Front of your shin) as well as your Tibialis Posterior, which sits on the back of your tibia, underneath the two big calf muscle heads known as your Gastrocnemius. Muscle weakness in your hip, knee or foot can change the biomechanics of your lower limb joints, putting more load through your tibia. This potenitally can lead to Medial Tibial Stress Syndrome as
Connective Tissue - Each one of your muscles has tendons that insert into bone to achieve movement. When extreme load is placed on muscles, for example though excessive tightness or over training, the connection point between the bone (periosteum) and tendon can become irritated causing pain.
Your Tibia - Your tibia is your 'shin' bone. When you walk and run your tibia is placed under a significant load, which causes micro damage in the bone. This is a natural process and stops things like bone fractures from occurring. It also helps bone to become stronger by reinforcing parts of the bone that are subject to stress. This can occur with poor joint biomechanics or technique. Often load is not evenly distributed throughout the entire bone and is focused in one particular area. This causes more microdamge in that area compared to the rest of the bone. As this micro damage occurs bony matrix (the stuff that makes up bones) is broken down. Luckily bones have a great system that works to constantly produce new bone to replace it. Issues arise when the rate of breakdown starts to over take the rate that the bone's cells can replace it. This weakens the bone and can lead to medial tibial stress syndrome, stress reactions (the precursor to stress fractures) and/or a stress fracture.
What causes Shin Splints?
Shin splints have a variety of causes and usually involve a combination of a few listed below
Your feet -
Do your feet roll in (eversion) or roll out (inversion) when you walk/ run?
Do you have flat feet or high arches?
All of these factors change the way weight is distributed through your ankle and tibia (shin bone), which can cause irritation as we discussed above.
Refers to how your bone, muscles and joints interact to create movement.
Each joint has a specific range of movement, which it should be able to move through.
Whenever something in the body prohibits this range of movement, such as muscle weakness or tightness, joint stiffness and/ or a structure, such as a bony spur, the biomechanics of the joint will change.
This causes load to be distrubtied through the muscles, bones and joints differently which is where injuries like Shin Splints can occur.
Decreased Flexibility (Impacts your joint biomechanics)
Stiff joints can cause your muscle to have to work harder. Equally tight muscles can stop your joints from functioning efficently and change the way load is distributed through your shins.
The range of motion in your hips, knees and ankles can all impact on your shins.
Muscle Weakness (Impacts your joint biomechanics)
Muscle weakness can be just as significant a factor in Shin Splints as muscle tightness. Glut and hip stabiliser weakness can change the way your hip, knee and ankle function. Weak calf muscles can also play a part in shin splints. If your tibias posterior and foot arch muscles are weak your arch can collapse (flat foot) which changes the way load is distributed through your tibia. An interesting test is to see whether or not you can do 30 single leg calf raises without fatigue - this is number recommended for the average person to be able to perform to stay injury free, running 5km. (Please note that this test is not a specific test for shin splints)
Training & Technique
The surface you train on, your technique and/or the shoes you wear can contribute to shin pain.
Sudden increases to training load be it frequency, intensity and duration can all lead to shin splint like pain.
The way you run and how your feet impact the ground as you land can change the way load is distributed through your shins causing pain.
What can be done for Shin Splints?
Prevention! This is a multifaceted condition that can be tricky to solve once you have it. This is where we come in! Getting regular massage to improve muscle tightness and help with joint biomechanics is essential. Couple this with some strength training and finding someone who can assess your running/ sport specific technique (we have people we can connect you to). Check in with your training load and ensure you haven't build up too suddenly. You can talk to your coach or a health professional about this too.
Diagnosis - We like to bring in a team approach to treatment for this condition as it takes a combination of strength, mobility, and sport-specific retraining to resolve it. . Getting into see a good physio, who can assess you running style/ technique specific to your sport that could be causing shin pain, your muscle strength and/ or weakness as well as your flexibility is essential to getting a clear picture about why you are experiencing Shin Pain. We have a variety of physio's who we work with to get on top of this condition that we can recommend.
Rest - Pain Reduction, Ice and Decrease Inflammation. Take the load off the structures that are under 'stress' such as your tibia. This may mean taking some time off training. (Which is why prevention is so important!)
Improve your Joint Biomechanics - As discusses previously working out why your joints aren't functioning effectively and starting to correct this is essential to solve Shin Splints. This could involve
Improving your Flexibility - through things like deep tissue massage and trigger point therapy, self massage or stretching
Strength Training - for muscle that have been identified as weak and are impacting your your joint biomechanics.
Normalising you Foot Biomechanics - either with orthotics, strength training and or mobility work
Changing Equipment that is potentially contributing to your shin splints for example your shoes
Management Around Return to Sport & Technique Correction - This can more sport - specific strengthening before your return to your actual sport. Technical corrections to the way your run or your sport to help prevent the injury form reoccurring. Better pre-training and recovery habits such as activation/ mobility work pre-training and regular massage/ stretching / mobility whilst your build back up. Discussions with your allied health professionals and coach about modified training and progressive build up of your training, so you don't reinjure yourself.
PREVENTION!!!! Once you have had shin splints unfortuantly your are more susceptible to getting the condition again. Continuing to work on your technique, strength, flexibility as well as pre-training and recovery practices is going to be essential to help you avoid getting Medial Tibail Stress Syndrome again.