Shin Splints

Shin Splints 3/26/13

Its spring time, the snow is melting (almost), the high school outdoor track season has begun, many people will either start running again after a winter layoff, or start to increase their mileage as the weather gets nicer. With this increase in activity, something else usually happens around this time of year…..shin splints!

There are two different types of shin splints, with many different contributing factors to each condition. The term, “shin splints,” is a catch all phrase used to describe pain in the lower leg. Not all shin splints are treated the same, and sometimes, if treated improperly or not at all, those shin splints will turn into stress fractures! It’s important to determine the cause of shin pain and to correct the underlying causes.

The most common shin splints occur along the inside of the lower leg bone (tibia). This is technically called Medial Tibial Stress Syndrome. There is a muscle that runs along the tibia called the tibialis posterior. This muscle attaches in the foot and its function is to support the arch. If the arch is collapsing in and is not properly supported, it causes a traction force on the muscle as it runs along the bone. This force causes an inflammation of the outer layer of the bone where the muscle attaches to it. When this happens, ice should be applied to the area to decrease the pain and inflammation. The arch also needs to be properly supported to alleviate the stress on the tibialis posterior muscle. This support can come in the form of the proper footwear and / or an over the counter or custom orthotic. Even if the shoes are appropriate for the foot type, if they are old and past their life, they are no longer providing the support that they once did and they should be replaced.

Strengthening exercises performed barefoot, like single leg balance, heel raises, and towel curls with your toes are good to perform as a treatment and prevention of medial tibial stress syndrome. To make the towel curls a little harder, you can add your running shoe to the towel for some resistance as in the picture below! While orthotics can be very helpful in taking the strain off of damaged tissue, many runners don’t like to rely on them as a long term fix. By becoming proficient with these exercises, you are training your body to be able to dynamically stabilize the arch and prevent it from collapsing. Strengthening is the key to prevent recurring shin splints.

The second type of shin splint is called Anterior Lateral Tibial Stress Syndrome. This condition affects the tibialis anterior muscle and causes pain along the outside of the shin. The function of the tibialis anterior muscle is to dorsiflex the ankle, or to flex the toes up towards our shin. Dorsiflexion is necessary to be able to walk and run. Without dorsiflexion, we would be tripping over our feet because our toes wouldn’t clear the ground in the swing through phase of gait. The calf muscle performs the exact opposite motion of the tibialis anterior muscle. This motion is called plantarflexion. Plantarflexion occurs when we point our toes, as in the push off phase of gait. Often, in the case of lateral shin pain, the calf muscle is very tight. The tibialis anterior muscle has to work extra hard to be able to dorsiflex the ankle against the tight, strong, plantar flexor (calf). Proper stretching of the Achilles tendon and calf muscle is necessary to help decrease the stress on the outside of the shin. Trigger points, or “knots” in the muscle, also develop in the calf, making it difficult to stretch the tissue with traditional static stretches. Massage of the calf and release of the trigger points should be considered to help loosen the muscle tissue and make it more responsive to traditional methods of calf stretching. Tools such as The Stick, The FRoller, or the Trigger Point Ball are helpful to perform self-massage of the calf.

Footwear should also be taken into consideration for lateral shin pain. Typically, in the case of lateral shin pain, the foot and arch are rigid and do not do a good job of absorbing shock. Helping the foot with shock absorption through either a cushioned shoe or the use of arch support can help to take some stress off of the tibialis anterior muscle.

Strengthening the tibialis anterior muscle so it is more resistant to fatigue is also helpful. An exercise called “toe taps” is a good way to do this. Standing with your feet shoulder width apart, keep your heels on the ground and just lift your toes up off of the ground. You can do both feet at the same time or one at a time. Perform this for at least 20 repetitions on each foot. The more reps, the better! You should feel a burn with this exercise.

 Compression sleeves can be helpful in managing shin splints. Compression will help to stabilize the muscles against the bone, keep them warm, and encourage blood flow. The less movement of the muscle against the bone and the more oxygen the muscle receives from the blood flow, the less likely the muscles are to become fatigued. This is a great way to maintain your activity level while you are battling shin splints. However, wearing compression sleeves does not address the underlying cause of the shin pain, and that needs to be addressed.

Another factor that should be taken into consideration is a gradual increase in physical activity. Our body needs time to respond to stresses that we place on it. It will become stronger with time and training. If we do too much too quickly, we don’t allow proper recovery to take place. We just keep breaking down our shins little by little each day. Eventually, shin splints will occur. If shin splints are ignored or improperly cared for, the little break down of the bone each day will compound into a large breakdown of bone, resulting in a stress fracture. Take time to gradually progress with distance, speed, and number of days running per week. Also, keep in mind that the roads and sidewalks are very different than the treadmill and the body needs an adjustment period when that switch is made.

As you can see, there are a lot of contributing factors to shin splints, so a lot of things need to be taken into consideration when treating and preventing them. Here is a summary of the key points:

-       Proper footwear

-       Replace old shoes

-       Stretch calf muscles

-       Strengthen arch and ankle muscles

-       Ice

-       Massage calf

-       Take time to increase activity level

-       Compression sleeves

As always, if pain persists, consult with a doctor to rule out a stress fracture.