What are Shin Splints?
The term ‘shin splints’ refers to a group of conditions giving rise to pain in the lower half of the shin. There are several potential sources for pain in this area & therefore a thorough physiotherapy evaluation is important in identifying the cause. Shin splints are common in those who place a lot of force through the shin as occurs with activities involving running or jumping. The pain of shin splints is normally a deep ache that is made worse with weight bearing activity.
Causes of Shin Splints
The four commonly implicated sources of of shin splints include muscle, bone, tendons, & the interosseous membrane (a membrane that runs between the two bones comprising the shin). Most commonly, there are two types of shin splints. Shin splints at the anterior part of the shin involve the tibialis anterior, extensor hallucis longus, and the extensor digitorum longus. These muscles play a shock absorption role during walking & running. If these muscles are weak or placed under abnormal load during loading then shin splints may result.
Shin splints at the posterior tibia (shin bone) involve the tibialis posterior, flexor hallucis longus, & flexor digitorum longus muscles. The soleus may also play a role in this condition. Shin splints usually arise due to overuse on top of poor leg biomechanics.
Common causes include:
- Poor foot control/strength
- Rapid increase in training load
- Running on hard surface
- Decreased ankle range of motion
- Inadequate buttock activation
- Poor running technique
- Inadequate trunk control
Symptoms of Shin Splints
Shin splints cause a dull aching pain in the front of the shin that increases with training & dissipates with rest.
The involved area may be swollen & tender to touch.
If diagnosis is uncertain, then an MRI or bone scan may be indicated
Stages of Overuse Injury
During the early stages of overuse the shin pain will tend to go during the warm-up
At the second stage, shin pain may decrease during warm-up but will appear again soon after activity
As the condition progresses the pain will get worse with activity & the patient may be in constant pain. At this stage a longer period of rest is required to relieve symptoms.
Physiotherapy management of Shin Splints
The acute management of shin splints involves a period of rest from the aggravating activity. Replacement of shoes with ones providing greater support can also be beneficial.
Treatment options for shin splints includes the following:
- I.C.E. (rest, ice, compression, elevation)
- External brace or support
- Manipulation/mobilization of restricted joints.
- Soft tissue release of restricted muscles & to minimise scar tissue formation
- Range of motion exercises
- Strengthening exercises for the lower limbs
- Addressing poor muscle activation patterns of the hip & trunk
- Proprioceptive training e.g. wobble board
- Running technique modification
The final phase of rehabilitation for shin splints is the return to activity or sports phase. Shin splints do have a tendency to recur in athletes & so close guidance from your physiotherapist regarding training intensity & frequency. Continuing with your rehabilitation programme is vital at this stage as the underlying biomechanics that gave rise to the injury in the first place may still be present.
Other causes of shin pain include:
- Tibial stress fractures
- Compartment syndrome
To book an appointment for shin splints at the Physio Clinic Naas & Newbridge call:
(045) 874 682
Tibial Stress Fractures
It is important to differentiate muscle/tendon overload to other conditions with similar presentations such as fractures. Most cases of tibial fractures occur from running or jumping for prolonged periods on hard surfaces. In cases of repetitive stress on bone, the ability to remodel may be inadequate and a stress fracture may result. A stress fracture may be viewed as a more severe form of bone overload compared with shin splints. A combination of fatigue & repetitive traction of muscle at the attachment point on bone may be the cause. This can occur at a time of increased training workload.
The tibial bone on the inside of the shin is more commonly fractured than the fibula bone on the outside. Tibial stress fractures account for about half of all stress fractures occurring in adults (Matheson et al. 1987). Runners are more likely to experience fracture of the middle & lower third of the tibia. Middle third fractures are most common in dancers & are known to take longer to heal as well as being more likely to progress to a full fracture.
Diagnosis of stress fracture:
The classic presentation is of an athlete normally experiences pain at the end of a run that rapidly increases over a number of days. In others the pain increases gradually & is very localized in nature.
Physiotherapy management of stress fracture
The primary approach in dealing with any kind of fracture is to allow a period of rest in order for it to recover. Crutches may be necessary in some patients who experience pain with walking. A gradual return to training will take place over several weeks beginning with low impact activity.
Compartment Syndrome
Compartment syndrome is another condition, which may present with similar symptoms to shin splints. This normally gives rise to an aching or cramping pain in the leg after exercise that is decreased with rest. It may also be associated with numbness or tingling in the foot. The lower leg is divided into four compartments: the anterior, deep posterior, superficial posterior and lateral. Increased pressure in any of these fascial compartments may give rise to muscle & nerve damage. Compartment Syndrome usually occurs from increased exercise intensity; however, acute compartment syndrome may occur secondary to a significant leg trauma.
Physiotherapy management of Compartment Syndrome
In chronic (long-term) cases of compartment syndrome, your physiotherapist will generally recommend a period of rest of between 5-8 weeks. In acute cases with severe sensory loss a surgical procedure to release the fascia (fasciotomy) may be required.
To book an appointment for shin splints at the Physio Clinic Naas & Newbridge call:
(045) 874 682
or email: info@physioclinic.ie
