Shin Splints

Hello and welcome back to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. I have been meaning to cover the topic of shin splints for quite a while as it is a problem that many runners suffer with and that we have been able to help many patients with. As any runner who has experienced shin splints can tell you it can be extremely painful and debilitating and can cause significant time away from running.

 

What are Shin Splints?

This sounds like a simple question (because it is!) but there is actually some debate about exactly what shin splints are and which structures are causing the pain. For our purposes we will try and keep things simple and stick with the most widely accepted ideas. Shin splints (also known as Medial Tibial Stress Syndrome) are an overuse injury where the muscles and structures near the tibia (shin) itself get inflamed and irritated and cause pain when walking or most commonly running.

 

What are the Symptoms of Shin Splints?

Shin splints generally present as pain along the inside edge (medial part) of the shin bone (tibia), hence their more medical name of Medial Tibial Stress Syndrome. Mostly this pain is of a dull nature that builds and worsens the more the person is on their feet. The pain from shin splints usually only occurs when you are walking, jogging or running and often takes a bit of time to come on. Once you have got off your feet or rested the pain will in general subside and not be too problematic. Sometimes the area may be slightly swollen and you may be able to feel an area of muscle that is extremely tender just to the inside part of your shin bone. What exactly causes the pain with shin splints is still a matter of debate but currently thoughts are that it is due to muscles like soleus which attach to the tibia pulling on the periosteum to hard and causing pain. It is important to note that there are some conditions that present very similarly to shin splints such as a stress fracture of the tibia and if you are getting persistent shin pain it is important to get a thorough assessment from a physiotherapist to determine the exact nature of your problem.

 

Who is at Risk of Getting Shin Splints?

Well, anyone who is on their feet and spends a long time on their feet can get shin splints but by far it is most common in runners with some studies suggesting that they account for up to 17% of all running related injuries. Runner's, jumpers and anyone involved in sport that creates impacts on the lower leg are susceptible to shin splints.

 

What are the Causes of Shin Splints?

As with what is actually hurting, the exact cause of shin splints is a current area of research and no one is exactly certain why they develop in some individuals and not in others but the following are some ideas as to why shin splints develop:

• Going too far or too fast: by far this is the most common reason for shin splints (Medial Tibial Stress Syndrome) developing that I personally encounter as a physiotherapist. This in general causes a large overload of the area and usually a patient will describe a large increase in running volume which is then followed by pain in the shins which worsens with activity.
• Change in running surface: if you have always run on the road and then decide to swap over to trails or fell running then due to the increase load going through the shin and ankle muscle (you need to work harder to keep in balance) this can sometimes cause an overload and then shin splints.
• Poorly fitted or worn out running shoes: if you have just taken up running then you may have bought a pair of cheap non-specialist running shoes that don’t offer sufficient cushioning or support and therefore cause your shin muscles to become overloaded. Or it may be that you have been running for a while but your current running shoes are worn out and they need replacing and again this may cause an overload of the structures at the shin.
• Poor balance: this is a surprisingly common finding amongst many patients of mine who are keen runners. Having poor balance can often cause one foot (or possibly both) to land heavily and be unstable through gait which causes overload of the muscles and structures at the shin and the pain associated with shin splints.
• Weak hip or core muscles: being strong through the core and pelvis area is not something that any runners pay much attention to (as they generally prefer running!). However if you don’t have good stability in the pelvis and core area then this can cause the muscles and structures lower down in the leg and the shin to need to work too hard in order to keep you stable through gait. This can in turn cause them to become overloaded and give you the pain of shin splints.
• Excessive pronation: some people as they move through gait whilst running will find that their feet roll inwards and this is called pronation. For some runners this will not be a problem but for others this movement may be excessive and require the muscles of the shin and ankle to work harder that normal in order to control this movement.  This in turn can cause the symptoms of shin splints.

 

What are the Treatments for Shin Splints?

As the causes of shin splints (Medial Tibial Stress Syndrome) are varied it is also the case that the treatment options for shin splints are varied and depend upon the underlying cause of the problem. Usually the following will play some part:

• Rest: I think if you have read any of our other blogs you will understand by now that in the early stages of any injury rest will form a key component and part of getting better. I know that some people will not consider resting a key treatment but I really disagree and in my view rest is often the most underrated of the things that people can do to get better. In the case of shin splints (Medial Tibial Stress Syndrome) resting to allow the acute phase to settle and the structures to recover is vital.
• Early Intervention: Apart from rest, I would say that this is by far the most important part of recovering from shin splints and getting back to running. By getting assessment early and understanding what is going on and why you are getting the pain then you can more easily and more quickly understand what you need to do in order to get rid of your shin splints.
• Strengthening: In order to reduce the load and stress through the shin and ankle area you will likely need to work on improving your strength and stability in areas such as your core and pelvis.
• Orthotics: For patients for whom the key issue is a biomechanical issue at the foot such as over pronation then orthotics and an assessment by a podiatrist may be a key part of treatment for shin splints.
• Balance Work: if your shin splints are being caused by poor balance which is causing the muscles in the area to become overloaded then you will need to improve your balance. This can take a while and requires a patient approach over many months.
• Gait Adjustment: Occasionally the shin splints have been caused by a particular gait such as a crossover gait and in this case it may be necessary to attempt to make some (small) adjustments to your gait.
• Massage: Once out of the acute phase of shin splints, massage to loosen up the tissues and promote recovery can be helpful.

 

How Can ThreeSpires Physiotherapy Help with my Shin Splints?

As I have discussed earlier my experience is that physiotherapy can really help anyone with shin splints or Medial Tibial Stress Syndrome and our physiotherapists have a large amount of experience of helping patients with shin splints get back to running pain free. Below is an example of how our home visit physiotherapy service can help with shin splints:

1. Initial Assessment: after booking a home visit from one of our physiotherapists – this can be done easily either via email or calling us and having a chat, an initial assessment will be arranged. This initial physiotherapy assessment for shin splints (Medial Tibial Stress Syndrome) takes place at your home at a convenient time of your choosing. The assessment is 1hr in length and begins with a discussion of how your shin splints began, where the pain is, the type of pain and any past medical history relevant to your shin splints. After this our physio will conduct a detailed and comprehensive physical assessment to determine the underlying cause of your shin splints and the best treatment options to help with your shin splints. At the end of the physical assessment our physio will discuss with you the underlying causes of your shin splints and what the best plan of action is. Your physio will then give you a series of exercises and stretches aimed at enabling you to manage your shin splints and get yourself back to running. Your physio will then book any follow up treatment sessions needed to help with your shin splints.
2. Follow Up Sessions: these are almost always 30 minutes in length and also take place at your home. In these sessions your physio will spend the majority of the session with manual “hands on” treatment techniques aimed at relieving your pain and getting you moving better. They will also discuss progress and monitor your exercises and make any adjustments necessary to your management plan.

A Shin Splints (Medial Tibial Stress Syndrome) Case Study:

In this article about shin splints I have tried to be clear about the process involved with how our physiotherapy service can help with shin splits, however, sometimes, it can be helpful to have a real life example to understand the way things work. As such I have described a case study of a patient with shin splints (Medial Tibial Stress Syndrome) and how we were able to help.

The patient was a female in her 40s who had been experiencing pain in her shins, sometimes it was the left and at other times it would be the right. She was a keen runner but had been increasing her distance recently and that was when the pain had started. In normal life she had no symptoms and her pain would only begin after about 15minutes of running and then would slowly build until she would have to stop. On assessment it was clear that the patient did indeed have shin splints and that there were quite a few factors contributing to this. Firstly, she had poor balance bilaterally and was unable to stand on one leg for more than 4 – 5 seconds without losing balance. Secondly, she had a generally weak pelvic and core area that was not assisting her in reducing load through her feet, ankles and shins. Finally, she had a very narrow gait when running (it was if she was running on a tightrope) and this was clearly making the muscles in her shins work harder. After this assessment she was given a series of exercises to do which were aimed at improving her balance and general core strength. She was also asked to make some small adjustments to her gait (these changes were very small, as a change in gait can throw other things out). On follow up several weeks later her symptoms had improved dramatically and although she did occasionally get some pain she was able to manage this and it was clear that she was on the mend and would now be able to manage independently.

Okay, I hope that you have found this blog about shin splints (medial tibial stress syndrome) useful. We are a home visit physiotherapy service based in Lichfield and serving areas such as Sutton Coldfield, Tamworth, Cannock, Walsall, Rugeley and Burton and we can be easily contacted via: enquiries@threespiresphysiotherapy.co.uk and 0788 428 1623