Shin splints are a common cause of lower leg pain, they can affect all people from sedentary individuals to athletes. They often plague beginning runners who do not build their mileage gradually enough or seasoned runners who abruptly change their workout regimen, suddenly adding too much mileage, for example, or switching from running on flat surfaces to hills. During the summer months, we may have a reduction in activity due to the heat and humidity, then we aim to return to previous activity levels suddenly, this is a common example of an acute loading spike. Other causes of shin splints include the surface of play, the firmness of artificial surfaces causes an increased load on the lower leg to absorb impact, which over time can cause pain.
The nature of shin splints, also known as medial tibial stress syndrome (MTSS), most often can be captured in four words: too much, too soon.
Shin Splints are characterised by general pain on the inside of the lower leg, aggravating activities include running, dancing, hopping, skipping among others. Runners may find that they can do a short distance without pain but longer runs can cause an issue. Other causes of lower limb pain can be compartment syndrome (pain accompanied by severe swelling, sudden onset following very vigorous exercise) and bone stress injury/fracture (specific point pain, caused by a sudden increase in weight bearing load, risk factors can include osteopenia/osteoporosis and RED-s, more commonly seen in high level female athletes with low BMI and menstrual dysfunction). If you are concerned that it may be either of these conditions, please contact a medical professional for assessment.
Initial rehab focuses on symptom reduction and can include:
- Appropriate rest/deloading
- Ice the area 5-10 minutes, after exercise or 1-3 times a day
- Lower leg stretching
- Taping the affected area to provide support
- Soft tissue massage
Strengthening exercises help to address weaknesses that can have an impact on the affected tissues. For an individualised exercise programme consult a registered Physiotherapist. Some examples of exercises you may be given include:
- Hip and strengthening: Bridging, Clam, Hip abduction, Hip extension, Step Ups, Squats
- Calf strengthening: Heel raises, soleus wall squats, soleus bridges
- Progression to plyometric exercises (hopping, skipping, jumping)
Load management is an important part of the rehabilitation process, aiming to reduce/modify load (i.e. distance, speed, incline/terrain) to a comfortable level and then gradually increasing as our body is able to adapt to the stimulus. If any running is painful a simple way to reduce this load is to train on a cross-trainer or in a swimming pool.
Other management strategies can include but aren’t limited to footwear change and orthotics, which can alter the mechanics of the foot to aid load absorption.
Make sure you wear the correct running shoes for your foot type specifically, overpronators should wear motion-control shoes. Severe overpronators may need orthotics. Have two pairs of shoes and alternate wearing them to vary the stresses on your legs. Avoid hills and excessively hard surfaces until shin pain goes away completely, then re-introduce them gradually to prevent a recurrence.
If you have suffered from shin splints in the past it is important to maintain prehab exercises, these exercises are similar to those we complete in rehab to help maintain the strength and conditioning of the hip, knee and ankle muscles. As with rehab, load management is vital in preventing shin splints, avoiding acute spikes in load and paying attention to what our bodies are telling us.
Runner’s World: Shin splints http://www.runnersworld.com/tag/shin-splints
The Running Physio: MTSS https://www.running-physio.com/mtss-video/