SHIN SPLINTS

Shin splints are a type of "overuse injury" to the legs.  Theyare usually considered as pain along the inner border of the shin.  The condition is not a diagnosis we use but rather a blanket term used to describe several different pathologies.  These include conditions where the inner portion of the bone is stressed (Medial Tibial Stress Syndrome), the junction of the muscle and bone is inflamed (Periostitis) or may progress on to bone stress reaction or stress fracture.

How do shin splints present?

 Shin splints occur most frequently in runners or walkers particularly if new to training but may also present in any weight bearing activity such as netball and hockey. 

Shin splints cause pain in the front inner aspect of the leg below the knee. The pain of shin splints is characteristically a dull ache but may become more intense and sharper if it progresses.  Pain is often noted early in the workout, then lessens as you warm up but reappears towards the end of the training session.  Pain often returns after activity and may be at its worse the next morning.  Shin splint discomfort is often manageable at first however with continuing trauma the pain can become so extreme as to cause you to stop workouts altogether.

What causes shin splints?

 A primary culprit causing shin splints is a sudden increase in distance or intensity of workouts.  This increase in muscle work can increase the micro-trauma to the inside of the shin and the surrounding muscles.  The muscles used in lifting the foot and preventing it from flattening are most often involved. 

A tight Achilles tendon can also be implicated in the development of shin splints as can a lack of bend at the ankle.  This is because in an attempt to compensate for the lack of flexibility as you run the body flattens the foot and rotates the lower leg inwards which loads up the inside border of the shin.

Weakness in the muscles around the pelvic girdle (or core) such as the deep abdominals and glutes can contribute to the development of shin splints.  This lack of control of the pelvis when landing allows the knee to deviate inwards towards the other leg and also loads the structures along the inside of the shin.

How are shin splints treated?

In order to properly treat shin splints and prevent them recurring, the causative factors must be taken into consideration. No matter how much rest, anti-inflammatories and massage are used, without correcting the cause of the injury, the symptoms will continue to return.

Treatment for shin splints is as simple as reducing pain and inflammation, identifying training and biomechanical problems which may have helped cause the injury initially, restoring muscles to their original condition and gradually returning to training.

 Initially we use a relative rest regime.  This involves reducing the activity that provokes the pain but maintaining other exercise that may be more non weight bearing such as cycling or swimming. 

Icing helps in reducing inflammation and is applied directly to the inner part of the shin after activity to help settle symptoms.

Selection of the correct running shoes that are appropriate to your foot type is important in reducing the ongoing stimulus to injury as you train.

A biomechanical assessment identifies faults that may be present in running and landing patterns.  From this a routine of strengthening exercises is designed for you to help stabilise during standing and a stretching regime developed to improve ankle mobility.

A return to running is only when symptoms have generally resolved and follows a progressive routine with increasing duration and intensity.

Taping can assist stabilise the foot to allow the muscles that are responsible for holding the arch up (and preventing pronation) to rest and recover.

Soft tissue massage along the inside border of the shin can aid recovery.

Returning to Training

 As a rule of thumb with running, distances should not increase by more than 10% per week. For example, if you complete a total of 10 km one week, do not increase above 11 km the next week. This helps to ensure the muscles are not overworked.