In the first of our series on the ailments distance runners can suffer, former national cross country champion and physiotherapist Robbie O'Donnell looks at shin splints.
What Are Shin Splints?
Shin Splints, medically known as Medial Tibial Stress Syndrome (MTSS), is the term used to describe all pain that occurs in the leg below the knee. It can either be on the front outside part of the shin (anterior shin splints) or the inside of the shin bone (medial shin splints). It is an inflammatory condition that affects runners, dancers and people who engage in sports that involve jumping and running. 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. While shin splints can seem harmless, if left untreated they can really impact your ability to keep up training and even interfere with your daily routine. The good news is that you can prevent and treat shin splints quite easily (most of the time!)
Shin splints are a common overuse injury that causes pain along the inside or outside of the tibia (shin bone). As with most overuse injuries it is caused by an inability of the structures around this region to cope with the demands of training. As a common rule it is caused by doing too much too soon. The pain can be coming from injury to the muscles surrounding the tibia, the structures that attach these muscles to the tibia or the tibia itself.
Pain is usually felt early on during the physical activity, dies down somewhat, and then returns later on, sometimes during the same exercise session; this may occur during a long run. The pain can gradually become so bad that the activity has to be abandoned altogether.
A serious mistake is to try to "run through the pain" if it is a shin pain. This type of pain usually means there is injury to the bone and/or surrounding tissue. Forcing it more may worsen the injury and make the pain more intense and longer lasting.
Signs and Symptoms
Shin splints often start as a dull pain around the inside of the shin, usually around the middle third of the lower leg. They tend to be spread broadly along the shin bone unlike a stress fracture which presents with more localized and sharper pain.
You may feel pain before, during, or after activity. The affected area may be sore and tender (particularly to touch the bone), with some swelling and often both legs are affected. Pain often begins gradually and in the beginning it may come and go, however as the condition progresses pain can be present all the time.
The pain can be on either side of the shinbone, or in the muscle itself - this depends on the cause. It is important to remember that not all pain in leg is shin splints. Other common conditions such as stress fractures, tendon problems or compartment syndrome should all be ruled out, and may develop if shin splints are left untreated.
How Does It Happen?
The exact cause of shin splints is often difficult to pinpoint, however as with many overuse injuries, dysfunction at another body site can cause other tissue to take on more stress and begin to breakdown. Poor foot and lower limb biomechanics also play a big role.
How Do I Treat Shin Splints?
As many other conditions can mimic shin splints, it is important to visit your physiotherapist who can diagnose your condition correctly and advise suitable reductions to your training program. Furthermore, left untreated, shin splints have been known to develop into stress fractures or compartment syndrome, which can be far more serious.
Training modification is almost mandatory and then appropriate stretching and strengthening exercises will be needed. Some examples are seen in the pictures attached but everyone is different so consult a sports physiotherapist to identify the factors most likely to be contributing to your pain and assist with correction of any muscle imbalances, joint stiffness, training errors, and footwear advice.
While rest and ice will help to settle symptoms quickly and is a mandatory part of your treatment regime to settle the acute inflammation, rest alone will not get rid of the problem if you just return to the same training you were doing when the problem first arose.
Lunge stretch: With your hands against the wall, place your leg to be stretched in front of you . Keep your heel down. Gently move your knee forward over your toes until you feel a stretch in the back of your calf or Achilles tendon. Hold for 30- 45 seconds and repeat 4 times at a mild to moderate stretch pain-free.
Calf stretch: With your hands against the wall, place your leg to be stretched behind you. Keep your heel down, knee straight and feet pointing forwards. I often find this even better if standing on a ramp. Gently lunge forwards until you feel a stretch in your calf / knee of your back leg. Hold for 30-45 seconds and repeat 4 times at a mild to moderate stretch pain-free.
Kneeling stretch: Begin in four point kneeling (i.e. on your hands and knees) on a flat surface. Keep your knees and ankles together, toes pointed. Gently take your weight back onto your ankles until you feel a stretch at the front of your ankles or shins. Hold for 15 seconds and repeat 4 times at a mild to moderate stretchpain-free. This exercise can be progressed by placing a rolled towel under your feet.
Article written by Rob O’Donnell, Physiotherapist and Director of Southern Suburbs Physiotherapy Centre and former Australian distance running representative.
Southern Suburbs Physiotherapy has clinics in 3 locations:
705 Centre Road, East Bentleigh,
100 Lower Dandenong Rd, Parkdale
99 Bay Street, Brighton
There are physio’s with special interests in treating runners at all locations.
More details at: www.sspc.com.au