What is Shin Splints and what can you do about it?
If you are a runner then it is likely you’ve either suffered from or have head of someone suffering from shin splints. Shin splints is a very common injury to the lower leg and most commonly affects runners, cyclists, jumpers, sprinters and other track and field athletes.
If the underlying cause of shin splints isn’t addressed then this may lead to other areas of injury up the chain such as knee, hip or back pain.
What is Shin Splints?
To understand this injury it is important to understand the anatomy of the shin. The shin bone is called the Tibia. This is the big bone that is half of the knee joint, the other half being the femur and at the ankle is the inside bone that pokes out (aka medial malleolus). There are many muscles that attach onto the Tibia and it is the attachment of these muscles where the pain from shin splints usually occurs.
The important muscles to understand in shin splints are the tibialis anterior, flexor digitorum longus, soleus and tibialis posterior.
Types of Shin Splints
There are 2 types of shin splints, anterior and posterior with posterior shin splints being the most common presentation in clinic.
Posterior Shin Splints (medial tibial stress syndrome)
Posterior shin splints, also known as medial tibial stress syndrome affects the inside lower part of the shin (tibia) as in the diagram above. This is often caused by the pulling on the bone of the flexor digitorum longus muscle that irritates the attachment of the muscle onto the bone causing inflammation and pain. One of the most common causes of this aggravation on the tibia is from over pronation, poor running form, ramping up training too fast or just running too much without any recovery period.
Anterior Shin Splints
Anterior shin splints affect the front, outside portion of the shin (tibia) as in the diagram above. Like posterior shin splints the This is less common than posterior shin splints and can also occur at the same time as posterior shin splints. The double whammy!
How you run affects what muscles are working
If you are a heel striker when you run then it is likely that you will use the tibialis anterior muscle as to run on the heels you need to lift the forefoot (dorsiflexion of the ankle) which is what the tibialis anterior muscle does.
If you are a forefoot or toe runner then you will be using your calf muscles more.
So what can you do?
If you think you have shin splints then the first thing to do is to have an assessment to see if this is the case. If you do have it then soft tissue work and dry needling are going to be the first step to getting you out of pain. You also have to uncover what the root cause of the pain is. If it is poor form or over pronation when you run then you can address this with exercise and coaching. If the cause is too much running then introducing a rest period will help.
Exercises to help Anterior Shin Splints
Tibialis Anterior strengthening - using a theraband tied to a firm object place the loop around the top of your foot whilst sitting on the ground. Pull your body back so that there is enough tension on the band and then pull your foot back up towards you (dorsiflexion) slowly with a count of 3 and then slowly back with a count of 3. Repeat 10 times and then do 3 sets of this. An easy standing version is just to rock back on your heels and lift the front of your foot off the ground.
Calf raises are an essential exercise for a runner as you use these muscles all the time. The stronger the calves the less likely you will be to become fatigues with running and also less likelihood of injury. Stand with your feet pointing straight in front of you so that your heel and middle 2 toes are in alignment and also your knees. Take the weight onto the balls of your feet and lift your heels with a count of 3, then a count of 3 down. You can hold at the top for 2 seconds. Try 3 sets of 10. f you find this too easy you can incorporate some dumbbells or even find the calf raise machine in your gym. If you want an extra challenge try single leg calf raises.
Stretching tibialis anterior
This is one of the most under utilised stretches around. Most people stretch their calves but few people stretch their tibialis anterior. You need to have good knees for this, so if you can't sit on your heel then you will need to do the less effective standing version of this stretch. If your knees are fine then sit on your heels. For some that will be enough to get a strong stretch through the front of the shins. For others you can place a rolled up towel under the toes to increase the stretch or the most advanced is shown in the picture below by taking the weight back onto the hands and lifting the knees up off the ground. This will give you a strong stretch through the front of the shins. Hold for up to a minute per side.
Exercises for Posterior Shin Splints and over pronation
Pronation of the foot is generally caused when the muscles that hold the arch of the foot up are weak and allow the mid foot to collapse. The main muscle here is Tibialis Posterior.
When looking at pronation of the foot it is also important to look at the hip as if the hip is unstable it may actually be allowing the foot to drop inwards. The main muscle that needs to be worked on in the hip is the Gluteus Medius which helps to stop the knee dropping inwards which can also allow the foot to drop in.
Tibialis Posterior strengthening
Start by crossing one leg over the other as in the picture. Using an appropriate strength theraband tie one end around your foot and then place the other end of the band under your other foot. Drop the foot down towards the ground and then lift the foot up towards the ceiling. Take a count of 3 seconds up and 3 seconds down. Perform it slowly and don't rush. Repeat 10 times for 3 sets.
Calf raises with band pulling inwards.
When you do the calf raise with a band around the ankles the band will try to pull the ankles inwards into pronation. By resisting this you will be strengthening the muscles you need to build the arch and stabilise the feet such as the tibialis posterior.
Arch raises / toe curls
This can help to strengthen the flexor muscles of feet as well as the flexor digitorum longus muscle which is involved in posterior shin splints as well as flexor hallucis longis which is an important muscle for the toeing off phase of running and walking as well as stabilising the foot and ankle in standing.
Stretching Flexor Digitorum Longus
This is similar to a plantar fascia stretch or soleus stretch. Find a step and push toes up against it so that the toes are stretching back. Then bend the knee so that it travels forwards stretching the calves as well. This will actually be stretching the Flexor Digitorum Longus muscles as well as they travel up the back of the leg like the calves and are also plantar flexors like the calves.
You can also just cross your leg and pull the toes back as an easier stretch. You may feel this up the inside of the tibia where you get the pain.
4) Banded lunge - Glute medius for hip stability
This exercise will also require a theraband, this time tied off to something sturdy that won't move. Loop it around your knee and have it pulling inwards so that it is pulling your knee inwards and increasing the dropping in of the knee and foot. To correct this you have to pull the knee outwards and also raise the arch. While holding this knee position tracking over the 2nd and 3rd toes go into a lunge. Keep it controlled with a count of 3 down and 3 up. Repeat 10 times for 3 sets.
You can also use self massage tools such as the stick roller or a theragun to massage the muscles of the lower leg to helps release some tension as well. You can massage the calves, the inner and outer portion of the lower leg and also the muscles of the front of the shin.
Treatment at Muscle Therapy Australia.
As mentioned above soft tissue work and dry needling will be used to release tension on the periosteum of the bone (where the muscle attaches to the bone). Dry needling can help to release the muscles and also increase blood flow to the injured site to speed up healing. Friction massage around the site of the injury can also increase blood flow. Active release techniques can help to break up any scar tissue that may have formed allowing the tissue to move freely again without pain.
If you are a serious runner then having regular soft tissue work to the legs is essential in preventing injuries like shin splints from occurring in the first place.
What else could it be?
Shin splints isn’t the only cause of shin or lower leg pain. Other things it could be:
stress fractures of the tibia or fibula. Usually we think of stress fractures if a client isn’t responding to treatment. An X-ray will be used to diagnose any stress fractures in the bone. This can
Compartment syndrome. This is when the muscle swells within the fascial bag that contains it so much that it puts pressure on the nerves and blood vessels causing pain, numbness, weakness and in the worst case scenario loss of blood flow. The biggest difference between shin splints and compartment syndrome will be whether the symptoms go away if you stop exercising. If it settles down when you stop running then it is likely to be compartment syndrome as the swelling in the muscles stops once you stop. With shin splints even if you stop exercising the irritation has been done and will continue afterwards.
Muscle strain - you could also have strained a muscle of the lower leg. Usually this would be the soleus, tibialis posterior or flexor digitorum longus if on the posterior side of the shin or tibialis anterior, one of the extensors or peroneals on the front of the shin.
So there you have it, if you have shin pain then you should get it checked out before it becomes chronic and a much harder problem to fix. We are here to help. Please feel free to hit us up with any questions or comments as we love to hear feedback.