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Shin Splints

Shin splints are painful conditions in the shin that affects athletes or sporty individuals that participate in high impact sports or activities that has a lot of 

  • running
  • jumping

There's two (2) types of shin splints:

Anterior Shin Splints

Anterior shin splints, like its name (anterior means front), affects the front of the shin bone and involves the tibialis anterior muscle, which both lifts and lowers the foot during activities.

When this muscle and surrounding tissues is injured or inflamed, there will be pain whenever patient extends and lifts their toes with their heel on the ground.

This is called anterior tibial stress syndrome (ATSS) or anterior shin splints.

Posterior Shin Splints

Posterior (back) shin splints affect the inside back part of the shin bone, and involves the tibialis posterior muscle.

This muscle lifts and controls the medial (inside) part of the foot arch. If there is weakness or poor endurance of this muscle, it will lead to torsional shin bone stresses.

Symptoms will include pain along the inside back part of the shin bone. 

It is important to be able to differentiate this from tibial stress fractures, as both conditions are collectively known as medial tibial stress syndrome (MTSS).

causes of Shin Splints

Shin splints can happen due to overuse injuries or overtraining, which leads to the muscles that attach to the shin bone to be overstrained. 

It can also be caused or aggravated by inadequate foot and leg biomechanics, causing abnormal movement patterns and errors in training.

Of course there are other factors that can contribute to shin splints, such as 

  1. overtraining or overloading the muscles too quickly, without enough rest between training and competitions
  2. running on hard or angled surfaces
  3. biomechanical issues such as overpronation or oversupination of the feet
  4. decreased flexibility at the ankle joint
  5. poor hip-knee-leg muscle control
  6. poor buttock muscle activation control in the stance phase
  7. poor core stability
  8. tight calf muscles and hamstrings
  9. Weak quadriceps and foot arch muscles are also contributing factors.
  10. Equipment such as inappropriate footwear can also play a role in the development of shin splints. 

We need to quickly and accurately identify the underlying cause of shin splints and address it to prevent it from getting worse, get it healed and prevent it from coming back. That's why an in-depth and thorough evaluation of biomechanics, training techniques, and equipment can help to prevent and treat shin splints effectively.

What Structures are Injured in the case of shin splints?

Shin splints and shin pain results from the over-straining, overloading or overuse of the three main structures in the lower leg:

  1. Muscles in the lower leg can become injured due to excessive loading stress caused by repeated overuse. This overload leads to muscle tenderness, inflammation, or tight muscle knots. The tibialis anterior and tibialis posterior muscles are the most commonly affected muscles in shin splints.

  2. The tenoperiosteum, which is the zone at which the tendon joins the bone, is also often injured, tender and inflamed in shin splints. Swelling of different tendons can lead to pain in various areas of the shin.

  3. Shinbone (tibia) - injury to the shinbone usually happens in the lower one-third of the tibia and can range from mild (such as a simple stress reaction), to severe, such as stress fracture. Unfortunately, most of the time, bone damage isn't easily seen on standard x-rays and needs a bone scan or MRI to confirm or exclude a bone injury. We dont recommend ignoring chronic exertional compartment syndrome as it can be a dangerous or severe condition too. 

What are the Symptoms of Shin Splints?

The front of the lower leg typically experiences a dull ache and the main symptom of shin splint. Depending on what caused the shin splint in the first place, the pain may appear along either sides of the shin bone or inside the tibialis anterior muscle.

The affected areas may also be tender when pressed or palpated.

There are four (4) stages of shin splints:

  1. Stage one shin discomfort during warm-up activities that subsides with continued activity. 

  2. Stage two, the discomfort may disappear during warm-up but return after the activity or exercise ends. At this point, we highly recommend coming for a physiotherapy assessment and treatment before resuming regular exercise and training levels, dont let it get worse or ignore it.

  3. Stage three, if the shin discomfort worsens during activity, it is already medically necessary to seek medical consultation to confirm the diagnosis and rule out bone stress fractures. You may need a thorough shin splint physiotherapy program gradually return to activity. 

  4. Stage four, at this stage, you need to seek medical guidance to exclude stress fractures or any significant tibia fractures. The orthopedic doctor may require you to be non-weight bear on crutches or to wear an air cast. It is very important to stop all activity immediately. You will need a thorough shin splint physiotherapy program gradually return to activity. 

How to diagnose Shin Splints

We will need to first get your medical history followed by a physical examination of your shin.

Sometimes, we may need to call for

  • x-rays
  • bone scans
  • MRI

to identify or rule out other potential causes of your pain, such as in the case of stress fracture or muscle strain. These tests can help rule out injuries or conditions that can cause or aggravate your symptoms.

We will ask also about your

  • exercise routine
  • footwear

and any other factors that may be contributing to your shin splints. 

It is very important to receive a proper diagnosis to ensure that you receive the appropriate shin splint treatment and prevent the pain and injury from worsening.

Shin Splints Treatment

Shin splints are typically treated with a multi-stage physiotherapy program.

  1. Phase 1 we focus on early injury protection, pain reduction, and reducing inflammation in the shin. We will prescribe also lots of scheduled rest, cold therapy and protection. We may also recommend anti-inflammatory medication or natural supplements such as in the shop to reduce pain and swelling. Kinesio and sports taping can provide additional support for the painful and injured tissue.

  2. Phase 2 aims to regain full range of motion (ROM) with a combination of exercise therapy, muscle stretches, scar tissue management and other soft tissue management. This phase can take a few weeks. 

  3. Phase 3 we will thoroughly assess your foot, and we may prescribe you a foot orthotic.

  4. Phase 4 we focus on muscle strengthening of the calf muscle, shin muscle, quadriceps muscle, gluteal (buttock) muscle, and other lower limb muscles to prepare you to go back to sports and training. 

  5. Phase 5 is all about modified training program and return to your sport. Our physiotherapist will guide you with training schedules and exercises tailored to your specific sport, that will improve your sports and activity performance as well as prevent reinjury.

What kind of Results Should You Expect for your shin pain and shin splints recovery?

How well your shin splints recover depends on a few different factors:

  • how severe it is
  • how long it took for you to get treatment (the earlier the better)
  • how your shin responds to physiotherapy and management
  • how compliant you were with treatment and rest
  • what kind of load you are going back to

You must follow the physio's instructions and progress through each phases / stages of shin splint physio program at a pace that's suitable for your condition. If you attempt to progress it too fast too soon can (and will) lead to shin splint reinjury and more frustrations.

Please do take your shin splints seriously and seek professional physiotherapy treatments as quickly as possible. If you leave it untreated on a wait-and-see, and continue with overloading, overtraining and overusing, your shin splint can worsen into more serious and severe stuff such as

  • tibial stress fractures
  • muscle compartment syndrome

and they may need even more intensive or longer treatments (and even may need surgery).

So if you're experiencing shin pain, do make an appointment with our physiotherapist to assess and diagnose the pain, create a personalized shin splint recovery plan for you and treat you to complete recovery.