SHIN SPLINTS - MEDIAL TIBIAL STRESS SYNDROME

Definition:

 The pain known as shin splints, generally starts with a tight and painful feeling along the side of your shin bone (tibia). This is classed as MTSS, as the tibia bone is being stressed through dysfunction of the surrounding muscles. If these muscles continue to work in a dysfunctional way, they create more and more stress through certain points of the bone and this can then develop into a stress fracture of the bone.

Causes:

There are many risk factors to the development of tibial stress, some of which can be helped and others that can’t. These are known as intrinsic (things inside your body – some that you can’t change) and extrinsic (external things you can change) risk factors, as you will see below:

Intrinsic factors:

• Poor conditioning and high BMI (Body mass index)
• Previous MTSS or lower leg injury
• Lack of running experience and competitive running
• Female
• Increase in navicular drop (bone stability in your foot)
• Increased hip external rotation in males

Extrinsic factors:

• Type of sport
• Training frequency
• Shoes and orthotics
• Hard and uneven training surfaces

Prevention:

For those factors that can be changed, there are a few things you can do to help prevent shin pain, or at least avoid making it worse.

First there is the training frequency and load. For a high performance athlete this will be huge, but most of us can’t go straight to that level! It is important to start at level that is achievable for you. This is especially important if you have never been a runner or you have never played a particular type of sport before. The same goes for the type of surface you are running on. If you are on grass for every run until one day you decide you are only going to run on concrete, your body can’t adapt to the change fast enough, and hence you start to get dysfunction in the muscle and stress points.

The type of shoe you wear is also important, as you need to have the correct stability and flexibility for the type of activity you want to do.

Obviously some of the intrinsic factors can be changed too. However these factors are something you have no matter how fast or slow you start out and therefore you need to be extra careful if you have them. For instance, if your BMI is higher there is an increased risk of MTSS and stress fracture. This seems ironic in the fact that you need to do exercise to decrease your BMI, but it is as we have mentioned above…you need to start at a level that is achievable for you and your body. 

Now if you do have “shin splints” then the first thing to do is REST! I know you don’t want to hear that, but I actually mean relative rest from the intensity and frequency of training that you are currently at. For example if you think about a scab from a cut – if you continue to pick at it and pick at it when it is only half healed, the whole healing process has to start again and you are back to square one. It is the same with injuries on the inside, if you have MTSS and you keep stressing those muscles, they will not heal and you may develop a stress fracture.

It is best to see a physio as fast as possible, to help you get back on track as quickly as you can and set up your activity plan. They will help you build your training up specifically for you and your body, help prevent stress fractures and most importantly get you back to your best!

Treatment for Shin Splints

1 - Early Injury Protection: Pain Reduction & Anti-inflammatory Phase

As with most soft tissue injuries the initial treatment is - Rest, Ice and Protection.

In the early phase you may be unable to walk or run without pain, so your shin muscles and bones need some active rest from weight-bearing loads. Your physiotherapist will advise you on what they feel is best for you.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. As you improve a kinesio style supportive taping will help to support the injured soft tissue and provide some stress reduction for your shin bone.

Anti-inflammatory medication (if tolerated) and natural substances e.g arnica may help reduce your pain and swelling. 

2: Regain Full Range of Motion 

If you protect your injured shin muscles while they heal and strengthen. This may take several weeks. During this time period you should be aiming to optimally remold your scar tissue to prevent a poorly formed scar that will re-tear in the future. It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches, neuro-dynamic mobilizations and specific exercises. Your physiotherapist will guide you.

3: Normalize Foot Bio mechanics

Shin splints commonly occur from poor foot bio mechanics e.g flat foot. In order to prevent a recurrence, your foot will be assessed. In some instances you may require a foot orthotic (shoe insert) or you may be a candidate for the Active Foot Posture Stabilization program. 

4: Restore Muscle Strength

Your calf and shin muscles will need to strengthened to enable a safe resumption of sport or training.

5: Modified Training Program & Return to Sport

Most shin splints occur due to excessive training loads. Running sports place enormous forces on your body (contractile and non-contractile). In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with training schedules and exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance. 

Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

Your  physiotherapist will discuss your goals, time frames and training schedules with you to optimize you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimized your chance of future injury.

Prognosis:

There is no specific time frame for when to progress from each stage to the next. Your shin splints rehabilitation status will be determined by many factors during your physiotherapist's clinical assessment. You'll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.

It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration. The severity of your shin splints, your compliance with treatment and the workload that you need to return to will ultimately determine how long your injury takes to successfully rehabilitate.