Shin splints: how to manage your pain and recover
Shin splints are a common sports injury that we often see in our clinics. Shin splints are caused by overusing the shin muscles (tibialis anterior muscle) where they attach to the shin bone.
In many cases, it’s quite common for our patients to suffer from shin splints on both legs.
For those who don’t know what shin splints are, it’s best explained as a sharp pain that is localised to the muscles on either side of the shin bone, or in some cases, the shin bone itself. In most cases, pain generally gets worse as your activity load increases (e.g. the longer you run, the worse it gets).
Anyone who has experienced shin splints before, will tell you that the pain can completely stop you in your tracks!
So, what can we do to relieve shin splints pain?
First, we need to understand what gets injured and why they happen, so we can address the right problems.
Common reasons for sustaining shin splints are:
- Training errors
An abnormal or sudden spike in your training load (volume, intensity or frequency) will often result in an overload of tibial stress and then cause shin pain. This is often the case for people who are new to training or those who are increasing their training schedule without a plan.
- Increasing load too quickly for inexperienced runners
Bone density is an important factor in managing shin pain. Our body responds to the stress of regular training by increasing our bone density in our tibia [1], making it more capable in dealing with stress.
This is why shin problems are more common in less-experienced runners. Their bone has not yet adapted to the regular stress of running and makes them more likely to sustain injuries. It’s important to slowly increase load to allow the bone to recover. [2]
- Running form and cadence
If you tend to take long strides and make heavy contact with the ground while running, this may be causing unnecessary stress on your body. The longer your feet make contact with the ground with each stride, the more stress is placed on your muscles and bones as it supports your weight.
This is why it is recommended to stay “light” on your feet when running and to increase your cadence (stride frequency) to decrease the impact your tibia has to absorb when your foot strikes the ground [3].
- Running on a hard or uneven surface
Regularly running on hard surfaces or uneven surfaces can put unnecessary stress on your lower leg muscles. In turn, that stress can translate to pain in your shin muscles while you run.
If possible, try to run on grass, trails or a running track.
- Biomechanics (foot arch abnormalities, increased foot pronation)
People with lower arches on their feet tend to over-pronate (roll inwards from the ankle) which can reduce the amount of pressure absorbed by the foot and redistribute that press on the lower leg muscles.
The further along you are in your activity (run, basketball game, football match etc) your foot muscles can become fatigued, and the majority of the pressure is then managed by the calf and shin muscles. Custom orthotics can help your feet stay supported during activity.
Seeing a podiatrist for an assessment of your feet can improve your pain.
- Improper footwear
Your shoes play an important role in helping you move pain-free.
Wearing improper footwear for the activity you’re doing will contribute to shin splints, due to the foot not being properly supported or lack of shock absorption. For example, wearing flat and hard shoes for a run will cause unnecessary stress on your foot and lower leg muscles.
Wearing suitable footwear to match your activity (such as a supportive running shoe while running) will assist in reducing tibial stress.
- Poor muscular strength/control (especially around the foot, calf and hip)
Although the pain is located in the shin area, sometimes the root cause can be caused by muscles groups along your kinetic chain.
Having weak glute, hip, calf or foot muscles can cause tibial stress which can then lead to shin splints.
It’s good to consult a physiotherapist to understand if there are any weak points causing your shin pain.
There are three main structures that can be injured:
- Muscle - tension, ‘knots’ and tenderness through tibialis posterior and tibialis anterior (shin muscles)
- Tenoperiosteum - inflammation of the area where the shin muscle’s tendon attaches to the shin bone
- Bone - in more severe cases, stress fractures of the tibia can occur
In initial stages of the injury, pain usually comes on at the beginning of the activity or workout, disappears during and reappears during the cool down phase.
However as the injury worsens, the pain can remain throughout the entirety of your exercise and be present for hours, or even days afterwards!
Can’t I just keep running/training through my shin splints?
The short answer is – No!
Which isn’t what you might want to hear… but there’s a reason why.
The term “shin splints”, technically isn’t an injury in itself, it’s a term used to describe an overload of tibial stress - which shows up as shin pain.
This is your body telling you that something isn’t working correctly, or that you’re pushing to hard too quickly.
If you keep running/training through the pain, the best-case scenario is that your body adapts, and the pain becomes “manageable” or slowly subsides.
The worst-case scenario is that the injury develops from shin pain, into a fully developed tibial stress fracture! A stress fracture is a serious complication and will really put you out of action for a while.
How can physiotherapy and podiatry help shin splints?
If you’re experiencing any shin pain, it’s important to visit your physiotherapist or podiatrist as soon as possible! Shin pain is your body’s way in telling you that something isn’t right and shin pain can develop into a stress fracture if ignored.
Common treatment for this issue can include:
- Assessment to identify contributing factors
- Gatiscan
- Orthotic prescription
- Taping
- Exercise rehab
- Dry needling
- Massage
- Advice around load management
- Working towards functional goals
We have experienced physiotherapists and podiatrists that will be able to help you run pain-free again!
Book in to your closest Back In Motion today.
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This article was contributed by Jessica Garlick, Physiotherapist (BHSc, M. Physiotherapy practice) from Back In Motion Rosny Park.
References
- University of Missouri. “Building Strong Bones: Running May Provide More Benefits Than Resistance Training, Study Finds.” ScienceDaily. ScienceDaily, 9 March 2009.
- Magnusson, H. I.; Ahlborg, H. G.; Karlsson, C.; Nyquist, F.; Karlsson, M. K., Low regional tibial bone density in athletes with medial tibial stress syndrome normalizes after recovery from symptoms. The American Journal of Sports Medicine 2003, 31 (4), 596-600.
- Heiderscheit, B. C.; Chumanov, E. S.; Michalski, M. P.; Wille, C. M.; Ryan, M. B., Effects of Step Rate Manipulation on Joint Mechanics during Running. Medicine & Science in Sports & Exercise 2011, 43 (2), 296-302.