Intro: What are shin splints?
Pretty much everyone’s had them at some point in their lives after a long walk, hike, or run - I’m talking about shin splints. This condition is also called Medial Tibial Stress Syndrome (MTSS). You wake up with stiff ankles, sit up out of bed, put weight into your feet, stand up, and those first few steps are tough. Lifting your feet up to take each upcoming step is a little harder than it was yesterday. It’s not excruciatingly painful, it’s just a bit overworked and you can feel it.
Shin splints are a common overuse sports injury with incidence rates from 4% to 19% in athletic populations. They feel like a dull, achiness at the front of the lower leg(s). There may be swelling and pain even at rest. And it’s often most painful when standing or walking.
I know I had them when I first got back into running after years off. I also recall having shin splints after a 9 mile hike downhill in the Grand Canyon in which my shin and calves were on overdrive the entire time. Think back to a time you had them. What had you done to cause them?
Common Causes of Shin Splints
More often than not, shin splints are due to a sudden increase in physical activity like running, sprinting, jumping, and hiking that are high impact. That repetitive loading is what can bring it on. Maybe you are brand new to it, returning after time off, or drastically increased the intensity or duration of your workout this time. The next day is usually when you wake up hearing those shins screaming at you. Right?
poor ankle mobility
poor running mechanics (hyperpronation)
wearing poorly supportive shoes
skipping a warm-up
running on a harder surface (stress instead of the track)
running on a more inclined surface than you’re used to
if you have excessive hip movement when running
if you have excessive ankle plantar flexion or lack the strength/power to do the workout
Females are also more prone to this injury
Location & Muscles Affected by Shin Splints
Let’s look closer at what muscles are involved with this injury. Because the shins are not a muscle, they’re a region of the lower leg made up of the shin bone (tibia) and next to it is the fibula. The tibia is the larger bone of the two and is the one that sticks out the most. If you feel down the tibia bone and then move your hand just to the outside of it, you’ll feel the Tibialis Anterior muscle. This is the main shin muscle that performs dorsiflexion of the ankle, in addition to inversion. And this combined with inflammation at the posteromedial tibia is often the culprit!
Some of the other muscles in this tibia region are the extensor hallucis longus, the extensor digitorum longus and the peroneus tertius.
Testing for Shin Splints
A basic test is to literally squeeze the shin region. Squeeze the tibia bone and the surrounding muscular tissue. If there’s pain and tenderness, it may be shin splints.
Another less common but possible positive test may be for swelling (edema). If you press a finger into the shin region and it remains indented, you may have some swelling there. We call this pitting edema, but it could be indicative of injury beginning.
If the pain is severe and not improving, other common injuries to look out for are a stress fracture of the tibia, nerve entrapment, compartment syndrome, and artery issues.
Most of the time, shin splint issues can be resolved with Physical therapy alone. However if conservative treatment does not resolve it, the next step is to get imaging done to determine if there is more going on.
Conservative Treatment for Shin Splints
Disclaimer: The information provided is not intended to be a substitute for professional medical advice, diagnosis or treatment. Never disregard professional medical advice, or delay in seeking it, because of something you have read on this website. Never rely on information on this website in place of seeking professional medical advice.
Treatments for Plantar fasciitis (from basic to advanced):
Reduce the activity (or prolonged weight bearing) that may be aggravating it
Joint mobilization of the ankle (level depends on stage of injury & restrictions)
Ankle range of motion exercise (within a pain-free range)
Stretching especially of the tibialis anterior (plus contract-relax technique)
Strengthening exercise (including isometrics and neuromuscular stimulation) to load the area progressively
Low impact Cardio (to help vascularization or bring blood flow to the area for healing)
Functional exercise (form training for unilateral exercises especially)
Manual/Massage: soft tissue massage (especially of the tibialis anterior)
Below are some Amazon links to foot pain related products that may be helpful:
Physical Therapy Exercises for Shin Splints
As a Physical therapist, I saw many younger patients come into the clinic with shin splint symptoms. The main things I had them work on were learning how to best prevent this in the future (utilizing a mobility warmup, progressive overload instead of drastic training changes), how to mobilize the ankles and shins, and building up strength in the shins, especially eccentric control.
In the videos below, you can get some exercise ideas for shin splints.
Mission: Mobilize, Modify, Move
How to modify exercise if you have shin pain:
- If only one leg is injured, do bilateral exercises so your other leg can help out more
- Focus more on upper body and core exercises while the shin heals
- Do more open chain lower body exercises (think leg extensions and leg curls) so you don’t have to press through the foot as much
- Exercise on a softer surface if possible. For example, a track, gym flooring, or spaces with mats are going to be more gentle than a hard, concrete or asphalt surface. Better yet, walk/run/swim in the swimming pool!
Finally, here are some day-to-day changes you can make to optimize your movement:
- Before stepping foot out of bed each morning, do some foot and ankle stretches to warm them up
- Get orthotics and wear supportive shoes more often. This also applies to your running shoes - get fitted for the perfect fit for YOU.
- With exercise, have a plan that progresses slowly. Each workout, only increase one element whether it be the duration, intensity, speed, terrain, etc.
I hope you get feeling better soon!
Want 1-on-1 coaching from a Physical therapist and online trainer who can write you workouts around your injury? That way you can train despite your pain and retain your identity in the sport and your strength? Checkout 1-on-1 VIP coaching with me here!
Peace & love,
Thanks for reading!
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