Shin Splints (Medial Tibial Stress Syndrome)

Shin splints can occur because of overloading or faulty biomechanics. Over loading occurs when you increase the intensity of your work outs, change the terrain of your work outs (hard surfaces/uneven surfaces/hills) or when you first begin exercising. Compensatory movements in the ankle, foot, knee or hip may result in fatiguing of the ankle or hip stabilizers during the stance phase of running. This causes your arch to roll in and the posterior structures in the lower leg (soleus and tibialis posterior) attempt to counteract this over pronation resulting in excess stress. One or a combination of these factors can lead to pain on the medial shin during or after activity. As the condition worsens the discomfort may become present during normal daily activities.

Treatment may require orthotics to prevent excessive pronation of the ankle joint and it is advised that you seek professional medical assistance with your rehabilitation and exercise prescription. A physiotherapist can help you with 1st and 2nd phase treatment of pain and exercise therapy. A podiatrist can prescribe orthotics to correct ankle position and biokineticist can help you figure out the root of your problem and assess you for muscle imbalances or areas of inflexibility and weakness.

How to Combat Shin Splints

Pain management
You can use cryogenic therapy (ice massage) to decrease the inflammation and localized pain. Stop activities that cause discomfort for the first 7-10 days but you may maintain your cardio with cycling, elliptical trainer, pain free walking and pool work.

Flexibility
Generally the calves are tight and need stretching particularly the inner layer of calf muscles. Begin with the following stretches before seeing a professional who can highlight other areas of concern.

Picture A is a gastrocnemius stretch. There are other variations of the stretch like off the edge of a step. You may alternate between the two but perform 2 x 20-30 seconds per leg every day. Picture B is a soleus and achilles stretch. You will feel the stretch move lower down the calf when moving from A to B. Perform 2 x 20-30 seconds per leg every day.

Address the Cause
If you are experiencing excessive pronation you may need to ask the question ‘are my shoes the right ones for me?”. Make sure you are wearing running shoes and not active wear or fashionable sporty looking shoes. Check your orthotics regularly- it is not a once in a life time investment because they may need some ‘tweaking’ and keep in mind that orthotics designed for a neutral shoe cannot be used in a motion control shoe.

Take a look at your running style:

  • Do you run with a forward or backward lean
  • Run with your feet pointing out
  • Have flat feet
  • Land on a rigid foot
  • Have pelvic instabilities or one leg shorter than the other

Your running style will affect the way that your body responds to the ground reaction forces as you strike the ground. Any muscular weakness of fatigue higher up in your kinetic chain will also affect heel strike to toe off when running. Weak or tiring muscles in the pelvis can therefore change foot position. Below you will find some exercises that address the area of pain and take a look at joints higher up the body.

Improve stability and strength
Rubber tubing or theraband exercises may improve control and return strength to the muscles around the ankle but should not reproduce the symptoms. Try some of these to begin with:

Loop the band around your foot and proceed to do resisted movements in all the planes of ankle range of motion. Complete 2 x 15 per direction.
You can also focus on foot intrinsic and arch strengthening by scrunching a towel under your toes or picking up marbles. More dynamic exercises to help give you eccentric control (lengthening) include eccentric calf raises (A), Heel walking (B) and heel step downs (C).

Perform 2 x 10 of each exercise but in a pain free range of motion and not until you are able to progress to this level. Eccentric calf raises differ from normal ones in that you slowly drop the heels past neutral. You can make it more difficult by going up on two feet and lower with all your weight only on the one leg (this will double the difficulty). When walking on your heels try to step softly and don’t let the forefoot touch the ground. Heel step downs require the transfer of weight to the landing foot but without the forefoot touching the ground. This will work the front of the shin.

Proprioception exercises will tax the stabilizers and work the arch of the foot. They are essential in all lower limb rehabilitation programs and if done correctly can help with pelvic stability too.

Once you have mastered standing on one leg with level hips for 1min per leg try with your eyes closed and then move on to these progressions: Wobble board (A), Airex Mat (B), Lunges (C)

Progress to functional 3rd phase exercises as your condition improves such as stationary lunges, lunging onto a balance mat, or onto your toes.

We hope that this article gets you started in the right direction. If you need to understand your specific body and movement faults consider calling us to book a session with one of our Biokineticists to get a personalised assessment and program. We see many lower limb patients in our rooms who swear by the one on one interaction to improve the speed of recovery. We also can’t stress enough the need for a strong core and efficient weight transfer when rehabilitating all injuries. It is best to get your body assessed to see if you have any discrepancies if you are experiencing pain with exercise.
Jenna van der Merwe
Biokineticist

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