Shin Splints

Assess, Treat & Rehabilitate Shin Splints

Shin Splints is the common name for Medial Tibial Stress Syndrome (MTSS), generally regarded as a exercise induced pain, often found in runners.  Pain found, predominantly in the lower third of the shin bone (posteromedial tibial border) is caused by repetitive loading during running and jumping.

The American Medical Association (AMA) defined it as ‘Pain and discomfort in the leg from repetitive running on hard surfaces or forcible, excessive use of the foot flexors‘ .

Shin splint is the most common overuse musculoskeletal injury typically found in runners, dancers and footballers. 

Causes:

A number of causes have been identified.  Training errors, where an athlete overloads or runs faster than their ability allows, is a common one.  Another cause can be attributed to a change in a training regime with an increase in intensity, distance or duration.

Another cause could be running on a hard or uneven surface as well as poor footwear.  And lastly, intrinsic factors such as biomechanical abnormalities, for example hyperpronation of the foot, leg length discrepancies and abnormities in a person’s foot arch can all be contributing factors.

Cold has been shown to contribute to the symptoms of shin splints therefore it is really important that athletes commence a training session with an effective warm up.

Signs, Symptoms and Clinical Presentation:

A common symptom of shin splints is a dull ache across the lower third of the shin.  The pain is usually found in both shins and generally extends over ‘at least 5cm’.  Pain is often felt on each contact and some mild swelling may also be present.  There may be tender to touch for several days following activity which provokes the pain.

Initially pain may only be felt at the start of the activity, with it disappearing during the main workout and returning during the cooldown.  However, as the condition progresses the pain may be felt throughout the activity and even hours or days after (4)

Symptoms of shins splints could lead to a number of differential diagnosis. Two common conditions which could be mistaken for shin splints are:

Compartment syndrome:

A swelling of the muscle creating pressure in a closed compartment.  Symptoms include leg pain and nerve sensations which can eventually lead to muscle weakness.

Stress fracture in the lower leg.

This is an incomplete crack in the bone which is much more serious than shin splints.  Stress fracture pain can be pinpointed as a sharp pain.  It is much more localised with tenderness across an area less than 5cm.  After resting the bone overnight, stress fractures often feel easier in the morning because the bone has rested.  On the contrary shin splints often feel worse early in the day as soft tissue tightens overnight.

Treatment and Rehabilitation:

The main goals when we look at treatment and rehabilitation for shin splints is to relieve pain and return a patient to pain-free activity.  Treatment for shin splints tends to be primarily focused on conservative management.  A temporary reduction in the pain provoking activity or even a short time away is likely to reduce symptoms.

The aim of conservative treatment is to correct any imbalances or abnormalities in functional movement patterns, gait or biomechanics.  Rehabilitation should follow a progression of loading including graded running to gradually load the tissue.

A hands approach to treatment will also consider muscle and joint dysfunction that can have a contributing factor, this may entail soft tissue, joint mobilisation and manipulation.

Prevention:

The main aim is to avoid overstress on the tissues.  Custom made shock-absorbing insoles, including those with pronation control, along with graduated running programmes have been shown to be beneficial in the prevention of shin splints.

Deansgate Osteopathic Clinics Rehabilitation Strategy

Injury Assessment

Full Body Functional Assessment

Dynamic Gait Analysis

Report Of Findings

During the whole process we will discuss the examination and what each test and exercise tells us with a summary of findings.

The findings help construct a treatment plan to maximise recovery and injury rehabilitation.

Plan of Action

Along with our report of findings we will provide a plan based on the information gathered combined with extensive clinical knowledge to get you back to loving the sports and activities you enjoy.

This can include treatment modules, exercise rehabilitation and custom orthotics.

“What steps would you take to run pain free, perform better, and enjoy your daily activities again!”…