What Causes Shin Splints?
Shin splints are caused by overstraining of your muscles where they attach to your shin, common among participants of running sports.
The most common cause is overuse or overtraining associated with poor foot and leg biomechanics. Shin splints can be caused by a number of factors which are mainly biomechanical (abnormal movement patterns) and errors in training.
There are two regions where you can suffer shin splints:
Generally shin pain arises from a combination of three structures:
As a result of repeated overuse, one or more of your muscles in the lower leg may become injured through excessive loading stress. This can result in muscle tenderness, inflammation or knots.
The most common muscles that cause shin splints are tibialis anterior (anterior shin splints) and tibialis posterior (posterior shin splints).
All bones are covered in a 'shell', called periosteum. The tendons, which connect the muscle to the bone, attach on to this periosteum. This zone at which the tendon meets the bone is known as tenoperiosteum.
Almost all cases of 'shin splints' have some element of inflammation of the tenoperiosteum. Inflammation of different tendons leads to pain in different areas of the shin.
Damage to the shin bone usually concentrates in the lower one-third of the shin bone (tibia). The bone damage may be mild, such as a simple stress reaction, or may be a severe stress fracture. Except in the worst cases, bone damage is not visible on normal x-rays. A bone scan or MRI may be recommended if your physiotherapist or doctor need to exclude or confirm a bone injury.
What are the Symptoms of Shin Splints?
Shin splints cause dull, aching pain in the front of the lower leg.
Depending on the exact cause, the pain may be located along either side of the shinbone or in the muscles.
The area may be painful to the touch.
The Four Stages of an Overuse Injury:
Your physiotherapist will guide you with respect to how much exercise you can do. Here are some basic guidelines until you seek your physiotherapist's opinion:
Stage One: Discomfort that disappears during warm-up
Injury identification and treatment in stage one, allows continuing activity as long as the injury does not worsen. Professional guidance is recommended to ensure that your condition does not deteriorate.
Stage Two: Discomfort that may disappear during warm-up but reappears at the end of activity
At stage two, activity may continue at a modified pain-free level while being treated. Treatment must continue until completely healed. Professional guidance is highly recommended.
Stage Three: Discomfort that gets worse during the activity
If the injury progresses to stage three, activity must immediately cease. Professional guidance is highly recommended.
Stage Four: Pain or discomfort all the time
All activity must immediately cease. Professional guidance is highly recommended.
How are Shin Splints Diagnosed?
Shin splints are usually diagnosed based on your medical history and a physical examination by your physiotherapist. In some cases, an X-ray or other imaging studies such as bone scans or MRI can help identify other possible causes for your pain, such as a stress fracture.
Treatment for Shin Splints
Phase 1 - Early Injury Protection: Pain Reduction & Anti-inflammatory Phase
As with most soft tissue injuries the initial treatment is - Rest, Ice and Protection.
Phase 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 remould 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, neurodynamic mobilisations and specific exercises.
Your physiotherapist will guide you.
Phase 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.
What Results Should You Expect?
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.
How Can Shin Splints Deteriorate?
Left untreated and with continued overtraining, shin splints can progress into tibial stress fractures, which will require a minimum of six weeks resting on the couch.
For more information please contact your physiotherapist.
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