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Everything You Need to Know About Shin Splints

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:

  1. Anterior (along the front of the shin)
  2. Posterior (along the inside of the shin)
Most Common Causes

Generally shin pain arises from a combination of three structures:

1) Muscles
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).

2) Tenoperiosteum
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.

3) Bone
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:

  1. Discomfort that disappears during warm-up.
  2. Discomfort that may disappear during warm-up but reappears at the end of activity.
  3. Discomfort that gets worse during the activity.
  4. Pain or discomfort all the time.

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.

In the early phase you may be unable to walk or run without pain, so your shin muscles and bones need some active rest from weight-bearing loads. Your physiotherapist will advise you on what they feel is best for you.
Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.
Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.

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 3: Normalise Foot Biomechanics
Shin splints commonly occur from poor foot biomechanics eg flat foot.
In order to prevent a recurrence, your foot will be assessed. In some instances you may require a foot orthotic (shoe insert) or you may be a candidate for the Active Foot Posture Stabilisation program.
Your physiotherapist will happily discuss the pros and cons of both options to you.
Phase 4: Restore Muscle Strength
Your calf and shin muscles will need to be strengthened to enable a safe resumption of sport or training.

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.

It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.
The severity of your shin splints, your compliance with treatment and the workload that you need to return to will ultimately determine how long your injury takes to successfully rehabilitate.

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.

Less commonly, if your muscle sheaths become compressed by engorged muscles - muscle compartment syndrome can develop. Muscle compartment syndrome is a very serious shin complaint that often requires surgical intervention to prevent permanent muscle damage.

For more information please contact your physiotherapist.

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