Do you Suffer from Recurrent Shin Splints?
What a pain in the bone!
Words by APA titled Sports & Exercise, & Australian Olympic Team Physio Britt Caling
Shin Splints can be defined as “pain along the inner edge of the shinbone (tibia).” (American Orthopaedic Academy). ‘Shin Splints’ is the lay term for what is more commonly referred to as “Medial Tibial Stress Syndrome (MTSS)”.
MTSS is common in runners accounting for up to 17% of run-related injuries, and is also reported in other athletes that engage in jumping/plyometric type activities. It is characterized by pain on the inside of the lower leg in the region between ankle and knee, and is often more localised to the lower third of the tibia bone. MTSS pain is worse with activity and responds well to rest. Other signs and symptoms include:
– Pain on running, jumping, landing, increased weight-bearing activities which initially does not cause you to stop, however, this may be the case if symptoms and activity continue.
– The pain is normally described as an intense ache that reduces when the activity is ceased.
– On palpation there is pain along the lower inside border of the tibia.
– After activity the pain settles within 48 hours and does not wake you up at night. Often symptoms are worse on initial start-up of activity and improves through the session with worsening post-session/warm-down
The cause of MTSS may need to be differentiated as arising from:
1. Tibial bone overload, bone stress and possible early signs of stress fracture. During weight-bearing activities, the tibia bends causing bone strain. This strain normally causes micro damage in the bone, and a healthy response is for the bone to adapt to this by laying down more bone and becoming stronger. However, when the strain exceeds a certain threshold and the bone becomes overloaded, the bone cells may start to breakdown causing symptoms of bone stress.
2. Soft tissue origin due to traction of a tissue deep in the back of your calf. A tissue in your deep calf compartment called the intermuscular septum, in combination with the Flexor Digitorum Longus (deep to the calf muscles) and Solues (part fo the main calf muscle complex) muscles have a local attachment onto your tibia. This attachment may become symptomatic due to poor strength of your gastroc calf muscle, poor foot function and intrinsic foot muscle strength and poor differentiation of muscle within your deep calf.
Treatment for each of the 2 above causes is very different so if you experience MTSS pain it is essential to have your Sports Physio perform a thorough history & assessment to provide you with an accurate pathway of management.
Detailing specific treatment is beyond the scope of this article but should be discussed with your GCPSH physio because it needs to be individualised.
Prevention of MTSS involves:
– Maintaining excellent calf strength in both gastroc and solues. Your Physio can test your current calf strength-endurance capacity and guide exercises to improve this if needed.
– Establishing and maintaining good foot muscle strength and function. This can be achieved with foot muscle exercises and good technique in your sport. A visit to your Podiatrist may also be needed to guide the best shoe for you and/or prescribing orthotics to assist good foot function.
– Care with the addition or progression of weight-bearing exercise or activities in your training. Both your bone and muscular systems need time to adapt to any ground reaction forces. Liaise with a good coach to ensure your training is appropriate for you. Alternatively, discuss your training loads and progression with our GCPSH Exercise Physiologist or one of our Experienced Sports Physio’s.
– Discuss with your Physio the best surface for you to be training on.
– Regular performance of plyometric exercise (jumping, bounding, skipping exercises) in a limited form will assist in maintaining healthy bones. The use of these exercises needs to be guided by your Physio and/or Coach and/or Strength & Conditioning Coach. While these exercises are good for bone density, caution must also be used when adding/performing them and It is essential these exercises are performed in appropriate moderation, and with your training and medical history taken into account.
Other differential diagnoses for shin pain include: compartment syndrome; popliteal artery entrapment; various neuropathies; and frank stress fracture (there remains much controversy in the literature about whether MTSS and stress fractures are a continuum).
Should you be concerned about whether you have MTSS or a presenting differential diagnoses, seek an appointment with a GCPSH Sports Physio or our consulting Sports Physician for a thorough and detailed management.
Phone us on 07 5500 6470 for an appointment, or Book Online.