An Article Written by Yen-Chii Wong
Podiatrist – New Step Podiatry
SHIN SPLINT MANAGEMENT
"I can't today, I've got shin splints"
If this term sounds familiar, you’re not in the minority. Shin splints affects a large population of runners or those who play sports that involve running (e.g. soccer, AFL, rugby, basketball). It can be frustrating to experience because of:
a) How painful it can be to walk, let alone run on the hurt leg
b) How long it takes to recover
c) How easily it seems to come back when you think it’s healed
– Medial tibial stress syndrome
– Chronic exertional compartment syndrome
– Tibial stress fracture
– Tendinopathies or muscle strains of surrounding muscles
– Neurovascular entrapments
Want to know more on the three most common types of shin pains, their causes, treatment and preventative steps? Click here or on the picture to go to our previous blog article about shin splints.
Let's focus on...
Medial Tibial Stress Syndrome
For the purposes of this article, we will be focusing on medial tibial stress syndrome, or MTSS.
Medial tibial stress syndrome describes pain along the lower two-thirds of the shin bone (tibia). MTSS is best described as a continuum where the tibia experiences increasing levels of overloading. The end of the continuum results in a tibial stress fracture, where the bone can no longer deal properly with the loads it is taking on. This is why it is so important to treat MTSS early on to avoid potential future complications. Unfortunately, pushing through or ignoring the pain will not make it go away. The treatment for MTSS is multi-faceted because there are many factors that can contribute to its development.
The goal of treating MTSS is to firstly reduce pain, then to allow you to participate in your sport without the same issue recurring. We do this by treating soft tissue, bone, running gait, and mechanical issues to better deal with high loads that go through the legs with impact activity. In the early stages where there is minimal bone stress, treatment will involve:
Strengthening And Stretching Exercises
Running Gait Re-Training
Addressing Biomechanical Factors
Addressing any underlying conditions
This will most likely mean 2-3 weeks (or more, based on how painful the symptoms are) off running or high impact sports. It will be followed by a gradual return to run process, meaning you can’t go back to running 10kms straight away! For many runners, this is a hard pill to swallow. This is one of the main reasons MTSS can be dragged out for longer than it needs to (like it did for me). Your Strava or Garmin stats / run streak can wait, and there will be other races or games for you to participate in. It helps to think about the long-term plan – 2-3 weeks off running and a return to run is a lot more appealing than 4-5 months off with a more serious stress injury. Trust the process!
In the meantime, you are more than welcome to keep those fitness gains by other sports like weightlifting, cycling, and swimming. These sports can also help to strengthen up muscles that you use when running. This down time is also a good opportunity to address other contributing factors that lead to the shin pain.
Try to resist the urge to do a small ‘test run’ or poking the area to see how it’s feeling in this period. This sudden loading of the shin bone can slow down the healing process. We want to encourage the area to heal as quickly as possible so you can get back running sooner.
Strengthening and Stretching Exercises
When we run, our calf muscles – specifically the soleus which attaches just under the knee and continues into the Achilles tendon – take on 6.5-8x our bodyweight. Other muscles that are under the pump are the quadriceps, hamstrings, and gluteal muscles. You may be more susceptible to MTSS if your calves are not strong enough for the force they need to take on when running.
A progressive loading program to strengthen these muscles can aid in a reduced risk of MTSS recurring. This is a really important aspect of your recovery because it can help reduce future risk of injury. You should be able to start muscle strengthening while you take a bit of time off running. Plyometric exercises involve jumping and encouraging the use of your foot and ankle as a spring and will be introduced when it is appropriate. Incorporating plyometric exercises that help with the efficiency of landing and taking off can also help your running economy.
Running Gait Re-Training
Factors like overstriding, hips moving excessively up and down, and minimal knee bend at heel strike can increase the amount of force that needs to be absorbed by the calf muscles and shin bone. It also means more energy needs to be generated through the muscles to keep you moving.
Making small adjustments with some simple cues can reduce forces going through the calf muscles and shin bone. We may even recommend seeking the help of a professional running coach if needed.
Addressing Biomechanical Factors
We may find certain aspects of your lower limb mechanics can influence the amount of force going through the tibia to lead to MTSS. These factors are variable – you could have a flatter arch, higher rigid arch, bowed legs, knocked knees, stiff ankle joints, too much internal rotation of the hip, rigid or hypermobile big toe joints… That’s also not to say that if you have these things, you will definitely get MTSS. It’s just another piece of the puzzle.
Your podiatrist can identify if any of your biomechanics is contributing to your shin pain. We may recommend changes in footwear or foot orthoses. Manual therapies like foot mobilisation and dry needling can help with restricted joints or ‘tight’ feeling muscles.
When you start your return to run, the Solushin is a great tool that can be utilised in your recovery. It is a splint that can be worn before and after exercise and helps to improve ankle range of motion and reduce tension in calves. The splint applies counter traction to the soleus (calf) muscles to reduce tension within the calf. The compression of the device assists with inflammation.
Addressing Any Underlying Conditions
Checking for underlying conditions that may contribute to lower bone density is not only part of management but an important preventative measure for future injuries. We want to make sure you are at a low risk of a bone stress injury becoming a stress fracture. Factors we may encourage you to investigate include low vitamin D and calcium levels, hormone-related imbalances, high training loads, and a stressful lifestyle.
If your MTSS is left untreated, it will progress to a stress fracture. The return to sport time for a stress fracture is significantly higher than that of an MTSS injury.