Shin splints, also known as medial tibial stress syndrome (MTSS), is a common injury affecting runners, athletes, and people who engage in high-impact activities. In this blog post, we will look at lower limb anatomy, risk factors for Shin Splints and What the goal of Physiotherapy is in this condition.
Anatomy
The Tibia (Shin Bone) and its surrounding soft tissue structures including muscles and tendons aim to ensure appropriate force absorption during impact activities such as running. Shin Splints typically develops from overuse and repetitive stress, where the medial (inside border) of the Tibia becomes inflamed and painful. Inflammation occurs as a result of bony microtrauma and consequential stress response of the outer lining of the bone (Periosteum) as a result of overloading.
Though not as serious as fractures, shin splints can still cause significant discomfort and disrupt physical activity. If not treated properly, they may lead to chronic pain and more severe injuries, such as stress fractures.
Bony Anatomy of the Lower Limb
Risk Factors for Shin Splints
Several factors can increase the likelihood of developing shin splints. These include:
Overuse or Sudden Increase in Activity: A rapid increase in exercise intensity, duration, or frequency, especially in high-impact activities, may exceed the capacity of the bony and soft tissues structures of the lower limb, leading to an inflammatory response.
Improper Footwear: Wearing shoes that don’t provide adequate support or cushioning can lead to changes in proper alignment and excess strain on the shin area.
Increased BMI: Having a higher BMI leads to increased lower limb forces during activities, increasing the risk of developing injury,
Weak or Imbalanced Muscles: Muscular imbalances or weakness in the lower leg, increases the chance of getting shin splints
Previous Injury: Having a history of lower limb injuries increases the likelihood of developing shin splints due to the biomechanical changes that come about as a result of previous injury.
Before we move onto physiotherapy treatment of shin splints, what % of runners do you think suffer from this condition? (Answer at the end of the blog)
Up to 10%
Up to 20%
Up to 30%
Up to 40%
Physiotherapy Treatment for Shin Splints
Physiotherapy plays a crucial role in managing and treating shin splints. The treatment process follows a systematic approach to relieving symptoms and gradually increasing loading through specific exercises. Here is an example of what a treatment pathway for Shin Splints might look like:
1. Offloading Period & Pain Management
For those with very irritable and painful Shin Splints a specific offloading period is utilised to reduce inflammation and allows the area to “Settle”. At this time, pain management strategies such as Ice/Heat, Analgesia and Taping are prioritised.
2. Physical Assessment
An individualised Physical Assessment is completed to highlight any key areas of muscular weakness and functional imbalance to work on through the Rehabilitation process. This helps us to target important areas of the musculoskeletal anatomy to reduce future likelihood of injury
3. Re-loading period
As the area settles and pain reduces, a graded loading protocol is utilised to regain the functional capacity of the lower limb to be able to manage higher load activities like running. Building through this graded exposure protocol ensures minimal injury flare-up and optimises outcomes of rehabilitation. Exercises may flow from initial Isometric loading > Functional Plyometrics to restore full capacity and tolerance to higher load activities.
4. Package Treatment
A variety of treatment modalities may be utilised on the rehabilitation pathway and may include: Massage, Manual Therapy, Taping, Orthotics, Dry Needling and Electrotherapy. However, these extra modalities are only utilised in addition to our earlier discussed loading protocol and on an individual case-by-case basis.
3 Shin Splint Rehab Exercises to try
Depending on the irritability of your condition, you may be able to utilise these exercises in the initial stage of the condition before seeking a Physiotherapist for guided rehabilitation. However, these exercises should evoke a pain response >2/10:
1. Tibial Raises
Strengthening the tibialis anterior (Muscle on the front of the shin) is an important aspect of rehabilitation. Start in sitting or standing, the aim is to bring your toes up towards your shin, then slowly lower. Keep this exercise done slow and controlled throughout the movement for the most benefit early on.
2. Foot Intrinsics
The intrinsic muscles of the foot are important for stability. In the initial stage, simple foot strengthening exercises can be very useful. During running based activities, the foot is the first part of the body to make contact with the floor. Therefore, building a solid base for repeated ground contact is essential. Start in sitting with your foot up and your toes extended, then while keeping your toes extended, point the foot. When you get to the bottom, curl toes your toes, while keeping the toes curled, bring the foot back up, then repeat.
3. Isometric Heel Raise
Just like building strength in the Tibialis Anterior is important, the muscles of the calf complex (Gastrocnemius/Soleus) need some love to. In the initial stage while the area is still irritable an Isometric heel raise is a great way to get some calf loading introduced into your rehabilitation.
Its just like completing a normal calf raise, but hold towards the top of the raise and hold for a period of 10-45s, depending on what is tolerated.
Conclusion
The Answer to the question above was: Up to 20%!!
Shin splints are a painful and often frustrating condition caused by repetitive stress on the lower leg, but with proper care, they can be managed effectively. A comprehensive treatment plan that includes rest, physiotherapeutic intervention, and modifications to exercise habits can help alleviate pain, promote healing, and reduce the risk of future injuries. If you're experiencing shin splints, seeking advice from a physiotherapist can provide personalized strategies to get you back to your routine safely and efficiently. Find some extra links below to more information from the NHS & Journal Articles:
NHS Website: https://www.nhs.uk/conditions/shin-splints/
Journal Article - ShinSplints: https://www.ncbi.nlm.nih.gov/books/NBK538479/
If you are interested in more Physiotherapy Blog content check out our other posts!
Jake Solomons (HCPC, mCSP)
Elevate Physiotherapy
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