Shin Splints

posted in: ankle, calf, foot, The Lab | 0

Are you a runner or athlete who is struggling with lower leg pain?

Do you have achy shins?  Does the tibia bone hurt when you press hard on it – from the ankle to just below the knee?

If so, you may be experiencing shin splints and didn’t even know you had them.  Maybe you do know you have them, and taking anti-inflammatories, wearing gnarly orthotics, and rest has not really done much. Well we hate to break it to you, but taking a pill, providing added support or pillowy shoes, or rest will NOT fix the CAUSE of your achy shins.


What are Shin Splints?:

Shin splints are one of the most common overuse leg injuries. It is also known by a number of other technical names, such as medial tibial stress syndrome (MTSS), soleus syndrome, tibial stress fracture, periostitis, exercise induced leg pain and chronic exertional compartment syndrome.

Tibial Stress Fracture
www.methodistorthopedics.com

Shin Splints
http://chicagofootcareclinic.com/footproblems/commonfootinjuries/shinsplints.html


Symptoms: 

There are two spots where the pain is typically found:

  1. Front of the lower leg : When you feel pain in the front of your lower leg it is usually due to overuse of the anterior tibialis muscle, a limited or stiff calf (gastroc- soleus complex), a weakened anterior tibialis, and/or an over-pronated foot when bearing weight.
    Shin Splints- 2
    http://teamdoctorsblog.com/2012/12/shint-splints-self-help-tips-treatment-and-prevention-from-team-doctors/
  2. Back of Lower Leg: When you feel pain in the back of your lower leg it is usually due to a weak or inflamed posterior tibialis muscle (one of the tissues that supports your arch), a tight calf (gastroc-soleus complex), and/or muscle fatigue from training beyond your capacity.


Causes: 

Remember that the location of the pain is rarely the location of the cause.

Causes include:  Overuse, fatigue, muscle length issues, tightness or stiffness in the calf region, anterior tibialis (muscle on the front of the lower leg), and or posterior tibialis (muscle on the back of the lower leg), weakness in the lower leg and hips.

If you have really tight calves (gastroc-soleus complex) it can create a weakness or even inhibit (shut off) the anterior tibialis, the muscle on the front of your lower leg that helps dorsiflex your foot when running or walking as well as helps control the plantar flexion when running or walking.  This is not an awesome feeling and throws off the biomechanics our bodies are designed to deliver.

Another cause is from poor shoe choices that weaken your feet.  Wearing pillows on your feet or shoes with more than a zero drop, zero arch are doing your feet a disservice and making them weak. When your feet are weak it creates a weakness up the chain  – specifically in the front of your shin and leads to a tight calf (gastroc-soleus) complex.  2


Who Experiences Shin Splints

Anyone!  Runner, Non- runners.  Shin splints are activity-based so anyone who walks, runs with pillowy shoes, high heels, and or weakened and stiff lower leg tissues is susceptible to them. 3


What the research says about shin splints: 

  1. Shin Splints make up 12-18% of all running injuries.3
  2. Ankle Dorsiflexion range of motion is found to be a significant predictor of the risk of incurring shin splints.  Poor mobility is associated with up 2.5 times the risk of injury and high levels of mobility (hypermobility) are associated with 8 times the risk for obtaining injuries such as shin splints. 4
  3. Those with pronatory foot types and navicular drops are also are at higher risk for shin splints.  Mobilizing and strengthening all deficits in the kinetic chain should be corrected.  For example, if your ankle flexibility is not the issue, then focus on strengthening the foot muscles, lower leg muscles, as well as glutes (all 3 of them). 5
  4. If you are an avid runner, wearing compression sleeves or socks around your lower leg are also very helpful.5


Tests – Treatments  


Ask yourself these questions:

  1. Can you do a pistol with a strong active foot and hip?
    If No, then start there, on the calves (gastroc-soleus complex) as well as posterior tibialis muscle.
  2. Can you sit back on your heels with your toes pointed?
    If no, then work on the mobility of the front of the shin.If yes, then work on the strengthening of the front of the shin.
  3. Can you walk on your heels?  Another test especially if you CAN get into a pistol.  This will show how strong your anterior tibialis muscle is. If it is a struggle, then you know what other area you need to work on.
  4. Can you do 20 single leg calf raises (just lifting your body) no problem without losing range of motion?
  5. When standing do you lose your arch in your foot?  If Yes, then start to work on the arch of your foot by gently LIFTING the bottom of your foot towards the sky. This does not have to be a 1 RM endeavor, rather a gentle lift (your toes should not be gripping). Keep your feet like that all day when standing statically or sitting. When you move keep your toes facing forward and your arches from caving in the entire time.  Your arches should cave a little when walking and running but not the entire time your feet are on the ground. 5


Movement Rx Prescription for you: 

  1. Perform the preceding tests, and work on the POSITIONS you found were limited as well as strengthen the positions you found were weak.
  2. If you are still having trouble, Call us at 1- 877-854-1343.


References: 

1Kisner C, Colby LA. Therapeutic Exercise Foundations and Techniques 5th Edition. Philadelphia PA: F.A. Davis Company. 2007: 776-777

2Starrett K, Murphy, TJ. Ready to Run. San Francisco, CA: Victory Belt Publishing. 2015.

3Wilder RP, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clinic and Sports Med. 2004; 23: 55-81.

4Pope R, Herbert R, John K. Effects of Dorsiflexion range and pre-exercise calf muscle stretching on injury risk in Army recruits. Australian Journal of Physiotherapy. 1998; 44:165=172

5Bennet JE, Mark RF, Bridget P, et el. Factors contributing to the development of medial stress syndrome in high school runners. JOSPT. 2001; 31:504-510