Shin Splints

THE TIBIA

This is the main long bone in the lower part of the leg, sometimes called the shinbone. The smaller long bone which runs down the outer side of the leg is known as the Fibula.

TIBIALIS ANTERIOR

Tibialis Anterior is a muscle in the lower leg below the knee. Tibialis Anterior has attachments to the Tibia bone on the upper two thirds of the lateral (outside) part or surface. The muscle goes down the outside of the Tibia towards the ankle where it crosses over the front of the ankle and attaches to the medial (inside) surface of the medial cuneiform and first metatarsal bone in the foot.

TIBIALIS ANTERIOR ACTIONS

The main actions of Tibialis Anterior is to assist in Dorsiflexion that is the action if lifting the foot and toes up off the floor when we are walking or running. The other action of Tibialis Anterior is Inversion of the foot and ankle this action turns the foot and ankle inwards. It will also act as a stabilizing muscle with other muscles around the foot and ankle in an action called group action, where muscles work together in certain movements to keep the joint in motion stable.

• The main symptom of shin splints is pain down the front and side of the shin bone (Tibia).
• Physical exercise and sports usually exacerbate (make worse) the pain in the shin and continue even at rest.
• Most of the time shin splints are a dull ache becoming more painful when continuing to exercise.
• Shin splints may affect one or both legs.
• Pain might increase if you palpate (press) on the muscle belly itself, down the front of the shin bone.
• Sharp pain on heel strike can be caused by a stress fracture.
• Local swelling might be visible.

If you get aches or pains on the front of your lower legs the chances are it is shin splints. There can be other causes of aches and pains in the front of the lower legs which we will cover later in this article. If there has been no serious trauma or injury and the symptoms get worsen on exercising then self-treatment can get rid of your shin splints. ATLPhysio will give you our help and guidance so that you can return to your sport or chosen activity as quickly as physically possible. The way shin splints got its name was quite simply the shin bone which is called the Tibia it has a ridge that runs down the length of it and it is commonly referred to as the shinbone. Just like the pads footballers use under the front of their socks when playing which are known as shin pads. These protect the shinbone (Tibia) at the front because it is prone to injury. The aches and pains in the front of the lower leg or legs as shin splints can affect both legs, normally get worse over a period of weeks or months let us look at the causes.

• It might be increasing your activity levels too much.
• Starting a new or harder exercise program.
• Being overweight.
• Tight calf muscles.
• Weak lower limb muscles.
• Flat feet.
• Poorly fitting shoes or trainers.
• Worn out shoes or trainers.

At ATLPhysio I have only treated people who have either started running or increased the intensity of their training programs.

Most of the time the causes of shin splints are unclear, that is why the ATLphysio list covers a wide variety of reasons. There could be several other factors that are not listed here or it could be that the shin splints could be caused by several factors that have been listed.

Other Causes

Lower limb sprains and strains

Tendon injuries and tendinitis around the ankle

Stress fracture in the Tibia or Fibula

Peripheral arterial disease.  Not common in sports and active people.

Lower leg compartment syndrome this problem is where the muscle fibres in the lower leg enlarge through training or other causes and this increase in the size of the muscle fibres causes pressure in the compartment leading to a dull ache or pain.

Most of the time shin splints can be treated at home. The following advice may help relieve the aches and pains in your legs.

REST

This is the first stage and not one athlete’s prefer to here from therapists, trainers, GP or Doctors. Unfortunately, this has to happen to prevent further aggravation, overuse and injury. Rest is also giving your body time to heal and repair itself. How long you ask? Well tissue aggravation is a better option that tissue damage, so stop or ease up on your activity. ATLphysio would recommend a three to four weeks rest or reduction in activity. If reduction in your activity does not reduce the symptoms you have no options but to stop activity altogether. After this time start and return to light physical activity and gradually increase the level of intensity over the next three to four weeks.

ICE

Whilst resting, reducing or stopped activities altogether ice needs to be used right at the start. Ice bags, ice cubes broken up in a light cloth or a bag of frozen peas all will do the same job. Hold the ice pack against the leg for approximately 20 to 25 minutes every 3 hours were practically possible. Ice acts as an analgesic and helps with swelling and pain.

COMPRESSION

Compression is not always a necessity with certain injuries or muscular skeletal problems and in some cases not always practical. To say to an athlete or active person who has sustained an injury you must follow the R.I.C.E. idea of treatment is sound advice indeed but the injury may not require the compression or elevation phases. Having to treat shin splints is much different than having to treat a grade 2 sprained ankles. Look at ATLphysio article on Sprained Ankle. It is possible that compression stockings may help in both the early and later stages of shin splints and even some taping methods should not be ruled out.

ELEVATION

Elevation like with compression might not be essential in the self – treatment of shin splints. Other than a resting phase of putting the feet up to relax when not on your feet might be the only thing required.

CONTINUING SELF TREATMENT

Starting with the rest and R.I.C.E phases ATLphysio’s continuing self – treatment advice would be:

SHOE INSOLES

Shoe insoles may be beneficial in correcting people with over pronation of the feet. This may require advice or assessment from a foot specialist.

MEDICATIONS

Over the counter medications such as Ibuprofen, Paracetamol for 7 to 10 days maximum may help. If uncertain then speak to a pharmacist, GP or Doctor for advice. Ibuprofen can be bought in gel form which can be massaged into the leg. Ibuprofen is a medication in the non – steroidal anti-inflammatory drug known as NSAID’s a class of drug which is used for treating inflation and pain.

TAPING

Taping may help, such as kinesio tape and K-tape. These sports tapes have different functions and qualities than the adhesive bandage tape.

COMPRESSION SOCKS

Compression socks have become very popular with athletes especially runners.

RESISTANCE BANDS 

Resistance bands have also become very popular in recent times and are widely used by individuals and therapist.

LOW IMPACT ACTIVITIES

In the early stages changing to low impact activities such as swimming, coss-trainer, stepper, yoga, tai chi or static bike.

FLEXIBILITY EXERCISES

Doing stretching exercises to the muscles of the lower leg may make your shins feel better.

STRETCHES OF THE LOWER LEG MUSCLES

The stretches list next might help prevent shin splints and will help in aiding your recovery from shin splints.

TIBIALS ANTERIOR STRETCH

Because Tibialis Anterior dorsiflexes (lifts the foot upwards to the shin) and inverts (turns the foot inwards) to stretch the muscle and tendon correctly 2 stretches are needed. One for the muscle and one for the tendon as it crosses over to the inside of the foot.

The opposite action of dorsiflexion is plantarflexion (pointing the toes downwards) and the opposite action of inversion is eversion (turning the foot outwards)

TIBIALIS ANTERIOR MUSCLE STRETCH

In a sitting position on the floor or sat in a chair, cross your affected leg onto the other leg just above the knee.

Grasp the far outer side of your foot with the same side hand.

Pull the foot across and inwards and hold for 20 seconds then relax.

Repeat the stretching exercise 10 times 20 seconds.

TIBIALIS ANTERIOR TENDON STRETCH

In a sitting position on the floor or sat in a chair, cross your affected leg onto the other leg just above the knee.

Grasp the top of the foot by the toes with the same side hand.

Pull the foot across and slowly push the foot down.

Repeat the stretching exercise 10 times 20 seconds.

GASTROCNEMIUS STRETCH FEET ROLLED OUTWARDS

Stand with your hands against a wall and at arm’s length.

Place your feet hip width apart.

Roll your feet outwards then bend your arms and lean forwards till you feel a stretch in your calf.

Keep the legs straight and the heels on the floor for 20 seconds then relax.

Repeat the exercise 5 times 20 seconds.

HEEL AND ROLL WALK

Stand with your feet apart take a pace forwards placing the heel on the floor with the toes upwards.

Slowly lower the foot whilst rolling the foot on the outer part until the big toe is on the floor.

The foot should be flat and slowly transfer your weight to the forward foot.

Repeat the next step with the other leg in the same pattern.

Repeat the stepping exercise for 10 paces then turn around for the next 10 paces.

STRENGTHENING EXERCISE FOR TIBIALIS ANTERIOR

Sitting on the floor

Tie an exercise band around something sturdy or your unaffected foot.

The affected foot should be turned inwards toes pointed up.

Turn the foot outwards and upwards towards your shin and hold for 2 seconds.

Relax the foot to the start position and repeat the exercise x 10 to 15 repetitions.

STRENGTHENING EXERCISE FOR GASTROCNEMIUS

DOUBLE HEEL RAISE SLOW AND FAST

SLOW EXERCISE

Stand with your hands against a wall or hold onto a work surface for support and balance.

Feet shoulder width apart.

Lift the heels slowly off the floor to the highest point to the count of 5 seconds.

Then lower the heels down to the floor.

Repeat the exercise x 10 to 15 repetitions

FAST EXERCISE

Stand with your hands against a wall or hold onto a work surface for support and balance.

Feet shoulder width apart.

Lift the heels up of the floor to the highest point as quickly as you can.

Then lower the heels down to the floor.

Repeat the exercise x 10 to 15 repetitions.

SINGLE HEEL RAISE

Progress strengthening Gastrocnemius by doing the same exercises standing on one leg at a time.

The sequence will be the same exercises slow and fast.

The following advice from ATLphysio may help individual’s chances of preventing shin splints, this is our advice:

Grade the increases of training at a steady progressive manor.

Incorporate stretching exercises before and after your training sessions.

Warm up and warm down at each of your training sessions or activity.

Wear appropriate training shoes with good insole support.

Introduce new activities gradually.

Mix training sessions with high and low impact activity.

Improve your general fitness levels.

If overweight, diet and fitness activities tend to be the best combination for losing weight.

Avoid uneven surfaces and run on track or playing fields.

It is a good idea to see your GP or Doctor if your leg pain does not improve or increases after following the self-treatment guide lines. Your GP or Doctor will ask about your symptoms and examine your leg to assess the cause of your leg pain.

Your GP or Doctor might refer you for an X-ray or scan to help diagnose the cause of your ongoing leg pains.

They may refer you to a physiotherapist for an assessment of your lower leg pain. The physiotherapist might treat you with exercises, stretching, ultra-sound or even acupuncture. They may also provide you with a suitable programme of activities.

Your GP or Doctor might refer you to an orthopaedic specialist or a consultant in sports medicine.