Shin Splint aka Medial Tibial Stress Syndrome
Published: 24 July 2024
What are Shin Splints?
Shin Splints, or Medial Tibial Stress Syndrome is one of the most common conditions we see at The Physio Clinic Glasgow. Athletes, and in particular runners are more susceptible to the condition. This often results in those with shin splints exercising and running less, or taking time away from their activities all together.
Essentially shin splints are a normally a condition of overuse. That meaning, athlete's have been often doing a little too much, a little too frequently for a little too long without adequate rest. But there may be other factors involved such as inadequate nutrition, general stress or possibly other factors not yet established.
The most common site of pain is the upper portion of the shin bone (the tibia), with tenderness over the region and pain exacerbated by running, jumping or landing activities. We often see a pattern of gradually worsening pain through a session, where the athlete has to eventually stop due to higher pain levels. On rest, athletes often notice fairly quick reduction in symptoms but it is not unusual for the pain to take days to start to settle down again.
Shins splints itself can be described as a periostitis, which is an irritation or inflammation of the soft tissue that covers the tibia bone. It is rich in blood vessels which provide nutrition to the bone, and is highly innervated meaning it has many nerve endings in the tissue. With this high innervation means the area is very sensitive, and so shin splints can be very uncomfortable for some people!
Additionally, there can be changes in the structure of of the underlying tibial bone with some athletes with shin splints. This can be described as cortical change.
What Can Physiotherapy Do for Shin Splints?
Essentially, the goal of physiotherapy is to reduce the accumulative load on the tibia to allow symptoms to settle and let our athletes return to the level of exercise they want to perform. Here are a few of the main strategies we may adopt:
Load Management
Load management is the deliberate reduction in activity with a goal of settling an athlete's issue. In runners this may involve a running plan with reduced training days, slower runs or even a reduction in inclines/ declines involved in runs (just less hills really).
In team sports athletes, this may involve similar strategies to runners. But more specifically, this could involve athletes partaking in less intense drills or non-contact drills when training. Often, this may involve capping athletes playing less minutes in competitive games, eg a footballer playing 45 mins per game vs a full 90.
By managing an athlete's load we usually avoid a period of complete rest from activity, which is not often the answer for resolving shin splints. More so active people like being active, so keeping athletes in there sport to some degree is typically very important to the person.
Strengthening
The goal of strengthening is actually much the same as with load management, that being we want to reduce the load on the tibia.
One particular area that is important to focus on is the calf complex. This includes the long calf muscle (gastrocnemius), and the shorter calf muscle (soleus). The soleus in particular is important in absorbing force on landing, and generating force with running.
Normally, this will entail a progressive heel raise plan starting with two foot variations progressing to heavily weighted single leg heel raise variations. Again the goal is to reduce force absorbed through the painful tibia, and in this case through the calf complex.
The glutes also plays a key role on reducing force through the tibia. And in particular, strengthening of the gluteus medius and gluteus minimus which are important stabilisers and force absorbers at the hip shoulder be prioritised.
There are an abundance of exercises which effectively strengthening the glutes, however we utilise a mixture of typical weighted squat and single leg variations, step ups and pilates style exercises to achieve this.
Impact Tolerance
We can promote positive changes in the bone and and periosteum of the tibia with a gradually progressive landing/ impact exercise plan. This is often performed early to mid rehab, and involves exercises which produce higher forces on the shin without flaring symptoms. We typically adopt a little and often approach to this, which differs from how we may strengthen.
Early impact tolerance exercises could include running or hopping on the spot, and progresses to broad jumps (jumping forwards onto two feet) and depth drops (dropping from a low surface to the ground). Laterally, this might include box jumps and other plyometric based movements.
Other Stuff
There are some that utilise other treatments with shin splints. The evidence, or research is often not supportive of many of these or is simply not there. So considering that, we always keen to focus on what we know works, which is load management, strengthening and impact/ loading exercise.
Soooo What's the Prognosis?
Well... Physiotherapy focusing on the above can be very effective in helping athletes with shin splints. However, the tissue involved including the bone and periosteum take time to settle and adapt to loading. Additionally, strengthening exercises normally takes months to yield bigger changes in strength/ force absorbtion.
With this, it is likely it will take an athlete months to resolve there issue. This is particularly the case with people more longstanding pain.
What is important to consider is that it is likely that what an athlete can perform and manage will be gradually greater throughout the rehab process. So what we can manage on month 3 will be greater than month 1, which will be greater than on week 1!
* note this is not meant as medical advice, if you have symptoms of shin splints we strongly recommend seeking a qualified physiotherapist to assess your issue!