Do you feel pain along your shins when you run or exercise?
If so, then you are likely experiencing something called “shin splints”.
Shin splints are one of the most common running injuries, reported to make up to 12-18 per cent of all running injuries.
What are shin splints?
Shin splints is not a true diagnosis but rather an umbrella term that includes various pathologies that can affect the shin (tibia). Shin splints are also referred to medically as ‘medial tibial stress syndrome’. Pain can be felt from the knee to the ankle along the shin bone.
What causes shin splints?
The cause of shin splints typically involves a combination of factors as opposed to a single factor. A common and significant factor in the onset of shin splints is a sudden and significant increase in training load and intensity. Have you recently added incline sprints to your running schedule? Or maybe your number of runs per week or distance of your runs? This can lead to overuse; Where the muscles and tendons are not able to handle the load and stress they are experiencing. Other factors include tight or weak calf muscles, poor hip stability, poor foot stability, incorrect running technique and inappropriate footwear.
How can you recover from shin splints?
There are 3 key principles when treating shin splints:
- De-load the bone.
- Address possible causative factors.
- Return to running with an appropriate loading program.
De-load the bone:
In the initial phase of rehab, you may need to cut back on running distance and/or intensity or put a complete pause on running altogether. This is all dependent on pain levels. In that case you want to maintain cardiovascular endurance by performing other non-impact exercises such as swilling and cycling. This is the same principle for athletes playing sport.
Address possible causative factors:
Those who address the contributing factors to their pain will have a better outcome than those who just rest and wait for the pain to subside. Those who don’t address the contributing factors will likely return to running and experience a recurrence of their shin pain. Contributing factors that must be addressed include:
- Training errors: Education on training load intensity, volume and scheduling appropriate rest between running. This is all individualised to the patient depending on fitness levels and training goals.
- Incorrect running technique: This is often related to an over-striding gait whereby the runner’s landing foot lands in front of their base of their support causing them to produce force that transmits increased loads through the foot, ankle and shin.
- Weakness of the hips: Weakness of the hip muscles (glutes, hip flexor) will increase the load that the runner will encounter with each stride. This will increase the workload of the runner’s ankles, shins, knees and even their lower back.
- Weakness and fatigue of the soleus/calf muscle: just over 50% of the propulsion when running is generated below the knees This means that the calf/soleus muscle need to generate a lot of power lots of force repeatedly. If a runner has deficit in calf/soleus strength, there will be increased loading on the shin. Not only does the calf/soleus muscle need to be strong but also needs to have good endurance to be able to produce forces quickly and repeatedly over a long period of time.
Return to running with an appropriate loading program:
The process to return to your previous level or running will require patience and time. If you rush back into running at an intensity which outweighs your threshold, you may experience shin pain once again and this may set you back even further. Rehab may even take up to 9-12 months for someone who has experienced shin pain 3 months or longer.
There is no magic formula for this phase of rehabilitation. It is important that the health practitioner communicates well with the runner. This is a case-by-case basis whereby the runner’s goals, injury history running volume and overall fitness/health will all be accounted for. A return to running program will be prescribed and be set at weekly, fortnightly and/or monthly intervals with progressions in distance and intensity made until the runner is able to run at their previous level with no pain. Often, runners can be too overzealous and do too much too soon. By following a prescribed running program, this can minimise the risk of recurrence and is important if shin pain is to be avoided.
How can physiotherapy help?
Our physiotherapists can assess your symptoms, running technique and muscular imbalances that may be contributing factors to your pain. Your physiotherapist will work with you to generate an appropriate treatment plan to get you back running and playing sport pain free and can minimise the risk of recurrence in the future.
If you are experiencing what you might think to be shin splints, book an appointment now with one of our team members and let’s get you back to running pain free and doing what you love most.
Written by Nick Dimos (Physiotherapist)