Shin splints
Shin splints, or medial tibial stress syndrome (MTSS) as it is known in the medical community, is a condition characterised by widespread pain over the inside edge of the shin bone. This usually manifests in the lower third of the bone.
Shin splints is caused by increased muscle tension creating stress and pulling on the posterior medial edge of the tibia. This pulling, when it is repeated over a long time can lead to irritation and swelling within the periosteum (the thin layer of tissue that covers bone). If the pain is ignored and this pulling continues over a long period of time, it will start to weaken the bone, and this may lead to stress reactions and stress fractures. The three muscles that are thought to contribute the most to this traction are the soleus, flexor digitorum longus and the tibialis posterior. This increase in tension can usually be traced back to weakness, overworking or fatigue in these muscles and this can be caused by a variety of reasons such as:
Sudden changes in activity – This is probably the most common reason we see shin splints and is generally why we tend to see it more at the start of a sports season. This change in activity can be, going from the offseason to preseason training or competition without a slow build up or suddenly increasing running distance or weekly mileage. This can lead to shin splints as the muscles have not had a chance to adapt to the load and so they fatigue quicker and increase the loading over the medial tibia. This might even be due to poor mechanics higher up the leg, such as in the hip, leading to these increased forces.
Foot posture – Overpronation can contribute to this condition. Overpronation can increase the tension in your medial shin as these muscles will contract eccentrically to resist pronation and with repetitive use they can tire and tighten leading to increased stress over the periosteum
Change in running surface – Your body is good at what it is most familiar with and going from hard surfaces such as the road to soft surfaces like grass or sand (and vice versa) when you are unfamiliar with them can lead to increased fatigue on the muscles and increased stress on your bones. When running on hard surfaces the body adapts use the muscles to shock absorb and so if you change to a softer surface these muscles will suddenly have to work in a range they are not used to, leading to quicker fatigue. When going from soft to hard the muscles must learn to come on earlier and quicker as the surface is no longer absorbing as much of the load for them. This also extends to shoes, changing from a highly cushioned or motion control shoe to a racing flat can lead to the same effect.
Treatment
Once you have shin splints, the most effective treatment is relative rest. This will reduce the pulling on the posterior medial tibia and allow the pain to settle down. This does not always have to be complete rest from the things you love, depending on your symptoms. Your physiotherapist will be able to guide you on how much rest is needed and help to offload the area further with massage, taping, orthotics and stretching and strengthening exercises. Here at Aevum physiotherapy we are also lucky enough to have access to a state of the art AlterG anti-gravity treadmill, which can help more serious cases get on their feet, walking and running quicker by utilising the ability to move with a reduced body weight, which will limit the loading on the tibia.