Shin Splints

What are Shin Splints?

‘Shin Splints’ is the generic term often used to describe pain that occurs in the front aspect of the lower limb, along the shin bone (tibia). In medical terms, it is known as Medial Tibial Stress Syndrome (MTSS) which more accurately describes the most common origin of symptoms.

However, the terms MTSS & shin splints are often misused to describe symptoms for pain from different origins in the lower limb. The location of the pain is important to differentiate as this can lead to a more successful outcome in rehabilitation.

Different ‘Shin Splint’ locations

Due to the variety of locations that symptoms may arise, it is important to discuss them independently;

·       Anterior Shin Pain – More likely to be the result of strain / inflammation to the connective tissue between the muscles and bone in this compartment (Tibialis anterior). Pain is typically felt vertically (top to bottom), along the length of the tissue.   Stress fracture pain can also be felt anterior but tends to be more specific in location and runs horizontally.

·       Medial Shin Pain – Maybe caused by overuse of the soleus muscle and its fascia that connects to the periosteum (connective tissue surrounding the tibia). Stress fractures can also occur along the medial aspect of the tibia, again with symptoms being more localised and horizontal.

·       Lateral Shin Pain – Can often be attributed to peroneal muscle / tendon injury or fibula stress fractures. Both of these can be caused by heavily spraining the ankle.

·       Posterior Shin Pain – Tends to be focused around the attachment of the posterior, deep and superficial compartments and the muscles that connect to the tibia and fibula along the length of the lower limb. Pain in this area can also be from Achilles Tendinopathy (see previous article)

What are the symptoms?

Typically, the client will report one or all of the following:

·       Pain located in any one of the areas listed above

·       Pain increases with running and excessive weight-bearing

·       Aching pain may continue after the exercise has finished

·       Calf muscles may be tight and inflexible

What are the causes?

The most common causes of Shin Splints are:

·       Poor exercise preparation

·       Sudden change in loading / activity / intensity

·       Running on hard / uneven / hilly terrain

·       Muscle Imbalance in the lower limb

Treatment of Shin Splints / MTSS & Pilates

The best acute treatment of Shin Splints is rest from the causative activity and ice & compression to the area of discomfort. Working out the potential cause of the symptoms will obviously aid in their management and prevention of future episodes.

In the large majority of cases, there has been a change to the individual’s ‘normal’ training programme and this often develops into a simple muscle imbalance in the lower limb.

For example, someone that decides to try running more hills may not have the endurance in the posterior compartment to continue propelling them (plantarflexion of the ankle), resulting in the need to lift the foot more (dorsiflex the ankle), to clear the floor.  This can lead to overuse of the anterior compartment and potentially the symptoms as outlined above.

Identifying such imbalances will help guide the rehabilitation programme. A large majority of the rehabilitation could incorporate Pilates based exercises. In order to achieve best results, the exercises should be made functional as early as possible. Weight-bearing and progressively increasing the loading is best.