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Sunday, March 3, 2019

Shin splints by Mike Blackwell & William Dao, February 2019

What is the condition?

Shin splints is where the lower third of the inside of the shin bone (tibia) becomes painful and is a common injury in runners (12-18% of running injuries). It is also known as “Shin pain” or “Medial Tibial Stress Syndrome” (MTSS) and it tends to occur more in females than males.

Shin splints can be a precursor to a stress reaction injury and then even a stress fracture if left untreated. The soft tissues such as tendons or connective tissues around the shin (periosteum) as well as bone tissue of the tibia become irritated due to too much too soon with regards to activity. This area of shin splints can be painful to touch and can swell.

If the aggravating load is not removed then shin splints can progress on to a stress reaction which can be a precursor to a stress fracture if the excessive load is not removed. A stress fracture is where the bone does not have the capacity to cope with the load being put on it and as such small fractures arise.

 

How do I get this condition?

i. Poor load management

Generally, shin splints is a result of too much too soon. A sensible approach to increasing running volumes is to gradually increase running distance from week to week. One way to do this is to adhere to the 10% rule whereby you don’t exceed an increase of more than 10% in weekly running volumes or intensity from previous week. Speak to your physio or running coach with regards to a sensible and graduated running program.

 

ii. Muscle imbalances

This can include tight or weak calf muscles, tightness in muscles around hips such as
hip flexors or weakness in hamstrings, gluteals or core muscles to name a few. This is
so important that you see a physio to get a full thorough assessment and then a
structured exercise program to address these issues.

 

iii. Running technique

The main culprits of running technique with regards to shin splints are cadence/ step
rate (number of steps per minute), stride length and foot strike position. There are of
course a number of other factors but this really is a great place to start and can make
a significant difference to your shin symptoms. This is one of the few scenarios where
we may try to change a “heel striker” to more of a “midfoot striker”. See your physio for
a treadmill running assessment to make sure running technique isn’t contributing to
your shin splints.

 

iv. Foot posture, footwear or change in running terrain

If the inside arch of your foot rolls in excessively (over pronation) as your foot hits the ground during
running then this could be contributing to your shin splints. Often the cause for your
foot collapsing in is weakness in foot and ankle musculature or gluteal weakness on
that side. It is also important to say that foot rolling in towards midline can be a normal
anomaly and totally normal for you. Over pronation obviously wasn’t a problem for long distance & track running Ethiopian  retired athlete- Haille Gebrselassie https://en.wikipedia.org/wiki/Haile_Gebrselassie

 

 

Footwear can also be crucial- generally running shoes have an expiry date but we
don’t base our decision to get rid of them on number of kilometres that they have ran.
According to well renowned running physio Brad Beer in his book- “You can run pain
free”, a more accurate way to decide whether to replace your running shoes is on
the following 3 principles:

A. Can the shoe be folded in half
B. Is the runner experiencing shin or general leg soreness
C. Is the shoe starting to feel boggy

If you answer “yes” to any of these 3 questions, then its time to start looking for a
new pair of runners.

Furthermore, if all of a sudden you change terrain from flat grassed runs to hilly
concrete this will increase the load going through your legs and this can be enough to
flare your shin splints. Like with everything else, if you are going to change terrain with
your running, do it gradually with a structured transition.

 

v. Bodyweight

Are you at your ideal running weight? The heavier you are, the more load goes
through your joints as you run. Now this isn’t a certain kg weight for males & females
but is specific for each person.

 

How long will it take to Fix?

This generally varies from person to person but our initial advice is almost always, stop running completely for 2 weeks when you have shin splints whilst starting your physio rehabilitation. Following this 2 weeks rest, we test if the lower third of the inside shin bone is still painful to touch and if the injured athlete can perform 20 single leg hops pain free. If the answer to this is yes then we would start them on a graduated return to running program but often it is still sore. If it is still sore, then we advise 2 more weeks of rest from running and then retest this again at 4 weeks. This process can sometimes go on for 6-8 weeks before restarting running again but it is important that in the meantime the injured athlete is still doing low impact exercise such as cycling, cross trainer or swimming to maintain their fitness.

Once they have been given the all clear, a 3-4 week return to running program is implemented and then often speed work is reintroduced anything upto 6-12 weeks after the return to running program has commenced.

 

What do I do to Fix it?

i. Reduce load ie stop running for 2 weeks– see above for timescales with return to running

ii. Address the cause of the injury– rest alone is not going to stop the shin splints returning when you go back to running. See your physio for assessment and a specific plan to stop this coming back

iii. Look at training schedule – for non elite runner- 3-4 runs per week is enough. At least
one rest day and something else (S&C, cycling, pilates, yoga, swimming etc).

iv. Get strong-

A. 2 leg straight knee calf raises +/- weight, 25 reps, daily

 

B. Single leg straight knee calf raises +/- weight, 25 reps, daily (if not irritable)

 

C. Single leg bent knee calf raises -6-8x BW, 3 sets +/- weight. Quickly up (1 sec), slowly back (4 secs)

D. Gastrocnemius & soleus calf stretches but often a tight muscle is a weak muscle so this may not be
needed. If you are going to do this exercise then make sure it is pain free and that you hold it for at least 30 seconds each side.

 

E. Gluteal & core stability exercises (see Gluteal tendinopathy blog- https://www.fixphysio.com.au/gluteal-tendinopathy-real-pain-butt-mike-blackwell/

F. Hamstring strengthening (see upper hamstring tendinopathy blog- https://www.fixphysio.com.au/upper-hamstring-tendinopathy-mike-blackwell/

v. Non Steroidal Anti Inflammatories (NSAIDS)– such as ibuprofen. Please seek medical advice from your pharmacist or doctor before taking

vi. Footwear

vii. Running assessment

If you have any further questions on shin splints then please email us at reception@fixphysio.com.au or come and see us at Fix Physio in Sydney CBD www.fixphysio.com.au/booking

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