As featured in the May 2014 issue of the MMA Main Event Magazine in the US.
Written by Megan Gaudry.
The views and information provided by Aspire Health & Rehabilitation, and Megan Gaudry, in the form of blogs, videos, photos and reviews are not in any way to be substituted as a Medical consultation, and are for education purposes only.
Bone anatomy. Image courtesy of Wikimedia Commons. I have been suffering from shin splints (or shin pain), proper name is Tibial Stress Syndrome on and off since 17 years of age; it is a very common musculoskeletal condition of the lower limb and is experienced by many, particularly athletes such as runners. It is associated with pain and occasional inflammation to the lower leg, such as the medial (inside) and lateral (outside) aspects of the shin bone (tibia); and the pain can either increase with impact/or training, or can decrease during rest or after warming up. Shin splints if mistreated can result in stress fractures, compartment syndrome among others.
Unlike many others I know of who suffer shin splints, I had always suffered lateral shin splints rather than medial. It is thought that this may result from having excessive flat feet, also known as excessive pronation, where the arch of the foot is reduced. Due to having weak and dysfunctional feet (flat feet) , it results in excessive rotational force on the fibula (next to the major shin bone), and overuse leading to stress fractures and reactions.
Unlike many others I know of who suffer shin splints, I had always suffered lateral shin splints rather than medial. It is thought that this may result from having excessive flat feet, also known as excessive pronation, where the arch of the foot is reduced. Due to having weak and dysfunctional feet (flat feet) , it results in excessive rotational force on the fibula (next to the major shin bone), and overuse leading to stress fractures and reactions.
 Flat feet. Image by FA RenLis (Wikimedia Commons). However those that are more likely to suffer from shin splints, include; those with calf tightness, restricted ankle movement (particularly when pointing foot upwards called dorsiflexion), chronic ankle sprain sufferers, posterior tibial tendon weakness, overuse and over-training such as preseason and increased loads/intensities. |  Leg musculature. Image courtesy of Wikimedia Commons. |
It is best to consult a physiotherapist to be assessed and have shin pain complications and fractures ruled out, as well as to assess as to why you suffer from them. Below I have given 9 treatment and preventative strategies that have been recommended by research, and/or are used/ recommended by Physiotherapists to assist with managing your shins splints;
Orthotics
Having a GaitScan or biomechanics assessment performed on your lower extremities while you stand, sit and walk; this will help to assess if there is a biomechanics imbalance that might be resulting in your shin splints or other injuries, such as excessive flat feet, which can be treated with exercises and orthotics (either custom made or off-the-shelf). Consult a Physiotherapist or a Podiatrist if this is something you think will help. Off-the-shelf orthotics can set you back between $40-80 depending on where you get them from, and typically last up to 12 months (and that’s pushing it, particularly if you use them a lot); whereas custom made orthotics are more expensive at $300-400 again depending on where you go and if you have Private health insurance, however do last up to 3 or more years. Custom made orthotics are durable, and you might able to get the first one or two customisations for free. I’ve personally had both types, and would recommend the custom made ones if you can, however it all depends on your budget, you can get away with off-the-shelf it just won’t be as durable and long-lasting. In saying that, the primary aim is to train your feet to be strong, and their must be a plan in place to get out of orthotics!
Having a GaitScan or biomechanics assessment performed on your lower extremities while you stand, sit and walk; this will help to assess if there is a biomechanics imbalance that might be resulting in your shin splints or other injuries, such as excessive flat feet, which can be treated with exercises and orthotics (either custom made or off-the-shelf). Consult a Physiotherapist or a Podiatrist if this is something you think will help. Off-the-shelf orthotics can set you back between $40-80 depending on where you get them from, and typically last up to 12 months (and that’s pushing it, particularly if you use them a lot); whereas custom made orthotics are more expensive at $300-400 again depending on where you go and if you have Private health insurance, however do last up to 3 or more years. Custom made orthotics are durable, and you might able to get the first one or two customisations for free. I’ve personally had both types, and would recommend the custom made ones if you can, however it all depends on your budget, you can get away with off-the-shelf it just won’t be as durable and long-lasting. In saying that, the primary aim is to train your feet to be strong, and their must be a plan in place to get out of orthotics!
Adequate footwear
Time and time again do I see people, and even some athletes using inappropriate footwear while training, these include wearing shoes that don't provide any support such as heel, arch and shock support or use shoes that are way past its use-by date. Everyone’s feet are different, some have high arches, some flat, and some neutral among many other biomechanical considerations; therefore just buying any old shoe, or ones that look pretty isn't appropriate. It is best to consult with your physiotherapist or podiatrist as to the right shoe for you. In the past I had been recommended by a Physiotherapist to buy Asics, Brooks and New Balance as options as I have a wide foot and wear orthotics; I have had some great results with these brands (in saying this I am not sponsored or paid to recommend these brands!). Also you couldn't go past some shock absorbing inserts to decrease the shock transferred to your shins.
Time and time again do I see people, and even some athletes using inappropriate footwear while training, these include wearing shoes that don't provide any support such as heel, arch and shock support or use shoes that are way past its use-by date. Everyone’s feet are different, some have high arches, some flat, and some neutral among many other biomechanical considerations; therefore just buying any old shoe, or ones that look pretty isn't appropriate. It is best to consult with your physiotherapist or podiatrist as to the right shoe for you. In the past I had been recommended by a Physiotherapist to buy Asics, Brooks and New Balance as options as I have a wide foot and wear orthotics; I have had some great results with these brands (in saying this I am not sponsored or paid to recommend these brands!). Also you couldn't go past some shock absorbing inserts to decrease the shock transferred to your shins.
Massage for tightness
1. Soft tissue release- this involves a good old massage using your fingers, palm of your hand, or even your elbow. If you've been treated for shin splints already then you most likely know what I'm talking about, as well as how much this may hurt too. Massage can include either side of the tibia (shin) bone, as well as the calf muscles. You will find that this may hurt, however don't back off, usually when I massage my shins and calves I experience instant relief to my shins following and better movement in my ankles. You can either massage yourself in a sitting-type posture, or if you think that you might back out, have someone else massage them for you. Tip: make sure you use moisturizer, otherwise friction will burn and you may look hair.
1. Soft tissue release- this involves a good old massage using your fingers, palm of your hand, or even your elbow. If you've been treated for shin splints already then you most likely know what I'm talking about, as well as how much this may hurt too. Massage can include either side of the tibia (shin) bone, as well as the calf muscles. You will find that this may hurt, however don't back off, usually when I massage my shins and calves I experience instant relief to my shins following and better movement in my ankles. You can either massage yourself in a sitting-type posture, or if you think that you might back out, have someone else massage them for you. Tip: make sure you use moisturizer, otherwise friction will burn and you may look hair.
2. Soft tissue release using equipment (foam roller, massage stick, or balls)- apart from the good old massage with your hands, there are many types of equipment you can use that works a treat. This can involve foam rolling your calves, or using a golf/lacrosse ball to get into the nitty gritty areas; or even using a massage stick, this is something I have been using since December 2013, I even nick-named it as the Torture stick, for those that have used this before you know why, it works as a great tool for massage.
Massage for inflammation/swelling and pain
Ice massage works a treat especially after a flare up, or immediately after training/competition for relief and to reduce inflammation/swelling. This is most commonly applied to the shin region, depending on where you experience the pain. A great way to apply this is to half or ¾ fill a Styrofoam or paper cup with water and freeze it. By using a paper/styro-foam cup you can handle the ice easily by holding the cup, and as it melts you can simply rip the foam/paper away. Ice massage should be continued until area is numb on touch, and can be done several times a day. Those with circulatory problems should use caution.
Ice massage works a treat especially after a flare up, or immediately after training/competition for relief and to reduce inflammation/swelling. This is most commonly applied to the shin region, depending on where you experience the pain. A great way to apply this is to half or ¾ fill a Styrofoam or paper cup with water and freeze it. By using a paper/styro-foam cup you can handle the ice easily by holding the cup, and as it melts you can simply rip the foam/paper away. Ice massage should be continued until area is numb on touch, and can be done several times a day. Those with circulatory problems should use caution.
Adequate warm ups
Warm ups enhance blood flow to the working muscles as well as conduction of nerve impulses. A good 5-10 minutes minimum should be spent on warming up prior to the core of training, or competition.
Taping
The type of taping I’m talking about here is Rocktape, or Kinesiotape as many people know it as. This taping application not only helps with swelling, by lifting the skin and allowing fluid to move; but also helps takes the pressure of nerves and stimulating muscle activation therefore decreasing pain and improving proprioreception. Below are examples on tape application for those that suffer either lateral or medial shin splints.
Warm ups enhance blood flow to the working muscles as well as conduction of nerve impulses. A good 5-10 minutes minimum should be spent on warming up prior to the core of training, or competition.
Taping
The type of taping I’m talking about here is Rocktape, or Kinesiotape as many people know it as. This taping application not only helps with swelling, by lifting the skin and allowing fluid to move; but also helps takes the pressure of nerves and stimulating muscle activation therefore decreasing pain and improving proprioreception. Below are examples on tape application for those that suffer either lateral or medial shin splints.
Stretching of muscles
If tightness is an issue, stretching should be focused on the hamstring, and muscles of the lower limb, including calf (gastrocnemius and soleus) muscles, in the aim to reduce tightness and improve flexibility. Stretches are demonstrated below;
If tightness is an issue, stretching should be focused on the hamstring, and muscles of the lower limb, including calf (gastrocnemius and soleus) muscles, in the aim to reduce tightness and improve flexibility. Stretches are demonstrated below;
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Review your training program
Ensure recovery is included in training programs, this is key as many times; shin splints result from overuse training, particularly in running programs or sports that require a lot of running. Perhaps look at ways to still improve cardiovascular fitness without high impact loads on the shins, such as cycling, swimming, rowing, and incorporate slow progressions of intensity and volume, as well as recovery periods into your training program for high impact activities such as running.
Strengthening exercises
Strengthening exercises should target the lower limb and foot, and can incorporate body weight and other equipment, the most common and easy to use is with a theraband; below are some basic exercises you can incorporate into your program. Keep in mind, strengthening the foot is also key (aren't demonstrated below).
Ensure recovery is included in training programs, this is key as many times; shin splints result from overuse training, particularly in running programs or sports that require a lot of running. Perhaps look at ways to still improve cardiovascular fitness without high impact loads on the shins, such as cycling, swimming, rowing, and incorporate slow progressions of intensity and volume, as well as recovery periods into your training program for high impact activities such as running.
Strengthening exercises
Strengthening exercises should target the lower limb and foot, and can incorporate body weight and other equipment, the most common and easy to use is with a theraband; below are some basic exercises you can incorporate into your program. Keep in mind, strengthening the foot is also key (aren't demonstrated below).
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If you have other treatment and or preventative ideas for shin splints, I would love to hear about them, please contact me via email aspirehealthrehab@outlook.com or the CONTACT US section of this page.
Yours in health,
Megan
Yours in health,
Megan
References used in this article
- Brukner, P., & Khan, K. (2009). Clinical Sports Medicine (3rd Ed). Mc Graw Hill, pg 555-575.
- Garl, T. (1994). Strength & Conditioning Journal. National Strength and Conditioning Association, Vol. 16 Issue 6. pg. 31-33.
- Newman, P., Witchalls, J., Waddington, G., & Adams, R. (2013). Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access Journal of Sports Medicine, Vol. 4, pg. 229-241.
- WInters, M., Eskes, M., Weir, A., Moen, M., Backx, F., & Bakker, E. (2013). Treatment of Medial Tibial Stress Syndrome: A Systematic review. Journal of Sports Medicine, Vol. 43, pg. 1315-1333.
- Tolbert, T., & Binkley, H. (2009). Treatment and prevention of Shin Splints. Strength and Conditioning Journal, Vol. 31, Issue. 5, pg. 69-72.
- Griebert, M.C., Needle, A.R., McConnell, J., & Kaminski, T.W., (in press). Lower leg kinesio tape reduces rate of loading in participants with medial tibial stress syndrome. Physical Therapy in Sport doi.org/10.1016/j.ptsp.2014.01.001.
* All photos (except those of Wikimedia Commons) used in this blog are a product of Aspire Health and Rehabilitation (2014) and cannot be reproduced without permission.
