Shin Splints? The secrets to reducing your pain!

Chances are you’ve heard the term shin splints before… Over the past few weeks I have noticed a spike in the number of patients coming in to the clinic with what is most commonly known as ‘shin splints’. This could be due to the fact that we are coming to the end of the winter sport season or maybe because we are sitting in the middle of the running season!
In the physio world ‘shin splints’ is actually a broad term used for a number of conditions which fall under medial tibial stress syndrome (MTSS) and is any pain experienced in the front of the lower leg.
In this post I am going to give you a guide on how to identify this condition and give you 3 simple exercises to help reduce your symptoms and get you back on the track!

So what are they…?
Medial tibial stress syndrome could be caused by a number of tibial injuries including tendinopathy, inflammation of the periosteum (connective tissue surrounding bone), stress reaction of the bone and remodelling of the periosteum.
The most common complaint we hear in the clinic from someone suffering this condition is a general, dull ache in the mid-lower part of the shin bone and is most commonly associated with increasing activity. The diagram to the right displays the usual area of pain for this condition.


The condition commonly presents in both legs at the same time but the pain may be greater on one side. At first it may only present at the beginning of exercise and once the body is ‘warm’ the symptoms disappear but then return as the body ‘cools’ down. As the condition progresses, the pain tends to stay throughout the whole event, including afterwards. Like the name suggests, shin splints are a stress reaction to chronic, repetitive loads going through the tibial bone.

 

 

What increases my risk of getting shin splints?

  • Females 2-3x more likely than males
  • Sudden increases in training (frequency, duration, intensity)
  • Running or playing sport on hard surfaces
  • Recent change in footwear
  • Fat fleet (Pes planus)
  • Weak or inactive core muscles
  • Biomechanical abnormalities and training errors

I think I’ve got shin splints… What can I do??

Most people will probably tell you to stretch or foam roll your calves if you’re suffering from shin splints… but this is only part of the answer.

Here we’ll look at 3 simple exercises which can help manage pain coming from the shin bone region. Remember this is a complex condition and ideally requires a physiotherapy assessment which is directly tailored to you and the causes of your tibial stress! If your symptoms aren’t improving or are getting worse, make an appointment with your trusted physio!

 

  1. Attack the source

Calf raises with eccentric focus

Studies show that weak calf muscles are more prone to muscle fatigue, leading to altered running mechanics and in turn extra strain on the tibia. This exercise is to start as soon as the acute painful stage has subsided and the exercise is tolerable.

             

  1. Attack contributing factors

Glute med

Crab Walks

The glutes are extremely important muscles which sit on the side/back of the hip and contribute to lower limb stability and alignment. Although this muscle is higher up the chain, weakness of the glute medius will result in torsion of the tibia and in turn greater stress on the bone!

It also allows you to start the rehab process early as these exercises do not cause excessive stress on the painful area of the shins.

       

  1. Attack poor foot biomechanics

Toe Swapping

When it comes to the lower limb, the inner foot muscles are extremely important in keeping the foot, in particular the arch, placed in an optimal position. These muscles often become weak or underactive leading to collapse or poor stability through the arch.

This exercise can be made easier and harder by performing in standing or on unstable surfaces.

        

 

What else could my pain be coming from…?

Stress Fracture: thought to be caused by similar processes to MTSS this is a more progressed condition in which small fractures start to appear in the tibial bone.

Chronic Exertional Compartment Syndrome: also occurs from repetitive loading or exertional activities. Can present with symptoms that indicate nerve involvement such as weakness or numbness in the lower leg. More commonly affects the outer region of the lower leg.

    

Galbraith, R. et al. (2009) Medial tibial stress syndrome: conservative treatment options. Current reviews in musculoskeletal medicine. Sep; 2(3) 127-133.

 

The Road to Recovery for Marion

Marion walked into PPS Physiotherapy Kellyville in February 2017 after fracturing her Left patella (knee cap) tripping over at home in late 2016. She underwent surgery to have a wire threaded through the patella to assist in the fracture healing.

Marion xray edited          20170104_185037

When Marion first attended the clinic she was wearing a knee brace, using a 4 wheeled walker and had high hopes I was about to fit her with a more comfortable knee brace.Unfortunately, the brace Marion was instructed to go into “just for comfort”, was bigger, bulkier and more uncomfortable than her previous brace. I said to Marion I’ll give you a few days and you will be begging to come out of it.

 

Sure enough 2 days later Marion returned ready to commence physiotherapy and the first thing she said was “you can have the brace back.”  Marion started physio with a long rehabilitation road ahead. The first priority was to increase her amount of flexion (bend) and extension (leg straight). On her first session, Marion was able to bend up to 45 degrees and extend out long to -4 degrees from straight. As a bit of a guide against what we would usually see, ideal range is between 125 degrees and 140 degrees of bend. You also need a minimum of 110 degrees to use stairs or complete a full revolution on a bike.

 

marion brace 1

 

Gradually we began to introduce strengthening exercises, balance tasks, learning to walk again and performing functional exercises.

 

In March 2017, Marion’s progressed plateaued due to the surgical wire limiting her ability to move and at times it would catch in the knee causing her considerable pain. The surgeon agreed to remove this wire, a few months earlier than desired, to reduce the pain and increase her function. At the same time, a small non-harmful lump was removed from the right knee which we commonly referred to as ‘Lawrence the lump’…so maybe we should make that 3 surgeries now!   20170412_154455

When Marion returned post her second round of surgery her progress again picked up and we were able to make greater achievements. These included;

– cracking the 90 degrees of flexion (bend) mark and beyond

– completing a full resolution on the bike

– walking without an aid

–  being able to return to driving

– becoming more confident using stairs

Today Marion has exceeded expectations and is now able to bend her knee to 137 degrees and extend all the way. She still has some difficulty going downstairs but is working hard on this and is regaining her confidence. Marion is also backMarion knee bend to most activities and is enjoying her ongoing improvements.

 

Marion was very diligent with sticking to her appointments, rehabilitation plan and home exercises.

 

The team at PPS Physiotherapy are very proud to have helped Marion throughout her journey with us and we wish Marion all the best for the future.

Kim and Marion

Solving the Problem of Chronic Ankle Instability

17/5/2017, James Coller. PPS Physiotherapy, Physiotherapist

Have you ever rolled your ankle?

Do you have feelings of chronic instability?

Have you rolled your ankle more than once over the past couple of years?

Most of you would answer yes to one if not all of the above questions! So why are these types of injuries so common and why is it common to repeatedly sprain the same ankle in a relatively short period of time.

Read More