There is no satisfaction without a struggle first
Those that have experienced shin splints know how frustrating it can be to train. Whether it’s running, skipping or box jumping. Pain can be so intense that we stop doing these movements for a short period or permanently out of fear. With shin pain, there are many different factors that cause it. This is why having it assessed and treated appropriately can help you ease back into these activities with more control over symptoms.
- Shin splints is a vague term used to describe overuse or repetitive strain of structures in the lower leg.
- In athletics and military, “shin splints” can affect up to 35% and is more prominent with females. (1)
Take a look at the several muscles in the shaft of the lower leg, and the layers we have in our bone.
It’s very easy to label the condition as “shin splints”. But looking at the different structures involved with shin pain a more accurate diagnosis would help direct treatment and management of the problem. Shin pain can also be produced by other conditions. Another reason to get assessed.
Bony shin splints
The outer layer of bone called the periosteum has a great blood and nerve supply. This makes it a common area for feeling shin pain. When training under normal stresses with adequate rest the density of bone increases which allows us to tolerate running for longer. If stress forces increase with little rest time in between, inflammation and pain develops. Pain ignored for long enough could result in a stress fracture.
Rest period of stress fracture: Depending on the severity and nature of the fracture it may take 4-12 weeks. Having it assessed and possibly X-rayed will help guide the timeframe.
Rest period for inflammation of the bone: This requires a shorter rest time but should be closely monitored to ensure we identify the cause of extra stress to the bone. Usual rest periods will be 4-6 weeks.
Muscular shin splints
Muscles of the lower leg are held within compartments wrapped up by fascia. During running for example these compartments build up in pressure. As the pressure rises, oxygen levels lower, toxicity builds and then results in pain. A condition known as Exertional Compartment Syndrome (ECS). If ignored this could lead to chronic exertional compartment syndrome which often requires surgery .
Rest period for ECS: Similar to the inflammation of bone, it may require between 2-6 weeks of rest. In this time, it is about identifying the issues causing the problem and building up a tolerance to the activity.
Tendon shin splints
Tendons are the pulleys of muscles, they connect to specific bony points to cause a movement. Inflammation of the tendon can be cause by excessively loading the tendon . Three tendons that lead to shin related pain are the Achilles, tibialis posterior and the peronei. Most common being tibialis posterior.
The Tibialis posterior muscle supports the arch and if it fails can result in many changes to the foot and ankle. Catching this fault early will allow you to correct the problem easier.
Rest period for a tendinopathy: This really depends on the length of time you’ve suffered, the severity and foot mechanics. Recovery time can take up to 12 weeks. Giving time to offload the tendon and building up stress’ again.
Managing shin splints
As mentioned above, it’s important to make a clear diagnosis to provide adequate rest and adjust back into your activity. Along with normal hands-on therapy and exercise prescription, physio can help shin pain specifically through adjustments made to the following:
- Training error – over training, excessive distances, change in running surface.
- Poor foot mechanics – A foot with a high arch or that rolls in poses a higher risk for stress fractures and tendon pathologies when running.
- Footwear – Shoes lacking adequate arch support for an unstable foot causes muscles/tendons to work harder.
- Running form – Analysing running form will help identify weak structures and correct poor patterns.
- Movement and balance control – Good balance at the ankle, knee, hip and a strong “core” of your trunk muscles play vital roles in evenly distributing the force.
- Muscle flexibility – Tightness of muscles can put excessive load on the tibia while running.
- Ankle mobility – Increased ankle range of movement with joint mobilisations and stretches can reduce stresses on the lower leg.
- Muscle strength and endurance – The strength of a muscle helps maintain a good position while running or jumping. But it also requires stamina to repeatedly hold position.
Returning to running
Returning to normal running with shin splints is always an uphill battle and is never a smooth transition. It’s a learning experience, understanding what your body can withstand and tailoring your rehab appropriately. It can be frustrating, but having patience with the process will get you back into your activity.