Your Guide to Shin Splints
This information has been prepared to help you fully understand your condition so you will be in the best position possible to work with your physio & follow the steps to your full recovery. Understanding the goals of your treatment & having complete confidence in your physio are vital elements of your recovery plan, so if you have any questions then please feel free to ask your physio.
Pain along the front or inside edge of the shinbone (tibia) is commonly referred to as shin splints. It usually results from increasing the amount of running you do too quickly, or with changes in training. It is a common injury in runners & also in sports that involve a lot of running like football, rugby & hockey. It can also occur in sports with lots of jumping like basketball or netball. Running on hard or angled surfaces (like the road camber) can increase your risk, as can other factors such as poor foot mechanics, incorrect footwear & tight calf muscles.
The lower leg is made up of two bones. The shinbone is the larger of the two bones & is called the tibia. The small, thin bone that runs on the outside alongside the tibia from the knee to the ankle is called the fibula. Many muscles that move the foot are connected to the tibia & fibula, & the most commonly affected muscles in shin splints are the tibialis posterior & soleus. These muscles attach to the tibia & when they are overused their attachment points become inflamed & cause pain, tightness, & if left untreated can cause stress fractures.
Dull, aching pain is usually felt along the front & inside edge of the shin where the involved muscles attach. This area may also feel tight & sore to touch. Initially pain may only be felt during activity but if the condition worsens then the pain becomes sharper, more severe & lasts longer after exercise. It may start to become constant, limit your normal walking, disturb your sleep & stop you exercising.
What Happens If I Don`t Fix My Shins?
Relative rest plays a key role in initially decreasing pain & inflammation, & you will usually be advised to reduce or cease the aggravating activity until your symptoms are under control. If you persist with the activity despite pain it can lead to further inflammation in the bone lining (periostitis) & eventually a stress fracture, which means you will have to have even more time off from activity. If the underlying cause of the condition is not addressed you are very likely to experience recurrences in the future.
How Long Does It Take To Get Fully Better?
This depends on the severity of your shin splints, how much you have pushed through the pain & how long you have had your symptoms for. It may take up to 6 weeks for the soft tissues to heal but your physio will return you to modified activity as early as possible. Cross-training (e.g. on a bike or in the pool) to keep as active as possible without increasing your pain, & returning to modified activity as early as possible can help you make a faster & more complete recovery. Generally the longer the pain has been there the longer it takes to resolve, so early treatment is very important.
Your journey to peak performance with Central Physio
Your physio has been extensively trained to thoroughly assess & diagnose your injury. They will give you a step-by-step recovery plan to make your treatment easier for you to understand. The most common phases, or steps, that you will go through during your recovery plan are outlined below. The order & timing of the phases are tailored individually for you & so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.
Phase 1: Optimise & Control Inflammation
Inflammation is the redness & swelling that occurs whenever you injure yourself. Our bodies need inflammation to start the normal healing process but we also need to control it. Therefore, the first goal is to reduce the inflammation & pain in your shin.
The techniques your physio may use to manage your inflammation include specific local massage & muscle releases, ice & stretches. Importantly, they will also guide you on modifying your current activity & exercise to ensure that you are not continually reaggravating your inflammation as this will significantly slow your recovery. Special taping techniques may be used to support the sore tissues & ease pain however taping is only used to help the area heal, not as a way to keep on training. Your home program may include using a foam roller or trigger-point release ball to restore length to tight muscles.
Phase 2: Clarify Diagnosis
Depending on the severity of your symptoms & your response to initial treatment your physio may refer you to for a scan to exclude a stress fracture. This usually involves an MRI which shows abnormal swelling & scar tissue in addition to information about bones. Although this step is often not required, in appropriate cases it helps make sure your management plan is effective & safe for you, & can prevent an early bony stress response turning in to a stress fracture. It can also help to give you more accurate time-frames for return to sport.
Phase 3: Correct Biomechanics
It is important to address the underlying problems that are causing your shin splints. If you only treat the symptoms & do not address the real cause of your problems then future pain & problems are very likely. Poor foot function is a very common cause of lower limb problems such as shin splints so your physio will use the specific assessments including the Gaitscan electronic foot assessment system to measure your foot mechanics.
If poor foot mechanics are found then orthotics are usually the treatment of choice for effective long-term resolution of your pain. Orthotics are devices worn in your shoes that correct your foot position to allow them to function more efficiently & spread stress & load to appropriate structures. Your physio will also check your running shoes & discuss your training routine to ensure that it is appropriate for you.
Your physio may recommend for you to have a Running Biomechanical Assessment which consists of a video analysis of your running technique and a Functional Movement Screen (FMS). Analysing your technique and seeing where corrections can be made can dramatically reduce your injury risk, as well as improve your performance by allowing you to run faster with less effort.
Phase 4: Restore Muscle Length
If you are active & do not stretch adequately then certain muscles in your legs will become tight. Correction of this muscle tightness is essential in achieving a lasting recovery because tight muscles will alter the way your leg moves & predispose certain areas to suffer increased stress & more risk of future injury.
Your physio will assess your calf muscles & also the muscles on the front & side of your lower leg for tightness. They will use techniques including stretches, muscle releases & rolling using a foam roller or trigger point release ball to help you regain flexibility within the muscle.
Phase 5: Functional Strengthening
Once you regain flexibility in your lower leg muscles the next stage is to strengthen them. Often muscles are weak because they are not being used properly, they have been damaged, or they have been inhibited after an injury. Returning them to full strength, including the strength of their attachment points to your bones, is essential to allow them to work without becoming sore & inflamed again.
Your physio will use specifically graded strength exercises & many clients find that working with an exercise physiologist to regain full functional strength is an ideal preparation program for returning to sport. This phase includes strengthening of all the muscles involved in controlling your leg alignment including your gluteal (hip) muscles, core & thigh muscles. Your program is tailored for your particular areas of mobility, stability & strength that need work, & also focuses on the demands of your chosen sport or exercise.
Phase 6: Sports/Ballistic & Advanced Strengthening
This is the last phase of your journey to full recovery. When you are returning to your activity you must be able to do it at full speed & resistance before being back in the game. You need to be able to apply your speed & force with the correct technique in training first to prevent another injury. In this phase we tailor exercises specifically to your activity by doing advanced sports-specific strengthening & high speed movements combined with rapidly changing directions. This phase is essential both for getting your back to your full level of performance, & also for preventing re-injury due to persisting background weakness or reduced co-ordination of muscle contractions.
Many clients find that seeing one of our Exercise Physiologists, Strength & Conditioning coaches or Personal Trainers is a great way to build strength, ability & confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your stability & strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer & reducing your risk of future injury.
For more information or to speak with one of our physio’s to discuss your symptoms please call us on 9280 2322 or contact the clinic.