Treatment for Shin Splints

Shin splints are a nagging injury that discriminates against no one – young or old, athlete or not.  Shin splints are a painful condition that affects many active people.  They can start as just a nagging, achy pain during running and evolve into pain with walking and going about your day.  Rest assured, the physical therapists at SSOR know how to treat shin splints.

What are shin splints?

Shin splints is a painful condition that is caused from overuse.  The shin bone or tibia is painful, mostly from lower leg muscles tugging on their attachments on the tibia, what is known as a stress reaction.  As a result, people dealing with shin splints have achy, painful shins on the medial aspect of the lower leg that worsen with activity and get worse over time.   Pain is typically poorly localized and tends to radiate along the lower leg or shin.

Cause of Shin Splints

The list of potential causes of shin splints is long because there are so many sources.  It may be easier to talk about them in terms of extrinsic causes (things mostly having to do with training) and intrinsic causes (things having to do with the individual person).

Extrinsic causes

1.  Training errors.  Sometimes people do too much too soon and don’t have a methodical progression to their activities. In addition, training surfaces can be an issue.  Running on concrete or in school hallways can lead to shin splints.  We often see shin splints a lot at the start of sports seasons when people are running around in cleats, which aren’t as forgiving as running shoes are.  Another training error is running the same route all the time.  We’re also seeing shin splints in young athletes at the start of a sport season who are suddenly doing a lot of running after a long period of not doing much.  This happens frequently at the start of the fall football season as kids really amp up running after a long, lazy summer.
2. Poor shoes.  You need to have good, supportive, comfortable shoes to train in.  Check the tread on the bottom and a good rule is change shoes every three months or 300 miles.

Intrinsic Causes

1.  Flat feet. If you have flat feet, all of your shock absorbing capabilities have been minimized and it creates torsion in the lower leg, which is basically a low-grade, repetitive twisting to the bone.
2. High arched feet.  If you have high arches, compared to flat feet, you have far less shock absorbing capabilities because of a fairly rigid foot.
3. Calf tightness.  The calf muscles can overpower the front muscles on the lower leg for one, and two, tight calves limit ankle dorsiflexion, which is required for proper movement.  Without ankle dorsiflexion, you will overpronate. Again, this causes abnormal torsion on the tibia.
4. Weakness in the ankle invertor muscles.  These muscles are basically the medial sling to your foot and also contribute to shock absorption as you strike the ground.
5. Weakness in the glutes.  This is an extremely important, but often overlooked one.  Your glutes are your main shock absorbers.  Without strong glutes, shock absorption has to occur elsewhere and it’s often placed on muscles that aren’t as built for it as the glutes are.
6. Hypermobility/laxity.  If you are too loose, your body has to work extra hard to control motion and the bones take the brunt of it.
7. Excessive tightness or inflexibility.  In this case, tightness limits shock absorbing capabilities.

 Symptoms of Shin Splints

People with shin splints complain of pain on the medial aspect of the shin bone with running.  Typically the pain subsides when they stop running/jumping.  Pain typically starts out as a dull, poorly localized ache that over time, can become more sharp and point tender.  There is typically no numbness or tingling associated with it, and there typically is no pain elsewhere.  If shin splints go untreated or gets worse, you can end up with a stress fracture.  In this case, pain will be more sharp and you will be more point tender, roughly about 6” above your medial malleolus, which is your medial ankle bone.

Exercises for Shin Splints

Treating shin splints basically comes down to addressing the cause/s.  This is best done with the help of a physical therapist or athletic trainer.  If training errors are the issue, evaluate your typical training surfaces and directions you run.  The same route over and over again is problematic.  If you increased mileage too fast or started aggressively after a period of being sedentary, that could be the issue.  Therefore, talking to a coach or getting a structured program may help.  With the recent trend of barefoot/minimalist shoe wear, this is also a potential cause.  See to it that if you decide to go this route, you should proceed with caution and gradually start this approach.
Regarding the intrinsic issues, orthotics or arch taping may help.  With high arches, rolling the sole of the foot on a tennis ball can help loosen the plantar fascia to enable more shock absorption.  Stretching and strengthening of the ankle muscles will also help improve shock absorbing capabilities.  Stretching of the calves, hip flexors, quadriceps and hamstrings will help improve flexibility and further enable the attenuation of shock.  Like many running-related injuries, a program focused on core and hip muscle strengthening will help immensely.  Exercises focused on the gluteals as well as the abdominal/low back area should be the focus of your recovery.  “Shin socks” or “compression socks” can help take the edge off a little when running.  Ice massage can be used along the medial shin after running to help with pain, and your physical therapist or athletic trainer can do some pulsed ultrasound over the tender spots on the bone.   Use of Kinesiotape, while very trendy, has minimal evidence on efficacy for something like shin splints.  Use of anti-inflammatory medications is somewhat controversial actually and there is some evidence showing that they may actually delay bone healing.  You might consider using an over-the-counter pain reliever instead.  Talk this over with your physician however.
Give us a call at (913) 904-1128 if you’re dealing with this nagging injury.  Remember, you don’t need a referral from a physician to see a physical therapist in Kansas anymore.