What are shin splints?
Shin splints or more accurately medial tibial stress syndrome (MTSS) is a term used to describe exercise induced pain in the lower leg which results from injury to muscles, tendons and bone around the shin, more specifically the tibia.
MTSS occurs most commonly in runners but can occur with any impact sport, it is often due to overuse but may be related poor technique, sub-optimal biomechanics, training faults, poor footwear and nutritional deficiencies. At first the symptoms may simply be a dull ache along the shin bone, felt during or after strenuous activity but they may progress to more severe pain, which may even be felt at rest. If ignored it may impact on your ability to exercise to the extent that you have to stop training altogether. So it’s important to listen to your body and not ‘train through the pain’.
What causes shin splints?
There are a number of factors associated with the development of MTSS:
- poor technique due to structural factors or poor lower limb biomechanics, namely inflexibility and/or muscle weakness
- reduced core and/or pelvic stability, both of which are important in establishing optimal load transfer between the core and lower extremity
- poor proprioception otherwise known as balance
- training errors such as an excessive increase in training frequency, duration or intensity
- exercising on a hard or uneven surface
- poor footwear
- poor foot biomechanics
- nutritional deficiencies
What can you do about MTSS?
The key is prevention. Whilst there isn’t one single prevention method there is consensus within the literature for the following:
- Undergo a screening examination by a suitably qualified physiotherapist in order to address any underlying risk factors
- The use of shock absorbing insoles
- The use of orthotics for those individuals with poor foot biomechanics or the right type of shoe for your foot type
- Replacement of your running trainers every 300-350 miles
- A graduated running programme with built in rest days
- Ensure you stretch regularly
- Do not increase your running distance by more than 10% per month
- Avoid hill training and running on hard or uneven surfaces for at least 4-6 weeks after a break from running
The key to recovery is the correct diagnosis and a thorough assessment to determine the primary causes(s) for the development of your symptoms, occasionally diagnostic tests such as a bone scan to exclude stress fractures or compartment pressure study to exclude compartment syndrome are required.
Our Physiotherapists have the expertise to undertake a thorough examination of your flexibility, muscle control, proprioception, structural alignment and movement strategies and so determine the primary cause(s) of your symptoms. Following this assessment they may recommend regular ice, rest, compression, manual therapy, taping, electrotherapy and/or acupuncture to facilitate your healing, and a bespoke exercise programme to reduce the chance of re-occurrence and get you back to where you want to be as soon as possible.
The Physiotherapist may recommend a biomechanical assessment with one of our experienced Podiatrists to ensure your footwear is suitable for your individual needs.
Alongside this will be a discussion of your training schedule; emphasising the importance of warming up, specific warm up exercises, the avoidance of over-striding and minimising a heavy heel strike, cessation or modification of hill running, avoidance of running on hard surfaces and advice on alternative exercise whilst your symptoms are resolving and you gradually return to running or your chosen sport.
Posted by Emma McPherson (physiotherapist)
Galbraith, R. M. and Lavallee, M. E. (2009)Medial Tibial Stress Syndrome: conservative treatment options. Current Reviews in Musculoskeletal Medicine 2(3) 127-133.
Craig, D. I. (2008). Medial Tibial Stress Syndrome: Evidence Based Prevention. Journal of Athletic Training. 43(3), 316-318.
Batt, M. E. (2011). Medial Tibial Stress Syndrome. British Journal of Sports Medicine. 45 e2.
Hamstra-Wright, K. L., Huxel Bliven, K. C. and Bay, C (2014). Risk fa tors for Medial Tibial Stress Syndrome in physically active individuals such as runners and military personnel: a systemic review and meta-analysis. British Journal of Sports Medicine.
Burne, S. G. et al (2004). Risk factors associated with exertional medial tibial pain: a 12 month prospective study. British Journal of Sports Medicine, 38:441-445
Hutson, M. and Speed, C. (2011). Sports Injuries. Oxford University Press.