Injury of the Week # 2: Shin Splints

Shin Splints: Also known as Tibial Stress Syndrome, or Medial Tibial Stress Syndrome (MTSS)

What is it?

When the covering of the (shin) bone called the periosteum starts to peel away from the bone from repetitive stress. This causes inflammation and pain along the tibia (shin bone) and can affect the surrounding musculature.

When do you notice the pain?

You will notice pain during exercise such as walking, running, playing sports etc. Commonly the pain goes away with rest, however the longer you ignore this pain, the more chronic it can become and if left untreated it can lead to a stress fracture.

Where does it hurt?

It will hurt along the posterior medial border of your tibia, which would be considered “posterior shin splints”, where the tibialis posterior muscle is effected. Alternatively you could experience pain on the outer edge of your shin bone known as “anterior shin splints”,  where the tibialis anterior muscle is effected (on the same side as your pinky toe).  If you track down the boney part of your shin, it will be along the inside edge (along the same side of your leg as your big toe).  Commonly it is tender to the touch so you should be able to find it easily.

How does it happen?

Commonly from overuse such as in running, insufficient arch support, poor running mechanics, improper running shoes for your specific arches, tight gastrocs (calves), weak tibialis posterior (muscle that runs along the inner edge of your shin). It can also arise when you have a sudden change in training volume, frequency, intensity (say you drastically increase your distance from 5k to 15k!), the terrain (ground) you are training on (running on a sidewalk vs. grass), change of equipment etc.

How can I help it go away?

Orthotics, proper running shoes (that you properly break in), gradually increasing your exercise volume/intensity/frequency as well as therapeutic stretches and exercises to come later this week!

STRETCH OF THE WEEK:

Rolling out the gastrocnemius (calf)

My preferred tools are a lacrosse ball & a step.

Put the ball on top of the step (or in my case, a puzzle box) and let your calf sink into the ball. Roll the ball around the entire surface of the calf. If you can tolerate it, when you find a sore spot just sit and hold until that sensation alleviates.

As with rolling out the plantar fascia, don’t go crazy! Do not roll so hard that you are in agony as you can often create inflammation (or add to it) by doing this too aggressively.
I like to roll out the calf first followed by a calf stretch (see #stretchoftheweek #3). Try rolling each calf for a minute or two and then do a 30 second stretch 3 times (both legs). This would be a great routine post-run/exercise!

PREHAB

How Can I PREVENT Shin Splints?

Other then seeing a Pedorthist to get custom orthotics and/or a proper footwear recommendation, there are some preventative exercises you can do to help prevent shin splints.

“J-Curl” Exercise: Tibialis Posterior Strengthening

This is a challenging yet effective exercise to strengthen the tibialis posterior. Have the resistance band around the ball of your foot and draw a J with your foot (when doing this on the left foot it will be a backwards J). You should be able to have good control over your foot during this movement. Don’t just let your foot whip back to either position, do this with control for the most benefit.  If you are poor at this exercise, keep practicing! There are many exercises where this came from and improving that mind-foot connection will help you prevent plantar fascia pain.

REHAB

What to do if you currently have shin splints?

If you currently have been diagnosed with shin splints, book in with your local rehabilitation professional! Since these places are likely closed at the moment, here are some at home tips you can do to reduce your pain:

  1. Ankle mobility: Place your foot a distance from the wall so that when you bend the knee, you can touch the knee to the wall while keeping your foot flat to the ground. You should feel some tension in the front of the ankle (not pain). If you can touch your knee very easily then move your foot further from the wall. Keep your foot flat the entire movement! You can repeat this 20 times and do both sides. This will help increase the dorsi flexion of your ankle.
  2. Try implementing some single leg balance into your day. This could even be done on a pillow to increase the challenge. Aim for 5-10 minutes of balancing per day
  3. Roll out & Stretch your calf (gastrocnemius). Refer to my #stretchoftheweek #3
  4. Wear shoes with good arch support (especially if walking around in your house, wear running shoes, birkenstocks etc. AVOID FLIP FLOPS!)

You will notice these recommendations are similar to the plantar fasciitis recommendations. Since these injuries are so close to each other on the body, there is common musculature involved. And again this goes back to the feet: poor arch support, ankle mobility and the strength of the surrounding musculature can lead to a host of problems!

Treatment is highly recommended when experiencing shin splints. The sooner you have the onset of pain, the faster you should seek help! These at home tips will be greatly beneficial, however seeking Athletic Therapy will give you the personalized care that you need.

Therapeutic Workout

How to get a therapeutic workout that will be beneficial for my shin pain and/or prevention?

Also you should have a good appreciation of what the arches in your feet are like. As you stand in barefeet, can you see the arches in your foot? Or do you have flat feet? That is an indication you need some extra support! This is something to consider when picking out your running shoes and/or seeking for custom orthotics. 

Try and watch your feet in a mirror while doing these exercises, do your feet cave inwards, do your ankles bend equally, do your knees collapse inwards? These are all great things to keep in mind and an indication that more mobility work and/or strength is needed.

1) Arch Curl: With your foot flat on the ground, press it firm into the floor and then curl your toes in to curl the arch of your foot. Repeat 20 times per side

2) Eccentric Calf Raise on Step: This takes some coordination: Place the balls of your feet on the step with your heels hanging off. Raise the heels with both feet planted on the step, take one foot off the step and lower the opposite heel slowly for the count of 3-5 seconds. Then place the other foot back on the step again and return to the starting position. Repeat. 3 sets of 15 reps.

3) Arch Lift: with half of your foot off the step, you are going to bring your foot up to neutral and then let the arch cave off the edge of the step and repeat. 3 sets of 15 reps

4) Posterior Lunge: You are stepping backwards into this lunge. You can either have the back knee touch the ground on the lunge or it can hover just above it. Repeat 3 sets of 15 reps per leg

This is a great therapeutic workout you can do anytime! We are really focusing on strengthening that tibialis posterior in this workout, so feel free to incorporate these exercises into any workout!

Injury of the Week # 2 RECAP!

  1. FLEXIBILITY: Roll out the gastroc (calf) with a lacrosse ball on a step ~1-2 minutes per side followed by a calf stretch (Refer to stretch of the week #3)
  2. PREHAB (Prevention): J-Curl Tibialis Posterior exercise with a resistance band: 3 sets of 15. Perform this with control
  3. REHAB: Ankle Mobility Knee Touches: 20 reps per side.
  4. Therapeutic Workout Thursday #TWT: Arch curl, Eccentric calf raise on step, arch lift on step and dynamic posterior lunge!

And that’s a WRAP on week 2 of #injuryoftheweek! I hope you learned a lot and can implement these exercises into your existing routines.

Next we are moving up to the knee!

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