Spring time is here, the weather is warming up and it’s time to get back outside in the sunshine.

Are you getting ready to start running outside again? One of the most common issues runners face when starting up a new program is shin splints (Medial Tibial Stress Syndrome). Described as a recurring dull ache along the inner part of the lower two-thirds of the shin bone, shin splints are an overuse injury to the connective muscle tissue surrounding the shin bone.  Shin splints can be attributed to the overloading of the lower leg due to a sudden increase in intensity or frequency in activity level fatigues muscles too quickly to properly help absorb shock, forcing the shin bone to absorb most of that shock. This stress is associated with the onset of shin splints.

It’s important to understand that not all shin pain is shin splint. Pain in the lower leg can also be caused by stress fractures or compartment syndrome.

Compartment syndrome of the lower leg typically involves the lateral or outside part of the shin. Compartment syndrome occurs when the muscle swells inside a closed compartment causing pressure within the lower leg. This may be a medical emergency that may require a visit to your physician right away.

A stress fracture includes an incomplete crack in the bone and tends to be more localized then shin splints.

Here is a list of clues the help you figure out what is going on.

Shin Splints

• Dull ache along medial lower two thirds of the tibia
• More soreness in the morning

Compartment Syndrome

• Pain along the lateral (outside) aspect of the lower leg
• Unusual nerve sensations
• Eventual muscle weakness, resulting in drop foot
• Intense pressure in the lower leg

Stress Fracture

• Localized pain when pressing on a specific point on the bone (Tibia)
• More soreness in the evening

The most common treatments for Shin Splints include

• Rest
• Ice
• Strengthening/Stretching
• Gradual return to activity

-Galbraith, R. M. & Lavallee, M. Medial tibial stress syndrome: conservative treatment options. Current Reviews in Musculoskeletal Medicine 2009; 1-10

Rest and ice allow the tibia to recover from sudden, high levels of stress and reduce inflammation and pain levels. It is important to significantly reduce any pain or swelling before returning to activity. Strengthening exercises should be performed after pain has subsided, focusing on lower leg and hip muscles. You should gradually return to activity, over multiple weeks, and work up to normal activity level. It is important to decrease activity level if any pain returns. You should consider running on other surfaces besides asphalt, such as grass, to decrease the amount of force the lower leg must absorb.

–Yates, B., & White, S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. The American Journal of Sports Medicine 2004; 32.3: 772-780

Stretches

Gastrocnemius (outer calf): Sit with both legs straight. Loop a rope around the ball of one foot and grasp each end of the rope. Flex your foot back toward your ankle, toes toward your knee.

Soleus (inner calf): Sit with one leg straight and the other bent. Grasp the bottom of the foot on the bent leg. Keeping your heel on the ground, pull your foot toward your body as far as you can.

Achilles Tendon (attaches heel to calf): Sit with one leg straight and one bent. Bring your heel close to your buttocks. Keeping your heel on the ground, pull your foot toward your body.

Standing Anterior Tibialis Shin Stretch: Standing, you may want to use a hand on a wall or other support for balance. Place the foot to be stretched just behind your other foot (which remains squarely on the ground), with the toe of the stretching foot touching the ground. Keeping your toe firmly on the ground, pull the stretching leg forward so you feel a stretch from the top of your stretching foot through your shins. It often helps to bend both knees slightly.

Hold these stretches for 30 seconds, repeat 2-3 times, perform 3-4 times a day

Strengthening

Toe raises are a good starting point when looking to strengthen the shin muscles. Start with only a few repetitions and gradually increase the numbers. The patient should be sat with both feet flat on the floor. Keeping the heel on the ground, the patient should lift the rest of the foot up as high as possible. Hold for a couple of seconds before slowly returning the foot back to the floor Repeat 10-20 times and increase to performing 2-3 sets. Less is more with this exercise, doing too much too soon can make symptoms worse.

Perform Heel Raises to strengthen all of the lower leg muscles, perform calf raises. These can initially be performed both legs together before being progressed to single leg only. Stand with the feet shoulder width apart and knees straight holding onto a wall or similar for balance. Lift the heels off the floor as high as possible and slowly return to the floor. This can be progressed even further by standing on a step with the heel off the back and lower the heel down past the level of the step. Repeat 20-30 times.

Heel and Toe Walking. Walk the length of a room either on the toes or on the heels will help to strengthen the calf and shin muscles respectively. Make sure you do this slowly and under complete control.

By Andy Broomhall, PTA, ATC

Back in Motion Physical Therapy – Portland, Maine

Learn More About Andy Broomhall