Shin Splints - Shin Pain
Have you experienced any of the below symptoms ?
If so why not talk to a member of the Maryborough Team, and we can devise a rehabilitation programme for you. The term shin splints is a common name often given to any shin pain at the front of the lower leg. However, true shin splints symptoms occur at the front inside of the shin bone and can arise from a number of causes. Shin splints symptoms:• Shin pain over the inside lower half of the leg. • Pain at the start of exercise which often eases as the session continues • Pain often returns after activity and may be at its worse the next morning. • Sometimes some swelling. • Lumps and bumps may be felt when feeling the inside of the shin bone. • Pain when the toes or foot are bent downwards. • A redness over the inside of the shin (not always present). Causes of shin splintsThe most common cause of shin pain is inflammation of the periostium of the tibia (sheath surrounding the bone). Traction forces on the periosteum from the muscles of the lower leg cause shin pain and inflammation. This has lead to the use of terms such as Medial Tibial Traction Periostitis.Shin splints can be caused by a number of factors which are mainly biomechanical (abnormal movement patterns) and errors in training. Here are the most common causes:• Overpronation of the feet (arch drops in)• Oversupination of the feet • Inadequate footwear • Increasing training too quickly • Running on hard surfaces • Decreased flexibility at the ankle joint Shin Splints TreatmentTreatment for shin splints is as simple as reducing pain and inflammation, identifying training and biomechanical problems which may have helped cause the injury initially, restoring muscles to their original condition and gradually returning to training.• Rest to allow the injury to heal. • Apply ice or cold therapy in the early stages, particularly when it is very painful. Cold therapy reduces pain and inflammation. • Shin splint stretches should be done to stretch the muscles of the lower leg. In particular the tibialis posterior which is associated with shin splints. • Wear shock absorbing insoles in shoes. This helps reduce the shock on the lower leg. • Maintain fitness with other non weight bearing exercises such as swimming, cycling or running in water. • Apply heat and use a heat retainer or shin and calf support after the initial acute stage and particularly before training. This can provide support and compression to the lower leg helping to reduce the strain on the muscles. It will also retain the natural heat which causes blood vessels to dilate and increases the flow of blood to the tissues to aid healing. • Shin splints strengthening exercises may help prevent the injury returning.• Visit a sports injury clinic for treatment and rehabilitation. Stretches we can give: In most cases of shin splints, the calf muscles (Gastrocnemius and Soleus) are tight. The muscles at the front of the shin (especially Tibialis Anterior) also require stretching. Gastrocnemius StretchesThe Gastronemius muscle is the largest and most superficial of the calf muscles. It crosses the knee joint to attach to the Femur (thigh bone) and so to stretch the Gastrocnemius muscle, the knee must be straight. There are various ways of stretching this muscle. Below are the two most common:• The patient stands facing a wall with a wide stance and the leg to be stretched behind. • They keep the heel down and the knee straight as they lean forwards, using the wall for balance and something to push against. • A gentle stretch should be felt in the back of the lower leg. Hold this position for 30 seconds and repeat 3 times.• The patient stands on a step making sure there is something to hold on to (a wall or banister etc). • The toes should be positioned on the step, with the heel over the egde. • The heel is slowly lowered, keeping the knee straight, until a stretch can be felt.• Hold the position for 30 seconds and repeat 3 times. This stretch can be performed both feet together to start with but is more effective performed one leg at a time. Soleus StretchThe soleus muscle is located underneath the larger Gastrocnemius and it doesn't cross the knee joint. Therefore to stretch this muscle the knee must be bent to relax the overlying Gastrocnemius.• The patient should stand facing a wall with the foot of the calf to be stretched at the back. • The knee of the back leg should be bent towards the wall, keeping the heel on the floor. • A stretch should be felt in the lower part of the back of the calf. hold this position for 30 seconds and repeat 3 times.Seated Shin Stretch Stretching the muscles on the front of the lower leg can be difficult to achieve. The following are the two easiest ways of doing so.• Kneel down and sit on your heels. • Gently push down on the heels to stretch the front of the leg. • Hold the stretch for 30 seconds and repeat 3 times. • This stretch can be increased by stretching one leg at a time and gently pulling the knee up Standing Shin Stretch• Stand with your toes of one foot on the floor on the outside of your other foot. • Bend the weight bearing leg to push your other ankle towards the ground.• Hold this position for 30 seconds and repeat 3 times. Strengthening Exercises for Shin Splints Strengthening the muscles of the lower leg can begin after the initial painful, inflamed phase has passed. Strengthening should be a gradual process and exercises should always be pain free.Toe RaisesToe 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. Calf RaiseTo 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 should width apart and knees straight. Make sure you have something to hold on to• Lift the heels off the floor as high as possible and slowly return to the floor. • Progress on to one foot only• 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. Heel Walking / Toe Walking• Walking 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.Resisted DorsiflexionDorsiflexion is the ankle movement where the toes are pointed towards the ceiling. To progress in strengthening the shin muscles resistance should be used in the form of either pressure from a partner, or even easier, a resistance band.• The patient should be sat on the floor with both legs straight. • Loop the middle of the band around the upper foot (just below the toes), pass both ends of the band behind the other foot and up the outside of the other leg and hold the ends there. • Push down on the band with the other foot to make it taught. • Move against the resistance of the band to point the toes towards the ceiling.• Return to the starting position under complete control.Shin Splints Prevention • Increase training gradually. • Do not run too often on hard surfaces. You can do more training if you run off-road. • Avoid running a lot on your toes. Not easy if you are a sprinter but varying the training surface can help. • Ensure you have the correct footwear and that it is not too old. A pair of running shoes will have lost most of their cushioning after 400 miles. If you run few miles but your shoes are over 6 months old then they still may need replacing. • Check you do not overpronate. See a podiatrist or Sports injury therapist / Physiotherapist that can assess this. • Continue to stretch properly - especially the muscles at the back of the lower leg. • Get a regular sports massage. This will help keep the muscles of the lower leg supple and in good condition. • Apply ice to the shin after training. This may help keep inflammation down before it gets bad. • Wear a shock absorbing insole. If you have this injury and need help with strengthening this tendon, please speak to a member of the Maryborough Club Team. We can take you through each of the stretches above and the strengthening exercises.