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Shin Splints shin splints

The betternow Cambridge physiotherapy sessions can aid with the treatment of Shin splints.

 

Over the past 50 years, the term “shin splints” has been commonly used when describing pain in the lower legs during exercise and is one of the most common problems in the lower leg in active/sporty people.

 

Although the term “shin splints” is still used by healthcare professionals, it is slowly being replaced by more accurate diagnoses related to specific structures. (1)

 

What else could be causing your pain?

 

  • Tibial or fibular stress fractures
  • Chronic exertional compartment syndrome
  • Arterial or nerve entrapment
  • Deep vein thrombosis
  • Fascial herniations
  • Muscle strains or tears
  • Medial tibial stress syndrome 

 

In typical “shin splints” pain is felt primarily over the medial (inner) part of your shin. This pain is commonly referred to as “medial tibial stress syndrome” (MTSS). For this discussion I am going to use the term MTSS.

 

Causes of MTSS/Shin splints

 

By far the most common cause of MTTS relates to running/jumping sports.

Dancers: 22% of dancing injuries were found to be due to MTSS. (2)

Runners: 125 high school distance runners showed a 13% incidence of MTSS (3)

Military- 124 Australian military recruits from HMAS Cerberus, Australia’s largest naval training facility were studied and during basic training, 40 of these recruits (35%) developed MTSS.

Symptoms of MTSS

 

Usually presents as pain two thirds of the way down the inner shin, towards to ankle.
In most cases, there is no traumatic event that has caused the symptoms.

Pain generally worsens with increased intensity/duration of running or jumping activities
Pain generally ends after that exercise is stopped.

What structures could be involved in MTSS?

 

 

So, MTSS essentially results from a pull from muscular attachments into the inner shin bone which can cause inflammation of the tendons attaching muscle to bone or even irritation of the outer surface (periosteum) of the shin bone itself. 

Muscles often involved:

 

  • Tibialis Posterior
  • Soleus
  • Flexor Digitorum Longus

 

What causes the pull onto the bone?

 

So, we know that muscles such as Tibialis posterior and Soleus can put a stress onto the inner shin bone but the question is why does this occur?

The answer is not straight forward and will need through assessment to find the underlying cause. If the cause is not addressed in treatment, the symptoms will not easily reduce.

 

Here are a few potential causes for MTSS:

 

  • Hip weakness- If the muscles in your hips are weak, this can affect the stability of your lower limb. If your hips are weak, your knees are likely to fall inwards which will affect biomechanics below the knee and into the foot.
  • Flat feet- over pronation (or flat feet) can be another cause of MTSS, again due to the biomechanical effect on lower limb, including lower limb musculature, resulting in abnormal loading/stress.
  • Tight muscles: Tightness in the Gastrocnemius (calf) muscle has been linked to flat feet as well as MTSS.
  • Footwear- MTSS can even be caused by wearing incorrect and unsupportive footwear, again due to the biomechanical influence on the rest of the lower limb.
  • Increased intensity of Training- A sudden increase in training intensity or a change in terrain can also increase the risk of developing MTSS.

 

Assessment and Treatment

 

Treatments for shin splints vary dependant on the cause. As part of the assessment of your shin, we look very closely at foot mechanics, joint stiffness (including; foot, ankle, knee, hip, and occasionally spinal). We also assess muscle strength into your core and lower limb to find areas that may be contributing to your pain. Muscle length examination is also a fundamental part of the assessment.

 

If you are sporty and your sport involves running then we may also need to look at you on the treadmill to see biomechanical faults with movement.

 

So, once a cause is established, we tailor a specific treatment programme.

 

This may include:

 

Specific soft tissue massage, joint mobilisations, Ultrasound therapy, orthotic prescription, exercises for lower limb strength and mobility as well as advice regarding lifestyle and graduated return to sport etc. Sport specific rehab is vital once symptoms start to ease as this will reduce the likelyhood of re:injury.

 

For more information on shin splints or to book in for an appointment call me on 01223 832 808

 

 

 

 

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