What are shin splints?
Shin splints, otherwise known as medial tibial stress syndrome (MTSS), are an overuse injury or repetitive-stress injury of the shin area (1).
This injury has a poorly defined set of symptoms which can make it difficult to diagnose. They include:
- Exercise-induced pain at the medial border of the tibia (shin bone)
- Pain provoked by pressing on it
- Dysfunction of the tibialis posterior, tibialis anterior, and soleus muscles are also commonly implicated (1).
Who gets shin splints?
Shin splints are common in those who perform high impact, repetitive activities that require running, jumping, and deceleration (2).
Being this is an overuse injury, performing high impact activities frequently over a long period of time or having a large spike in exercise intensity and volume are two of the main reasons for the onset of MTSS.
Not sure what a large increase in exercise volume or intensity is? Here is a personal example:
The one time I had shin splints was when I started playing basketball frequently in college. I took a summer basketball class that was two hours per day, four days a week. This was amazing since it was an excuse to play basketball often when prior to that I was only playing maybe once a week if I was lucky.
Midway through the semester, I began to experience pain to the touch in the front of my shins and it felt worse when I played basketball. This issue persisted throughout the rest of the semester (mainly because I never rested or did anything about it), but a few months after I stopped playing basketball, the pain went away completely.
What to watch out for?
Due to the fact that shin splints symptoms are poorly defined, we need to be mindful of other diagnoses that have similar presentations.
Stress fractures of the lower extremity account for up to 80%-95% of all stress fractures; the majority involving the tibia. They are caused by repetitive loading with resulting bony microfracture. Stress fractures of the anterior tibia and medial malleolus are high-risk fractures necessitating non-weight bearing and longer periods before return to play, and/or surgical treatment (3).
Chronic Exertional Compartment Syndrome (CECS)
CECS is a condition of increased pressure in the fascial compartments (muscles and neurovascular structures bound by fascia and bone) related to exercise that leads to recurrent episodes of pain. The anterior compartment is most commonly involved (45%) with the lateral, deep, and superficial compartments being less common. Symptoms are bilateral 85%-95% of the time (3).
How do we address MTSS?
In the initial treatment of shin splints, removing the loads that recreate your pain is important.
This does not mean you need to be inactive. As long as an activity does not make your pain levels worse you are allowed to do as much of it as you like. Just keep in mind that doing too much too fast can lead to an exacerbation of symptoms.
Once we remove the irritating stimuli, a thorough assessment of the body is necessary to figure out which areas of the body are not working optimally.
The most common issues I see are:
- Lack of foot/ankle mobility
- Decreased foot/ankle strength and stability
- Decreased mobility and weakness of the knee and hips
The short-term goal for rehab is to improve the areas of the body that are showing deficits in mobility, strength, and stability while decreasing the pain response. As rehab progresses and you start feeling better, we can then SLOWLY add the painful stimulus back in using the principle of progressive overload to build better tolerance and work towards return to sport/activity.
This is done by finding the amount of work that can be completed that causes no pain/soreness to minimal pain/soreness. As your body adapts and becomes better able to tolerate the forces, we then use the 10% rule to slowly increase our intensity and volume of training.
Here are a few exercises that I often prescribe to those with shin splints. Give them a try; hopefully, they’ll help! If they don’t, click the button below to hop on a discovery call to see if I can help you get out of pain.
Ankle Dorsiflexion PAILs/RAILs
Big Toe Extension PAILs/RAILs
Squat with Heel Raise
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