SHIN SPLINTS

What are shin splints?

Shin splints is the general name given to pain at the front of the lower leg. Shin splints is not a diagnosis in itself but a description of symptoms of which there could be a number of causes. The most common cause is inflammation of the periostium of the tibia (sheath surrounding the bone). Traction forces occur from the muscles of the lower leg on the periostium.

Symptoms of shin splints include:

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  • Tenderness over the inside of the shin.
  • Lower leg pain.
  • Sometimes some swelling.
  • Lumps and bumps over the bone.
  • Pain when the toes or foot are bent downwards.
  • Redness over the inside of the shin.

What can the athlete do about shin splints?

  • Rest. The sooner you rest the sooner it will heal.
  • Apply ice or cold therapy in the early stages when it is very painful. Cold therapy reduces pain and inflammation. Cold therapy can be applied. More information about cryotherapy or ice application can be seen in shin splints rehabilitation. Click for more detailed information about cold therapy.
  • Wear shock absorbing insoles in shoes.
  • Maintain fitness with other non weight bearing exercises.
  • 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 body’s natural heat. Heat causes blood vessels to dilate and increases the flow of blood to the tissues.

What can a sports injury clinic or doctor do?

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  • Prescribe anti-inflammatory medication e.g. ibuprofen. (Always consult a doctor before taking medication).
  • Tape the ankle for support. – A taping worn all day will allow the shin to rest properly by taking the pressure off the muscle attachments.
  • Analyze running style for over pronation and other biomechanical problems of the foot.
  • Use sports massage techniques on the posterior deep muscle compartment but avoid the inflamed periostium.
  • Operate

Important

Anti inflammatory drugs along with rest and ice can help reduce inflammation, particularly in the early stages. However if the underlying causes such as tight muscles are not treated through stretching and sports massage techniques then the likelihood of the injury returning is higher.

Rehabilitation

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The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any self treatment.

Aims of rehabilitation

  • Reduce pain and inflammation.
  • Identify any biomechanical disfunction (problems) that may be causing the problem.
  • Improve flexibility and condition of the surrounding muscles.
  • Return to full fitness.
  • Injury prevention

Reducing pain and inflammation

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Rest from activities that may cause pain. Stay off your feet as much as you can. Use crutches if necessary. People using crutches get taken far more seriously and given more sympathy than those who should be on them and hobble out anyway. Most shin pain will not need crutches though. Maintain fitness by swimming or cycling. Take the opportunity to work on upper body strength.

Apply ice or cold therapy. Cold therapy can be applied in a number of ways. Ice massage using an ice cube or a frozen polystyrene cup of water can be applied by rubbing the ice up and down the shin. There are also a number of specialist cold therapy products are available which can apply cold therapy and compression at the same time and are more convenient than ice. Ice can be applied for 10 minutes along the shin. The tissues along the shin are very superficial so the time of application will be less than a deeper area of the body for example a thigh muscle. Cold therapy can be applied every two hours until inflammation has gone down or at least three times a day.

You should not apply ice to an area if you have bad circulation. Ice itself should not be applied directly to the skin unless in the form of ice massage (where the ice is constantly moving) or ice burns to the skin can happen.

Taping the shin is a good way of helping the leg to rest if you cannot avoid being on your feet. It will support the muscle attachments at the sore spot on the shin taking some of the pressure and strain off the tissues.

NSAID (Non steroidal anti-inflammatory medication) e.g. ibuprofen may help in the early stages. Always check with a Doctor before taking any medication. Do not take Ibuprofen if you have asthma.

Improving flexibility and muscle condition

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Gentle stretching should be started as soon as pain will allow – the first day of treatment if possible.

If the pain has gone and you are now able to run then you may think the job is done, however if the condition of the lower leg muscles particularly the calf muscles is not improved then the injury is likely to re-occur.

Stretch both the front of the leg and the muscles at the back of the leg. Hold stretches for up to 40 seconds and repeat five times. Aim to stretch at least 3 times a day. This is a lot of stretching but will be worth it. Time it on a watch so as not to cheat.

Continue stretching daily throughout the rehabilitation phase and long after the injury has healed.

Using Sports Massage

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Sports massage techniques can be very effective for helping to prevent shin pain from returning. Applying deep massage to the muscles at the back of the tibia (shin bone) and the calf muscles will release some of the pressure on the bone itself.

Massage should be applied as soon as pain will allow – gently at first.

Apply massage to the muscles but stay away from the bone as this may cause more inflammation.

Massage can be performed every other day. A day’s recovery is required between sessions, especially if the massage has been deep.

If massage makes the injury worse then do not massage further.

Prevention of Shin splints

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  • 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 over pronate. 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

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