How to fix shin splints | Total Performance Physical Therapy

How to fix shin splints

June 6, 2019

Have you ever started feeling a dull ache in your shins at the beginning of a run that doesn’t stop bothering you until you stop?  Or have you started training for a race and increasing the amount of miles that you are running only to find that a couple minutes into the run you have a dull ache in your shins that you feel you can push through, but as you continue to run on subsequent days it only continues to bother you and seems to get worse and more consistent?  If so, you may be experiencing shin splints, which in medical terminology is often referred to as Medial Tibial Stress Syndrome (MTSS).  MTSS is characterized by inflammation of the muscles surrounding the tibia, or the shin bone.  What you might not know is that there are two types.  They are named based on the location of the muscles affected in relation to the shin bone.

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  1. Anterolateral:  Broken down into its components the word anterolateral means anterior and lateral.  This translates to inflammation of the muscles that are located in the front and outside part of your shin.  The main muscle that is affected with this type of MTSS is the muscle that crosses into the foot and causes your toes to point towards the ceiling called the anterior tibialis.  Pain with this type of MTSS will especially be felt during the parts of walking or running that involve pointing your toes towards the ceiling to bring them off the floor or when your heel first touches the floor and you lower your feet towards the ground.
  2. Posteromedial:  Broken down into its components the word posterolateral means posterior and lateral.  This translates to inflammation of the muscles that are located outside and behind the shinbone.  The main muscle that is affected with this type of MTSS is the posterior tibialis.  This is one of the muscles that crosses into the foot and causes your toes to point towards the floor.
The muscles of the front of the leg

What causes Medial Tibial Stress Syndrome?

  1. Muscle imbalances.  Strength and flexibility of muscles as high up as your core muscles can have an impact on how the muscles that control your foot work.  The core is responsible for keeping your pelvis stable and reducing the amount of motion that occurs there when you run.  If your core is weak, the muscles in your hips have to work harder to not only control what your legs are doing, but also to prevent you from falling.  This will cause your hip muscles to fatigue faster.  As your muscles fatigue, they won’t do their job properly.  For example, if your hamstring muscles-the muscles on the back of your leg that cause your knee to bend-are tired, you won’t bend your knee as much.  So in order to keep your foot from dragging as you’re running, muscles in your lower leg such as the tibialis anterior have to work harder to bring your foot upward and off the ground during running, which can cause you to have the anterolateral type of shin splint.
  2.  Tight plantarflexor muscles.  Plantarflexion is a term used to describe the motion that involves pointing your toes toward the floor.  If the muscles that cause this motion are tight it will be more difficult for the muscles on the front and outside part of your shin such as the anterior tibialis to pull your toes towards the ceiling.  This can cause inflammation and irritation of the muscles on the front and outside of the shin and the anterolateral type of shin splint.
  3. Training Errors.  If you are inactive for a period of time and randomly decide to start a new intense workout program, your muscles aren’t strong enough to meet the demands that you are putting on them with your workout.  This can cause inflammation of muscles and either type of shin splint.  Training on a hard surface such as pavement increases the work that the muscles on the front and outside part of the shin have to perform.  Pushing them causes inflammation and the anterolateral type of shin splint.
  4. Improper footwear.  If there is not enough shock absorption in your shoes, when you run and your heel contacts the ground it is thrown into a position where your toes are pointed toward the ground (plantarflexion).  This increases the work the muscles on the front and outside part of your shin have to do as they try to slow your foot down as the toes point toward the ground.  This can cause the anterolateral type of shin splint.  Footwear that lacks arch support can cause the posterolateral type of shin splint as it increases the work that the muscles behind and on the outside of the shinbone have to do.
  5. Improper positioning of the foot.  If while running, you excessively flatten the arch of your foot (pronation) when it contacts the ground it causes the muscles behind and on the outside of the shinbone to work harder causing the posterolateral type of shin splint.  The surface you run on, such as a banked surface, can also cause you to excessively flatten the arch of your foot and cause this.

Why is it important to recognize MTSS and not just push through the pain and discomfort?

If the cause of the MTSS you are experiencing is not treated and you continue to put stresses that the muscles aren’t accustomed to on them, you could get a stress fracture of your tibia or shin bone.
Some of the forces that are put on your bones from the weight of your body are usually taken away from the bones by the muscles, but if the muscles are not functioning properly because they are inflamed, the bones are forced to take on more than they are used to.  This can cause pinpoint tenderness over the fracture site, swelling, and pain that is increased with activity and decreased with rest.How do you avoid stress fractures and treat MTSS?A common misconception with MTSS is that resting from the activity that caused it and doing nothing else will make it better.  Although it may be true that you won’t feel that pain after a couple of days of rest, if you continue to perform the aggravating activity or use the footwear or walking/running pattern that you were using, it will only come back.  So when it comes to treating MTSS, the answer is simple-treat the cause.  A physical therapist can help you determine the cause and determine an appropriate treatment.

  1. Muscle imbalances.  If it is determined that you have muscle imbalances, appropriate strengthening and stretching exercises can be prescribed for your core and hip muscles to take the extra stress off of the muscles in your leg and decrease your risk for developing stress fractures.
  2. Tight plantarflexors.  If you feel like your calf muscles are tight, stretch!  A simple and easy way to stretch your calf muscles is by standing on a step or stair and allowing the heel of the leg that you would like to stretch to hang off the edge of it.  Pushing into that heel should allow you to feel a stretch along the back of your lower leg.  Holding this for 30 seconds 6 times a day, everyday should allow you to increase the flexibility of your calf muscles and take some of the work off of the muscles on the front of your shinbone.
  3. Training Errors.  An important thing to remember when starting any exercise program is that your body needs time to adjust to the new stresses being put on it.  So, if for example, you are starting to train for a marathon, you shouldn’t go out and run 10 miles on the first day.  Depending on your previous level of running, it might be more appropriate to start with three miles and add a couple of miles every week.  In terms of training surface, running on grass will decrease the amount of work your muscles have to do, decreasing the possibility of inflammation and irritation of the muscles around your shinbone.
  4. Improper footwear/positioning of the foot.  A physical therapist can do an evaluation of your foot to determine if you are flat footed or move into this position during running.  Depending on what is found, you may be prescribed a semi-custom fitted orthotic and/or strengthening of the muscles that control the movement of your foot.
For more information on physical therapy services head to www.totalperformancept.com.