With my work at a dance school I’ve come across several cases of shin splints but it’s not just these students with hours of dancing that suffer from ‘shin splints’. Well conditioned footballers can even suffer from this condition as does the amateur runner. Though it is commonly called Shin splints, this covers a multitude of conditions which come under the same umbrella for example:
- Anterior tibial myotendinitis
- Posterior tibial myotendinitis
- Stress fractures of the tibia and/or fibia
- Tearing of the interosseous membrane
- Anterior tibial tenosyovitis
Most common causes
One the most common causes is an overused muscle, either as an acute injury or delayed onset muscle soreness (DOMS). The muscle pain is caused by any activity that involves running, jumping, also sometimes even walking. Untreated shin splints can lead to a stress reaction mid-shaft in the tibia, which can eventually lead to a stress fracture. A stress fracture can be diagnosed by an MRI and takes much longer to heal than shin splints.
The reason that ‘Shin splints’ occurs in the activities mentioned above is because the purpose of the muscles of the anterior shin (tibialis anterior) is to dorsiflex the foot (bend the foot upwards at the ankle). Other muscles here include the extensor digitorum longus muscle and the extensor hallucis longus, which move the toes, 2-5 and the big toe respectively, upwards. It may not be obvious why a muscle which raises the toe can be stressed or injured by running, given that it is not responsible for propulsion. The reason is that some runners overstride, and land heavily on the heel with each footstrike. When this happens, the forefoot rapidly slaps down to the ground. Effectively, the foot, which is dorsiflexed prior to making contact with the ground, is forcefully plantar flexed (bending the foot downwards at the ankle). This forceful plantar flexion of the foot causes a corresponding rapid stretch in the attached muscles. A reflex in the muscles responds, causing a powerful contraction. It is this eccentric contraction ( eccentric contraction is carried out when performing an action against resistance) which leads to muscle soreness and possible injury to the muscle, tendon or connective tissue.
In younger people “shin splints” can be caused by an overuse in tissues which are not developed enough to cope with the stress of the activity they are doing. In older people it can be due to a sudden change from an inactive life to an active one. This can be further compounded by simply wearing inappropriate footwear, training on uneven surfaces. It can be brought on by having collapsed arches or a current hip or knee injury which can have a knock on effect on the lower leg.
Symptoms
The most noticeable symptom is pain in the middle third or lower third of the tibial area. This usually comes on only after activity at first but in more severe cases it can hurt just simply walking.
In the more severe cases if you cannot bring your toe towards your knee with your knee locked and pain is caused by extending your ankle these are other clear symptoms of “shin splints”.
Treatment
The first step especially in more serious cases is rest from any activity that causes the pain. Ice applications during the first couple days will also help. With stress fractures like the main element in the recovery process.
Massage can begin immediately to the calf area using deep massage and effleurage and petrissage (terms for techniques used in Remedial Massage). After a couple of days then work can begin on the anterior muscles. The reason this takes a little more time is that with it being a lot closer to the bone it is a lot more sensitive than the calf.
This should be accompanied with some stretching exercises for the calf muscles and the antagonistic muscles (antagonistic muscle – a muscle that opposes the action of another; “the biceps and triceps are antagonistic muscles”) which can be started with very early in the recovery process and once these become more tolerable then isometric exercises can be introduced gradually.
If you have any further questions with regards shin splints please do not hesitate to get in touch.