A large problem for runners that get shin splints is being told to stop running. Here we provide a brief overview for you about shin splints, the predictors, the risks and the benefits of seeking care.
This is a symptom to the front inside and front outside portion of the lower leg. The symptoms can include throbbing, sharp and debilitating pain. If symptoms such as numbness and tingling occur it is possible that the condition has become an exercise induced compartment syndrome, which if persistent is a straight shot to an ER.
For Medial Tibial Stress Syndrome the symptoms decrease as activity decreases. What it would appear is muscle and tissue fatigue from activity. We keep this in mind as changing up an athletes running schedule in amount, frequency and duration. Tissue capacity requires time to build with repeated stressors. The condition of MTSS appears to be tied to running athletes and military cadets commonly.
One of the most primary risk factors for MTSS is foot hyperpronation. (2) This means the foot is extremely flat, and wearing an orthotic doesn’t generally make much of a difference.
There is research linked that shows the main risk factors of shin splints include an increased Body Mass Index, increased navicular drop which leads to hyperpronation, a greater range of motion in plantar flexion i.e. toes pointing down, and greater hip external rotation. (1)
The group of muscles that gets targeted the most with MTSS are a combination of the tibialis anterior muscle, extensor digitorum longus, extensor hallicus the flexor digitorum longus, flexor hallicus longus and tibilalis posterior.
What this means to you: it means that knowing that it isn’t one muscle means that treatment will involve the treatment of the lower leg and ankle. It means that improving the symptoms is possible with treatment and rehab. The goal here is that we build up a more resilient tissue by building up capacity from training and exercise.
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What is the warm up or exercises to help this?
There is a term thrown around currently called “prehab” its meaning is you are able to do exercises that will prevent an injury. It is a great idea. It can be difficult to know you have a need to build up muscular endurance in one particular area until you have an injury or complaint. Here are a few helpful exercises with videos that are meant to focus on shin splint prevention.
As part of prehab what must be taken into account is the amount of running per week the athlete is doing.
Treatment of MTSS is always predicated as to what joint motions or conditions the patient presents with. Assessment of the patient with MTSS involves a gait analysis, posture scan, movement assessment in activities that produce the symptoms. Inside ChiroMovement Muscle & Joint Clinic a full assessment is part of your initial visit. This information helps to build a list of possible diagnosis that can be part of the problem. With all lower body conditions it is important to know what each joint does when in certain provocative tests, ie, running for shin splints, or compartment syndrome with endurance athletes.
What is missing from this style of treatment is the use of ice or heat.
Treatment may include a multi-modal approach for MTSS. It can involve manual therapy techniques for the muscles stated above. Dry needling is an option often deemed necessary to work on shortened and tight muscles. The use of cupping therapy has been seen as beneficial, as is using kinesiology tape. (5)
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What are the best ways to prevent this? Shoe wear appears to be a major factor in providing a shock absorption. Shoes are definitely part of the issue. Tissue preparedness and muscular capacity are major players at this. Prevention of shin splints would entail increasing aerobic capacity, increase cardiac output and strengthen the muscles of the foot, ankle and up to the knee. All play a role in absorption of forces.
Shoe wear also becomes a very touchy subject for runners. Whether it be for a brand or a look it is important to have the correct footwear as a runner hitting high mileages weekly.
With all conditions it is important to know as much about you when you come in. Your past medical history, your surgical history, injury history and your everyday tasks or movement requirements all tell the tale about you.
In providing you with a treatment plan it is important that you know the risks and benefits of both doing nothing and beginning care as well as having other options out there.
Whether you are a novice runner, or avid medal winning running athlete we are here to help you.If you are in need of continued care then please reach out and get scheduled today.
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- Winkelmann ZK, Anderson D, Games KE, Eberman LE. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J Athl Train. 2016;51(12):1049-1052. doi:10.4085/1062-6050-51.12.13
- Reshef N, Guelich DR. Medial tibial stress syndrome. Clin Sports Med. 2012 Apr;31(2):273-90. doi: 10.1016/j.csm.2011.09.008. PMID: 22341017.
- Franklyn M, Oakes B. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments. World J Orthop. 2015 Sep 18;6(8):577-89. doi: 10.5312/wjo.v6.i8.577. PMID: 26396934; PMCID: PMC4573502.
- Winters M, Eskes M, Weir A, Moen MH, Backx FJ, Bakker EW. Treatment of medial tibial stress syndrome: a systematic review. Sports Med. 2013 Dec;43(12):1315-33. doi: 10.1007/s40279-013-0087-0. PMID: 23979968.
- Kachanathu SJ, Algarni FS, Nuhmani S, Alenazi AM, Hafez AR, Algarni AD. Functional outcomes of kinesio taping versus standard orthotics in the management of shin splint. J Sports Med Phys Fitness. 2018 Nov;58(11):1666-1670. doi: 10.23736/S0022-4707.17.07520-X. Epub 2017 Oct 24. PMID: 29072026.