Shin Pain – an insight into the condition and its rehabilitation.
Medial tibial stress syndrome presents as pain along the shin bone and is often referred to as “shin splints”. It is a relatively common injury and can affect athletes involved in impact sports, and up to 35% of runners.
The cause of shin pain is usually related to a sudden increase in load as one increases training intensity in view of an upcoming running event or game. This means an increase in either kilometer distance achieved, or pace and speed, or type of terrain (concrete vs grass vs soft sand etc), or tackling more hills or inclines. In some situations, it can even be caused by a sudden change in training shoes, which results in different biomechanics and way of loading the lower limb.
It is hypothesised that pathology of medial tibial stress syndrome involves dysfunction in the muscles that attach along the shin bone (tibia), namely posterior tibialis and flexor digitorum longus muscles. It is thought that that increase in load can result in increase in tension within these muscles, causing greater shear forces at the attachment sites of these muscles on the tibia. This in turn may result in symptoms such as pain, swelling and edema. In some severe cases, medial tibial stress syndrome can even lead to micro-fractures along the periosteum of the tibia if left untreated and aggravating triggers are not addressed.
Novice runners who have just picked up running as a new year resolution, for example, are particularly likely to develop this type of injury as their body has not conditioned and adapted to the demands of the new activity yet. Runners with higher body mass index (BMI), decreased hip strength and increased foot pronation were also found to be at higher risks. Females were also more prone to developing this type of injury due to having a larger pelvis and its implications on the biomechanical function of the lower limb.
So, what do I do if I have shin pain? – Does this mean I have to stop running?
Nope. Not necessarily…
Treatment of medial tibial stress syndrome involves an array of different approaches, including reducing load. This does not however mean that you should stop running altogether. It may be essential in some situations to have a temporary break from running until the acuteness and severity of your symptoms diminish to allow you to start a rehabilitation program towards starting to run again. But in most cases, it is a matter of allowing a relative reduction in load – run less distance, run smarter – and start a strengthening and conditioning program to address the biomechanical deficits identified by your physiotherapist.
In the early stages, the physiotherapist may treat the surrounding musculature to reduce any potential tension along the tibia and teach you some useful stretches and management techniques.
The physiotherapist will assess your biomechanics range of motion and strength, review your training volume (kilometers distance achieved per week), help you break down the intensity of your training and assess your running technique.
Overall, you will learn to train smarter, run better and understand how to work the fine line of challenging your body towards improving your performance, and also allowing adequate room for your body to strengthen, condition and adapt accordingly to prevent resurgence of injuries.
So, do not hesitate to see one of our friendly physiotherapists for an assessment and start your journey to fitness and wellness.
Adriane Kabhlyuk , Physiotherapist and Pilates instructor
Collins, N, Bisset, L, McPoil, T, Vicenzino, B. (2007). Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis. Foot & Ankle International; 28:396–412.
Geoffrey, J. (2014). Dynamic foot function as a risk factor for lower limb overuse injury: a systematic review. Journal of Foot & Ankle Research: 7: 53.
Janice and Reiman (2017). Lower Extremity Kinematics in Running Athletes with and without a History of Medial Shin Pain. International Journal of Sports Physical Therapy: 7(4): 356-364.
Luedke et al. (2016). Influence of Step Rate on Shin Injury and Anterior Knee Pain in High School Runners. Medicine and Science in Sports and Medicine; 48(7): 1244-50.
Newman, P, Witchalls, J. Waddington, G, Adams, R. (2013). Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Journal of Sports Medicine; 13(4): 229-241.
Saeki et al. (2017). Ankle and toe muscle strength characteristics in runners with a history of medial tibial stress syndrome. Journal of Foot and Ankle Research; 10: 16
Saeki et al. (2017). Muscle stiffness of posterior lower leg in runners with a history of medial tibial stress syndrome. Scandinavian Journal of Medicine & Science in Sports.
Winkelmann, Z.K. et al. (2016). Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. Journal of Athletic Training. Dec;51(12):1049-1052.
Zachary et al. (2016). Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. Journal of Athletic Training; 51(12):1049-1052