Lionel Pannunzio PT / SCS
Shin pain while running
Introduction - What are Shin Splints?
Medial tibial stress syndrome (MTSS) is a condition that causes pain on the inside of the shin (the front part of the leg between the knee and ankle).
MTSS is commonly referred to as “shin splints” due to the location of pain over the shin bone; pain can be felt on the inside or the front of the shin bone.
The pain is non-focal but extends over “at least 5 cm” over the shin and is often bilateral
MTSS is one of the most common athletic injuries. It affects both the muscle on the inside of the shin and the bone to which it attaches, causing the connection between them to become irritated or even develop minor tears due to overwork. .
The two main muscles relating to shin splints are tibialis anterior muscle (located on the front of the shin bone), and posterior tibialis muscle (located inside and behind the shin bone). Overuse of these muscles is what creates the pain on the shin.
MTSS may affect up to 35% of athletes who run and jump, such as distance runners, sprinters, basketball or tennis players, soccer players or gymnasts. Military personnel, dancers, and other active people also can develop MTSS.
The most common complication of shin-splints is a stress fracture, which shows itself by tenderness of the anterior tibia.
Physical therapists help people who develop MTSS recover pain-free movement and learn exercises and tactics to prevent reinjury.
Shin Splints- Anatomy of the Injury
There are 4 muscle compartments in the lower leg:
1. Anterior: this compartment contains the tibialis anterior muscle, the extensor hallucis longus, the extensor digitorum longus and the peroneus tertius. This group moves the foot and toes up.
2. Deep posterior: this contains the flexor digitorum longus, the tibialis posterior and the flexor hallucis longus. This group moves the foot and toes down.
3. Superficial posterior: this is the gastrocnemius and soleus group; predominatly plantar flexors of the ankle.
4. Lateral: this compartment contains the peroneus brevis and longus, mainly foot evertors. This group brings the foot up and out .
Types of Shin Splints:
Anterior shin splints
The tibialis anterior is very important during the running stride.
This muscle has to work very hard in keeping the feet dorsiflexed (up) during every step and for that it needs to be strong to prevent your feet from slapping into the ground and producing excess stress to the lower legs.
Overstriding as a cause of anterior shin splints: the tibialis anterior tendon and muscle lengthen past their “normal” during over-striding which results in inflammation and pain.
Adding a hard surface, slapping too hard or improper shoe selection can add to the “overuse “ of the tibialis anterior and create shin splints .
Posterior shin splints.
With posterior shin splints pain is located on the inside part of the leg at the edge of the shin bone.
The tibialis posterior has a role supporting the arch as the body moves over the foot during the running stride.
Posterior shin splints in medical terms is known as medial tibial stress syndrome (MTSS).
The tendon will become inflamed and have micro-trauma if the forces applied to it are too great.
Runners who have high arches and supinate, are more likely to develop posterior shin splints.
Physical Therapy Treatment for Shin Splint
Rest and Load Management
Patients may require “relative” rest and cessation of sport for prolonged periods of time (from 2 to 6 weeks), depending on the severity of their symptoms.
Decreasing weekly running distance, frequency, and intensity by 50% is a good starting point when in pain.
Runners are encouraged to avoid running on hills and uneven or very firm surfaces
Use cross training with other low-impact exercises, such as pool running, swimming, using an elliptical machine, or riding a stationary bicycle.
Over a period of weeks, athletes may slowly increase training intensity and duration and add sport-specific activities, jumping exercises, and hill running to their rehabilitation program as long as they remain pain-free .
Athletes should scale back any exercises that exacerbate their symptoms or cause pain.
Physical Therapy - Modalities
Phonophoresis, electrical stimulation may be used in the acute setting to control pain.
Every rehabilitation must include reeducation of proper technique, gait retraining, and return to activity in a step-wise fashion.
Literature has widely supported a daily regimen of calf stretching and eccentric calf exercises to prevent muscle fatigue.
Other exercises focus on strengthening the tibialis anterior and other muscles controlling both inversion and eversion of the foot.
Patients may also benefit from strengthening core and hip muscles
Developing core stability with strong abdominal, gluteal, and hip muscles can improve running mechanics and prevent lower-extremity overuse injuries.
Developing muscle strength will improve endurance.
Runners should also change running shoes every 250 - 500 miles.
Orthotics: Individuals with biomechanical problems of the foot may benefit from orthotics
Proprioceptive balance training in single leg balance
Shin Splints- Anterior Tibial Stress Syndrome
On this variation of Shin Splints, The muscle affected is the Anterior Tibialis in the front and outer part of the shin
These muscles function is to control the foot from "slapping" down on the ground as your heel contacts the ground with walking and running and also works to lift the foot up off of the ground so that it doesn't drag as you swing your leg forward for the next step.
As we mention before modifying your activity to decrease your volume and/or intensity of walking and running, and then gradually building back up again.
Landing with a more FLAT foot or FOREFOOT strike when running
Building up the strength of Tibialis Anterior so that it can handle the load better as you build up volume and intensity .
Here I show just a few ways to start working on the strength of these muscles:
1. Tibialis Anterior Isometrics - Static Holds , 2 Feet > 1 Foot
Isometric contractions help with controlling pain and buidling strength reason why this is our first choice of exercise.
2. Toe Raises off a Step - 2 Feet
Finally we need to work on strengthening of this muscle in the whole range of movement. We use a step to raise and lower the toes from one end of the movement to the other.
3. Walking Drills
First will be walking on the heels to increase strenth of Tibialis Anterior then progressing to a control downward movement of the foot .
We said above that slapping the foot on the ground was one of the reasons why a person can develop Shin Splints therefore controlling this movement is a must during the rehab process .
Start with the foot up and control the movement down slowly repeating the same step several times.
As a general recommendation perform 2-3 sets of 12-15 reps. See how it feels aftewards or the next morning after exercises. A mild increase in pain is allowed but it the pain gets irritated dial down in repetitions and sets.
Shin Splints is a term used to describe pain in the front of the shin when running.
Solving this condition requires a comprehensive approach to correct all deficits that can be causing the pain .
The best approach to treating shin splints is to unload the tissue, increase the strength of the muscles affected ( Tibialis anterior and Posterior), as well as a well roundup hip and core strengthening program to finally load the tissue again with running program that progresses slowly to allow tissue adaption to the load of running
Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located in the beautiful City of Weston, where he treats Soccer Player, Runners and Athletes of all ages
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Board-Certified Sports Specialist
Owner of White Bay Physical Therapy
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