Every single runner has likely experienced some sort of pain or discomfort during a run. As we’ve discussed in previous blogs, running injuries are outrageously common. A popular complaint especially in newer and younger runners is shin splints. They personally plagued my running career intermittently from middle school to college. The notorious pain along the shin bone that seemed to come out of nowhere often occurred early in a track season, or as practices were starting to ramp up. The good news? Shin splints are fully treatable, and you can be pain-free long term.
What is it?
The colloquial term of “shin splints” refers to pain along the lower leg or tibia (shin bone). You may hear of “anterior” or “posterior” shin splints – these refer to different muscles that may be involved. Most commonly, shin splints reference pain along the medial side of the shin along the posterior tibialis muscle. This muscle sits very deep along the inner shin, and wraps around the midfoot to support the arch. Pain is typically noted along the bone and the mid muscle belly.The posterior tibialis is responsible for inverting the foot and ankle (or pulling it toward midline) and maintaining arch stability.
Anterior shin splints, on the other hand, involve the anterior tibialis muscle. True to its name, it runs along the front of the tibia, and is responsible for bringing the foot toward the shin, also known as ankle dorsiflexion. Pain presents more in the front of the shin bone.
How does this injury occur?
As with most running injuries, shin splints are typically due to tissue overload. They can be triggered with starting a new running regimen, increasing running volume, or sustained standing (especially on hard surfaces).
Pain is thought to be a result of micro-trauma through the muscles and bone (tibia), especially along the muscular attachments. These tissues can become sensitized to activity, and eventually become painful even with lower intensity loads like walking.
Who does it impact?
Shin splints are more common in young and inexperienced athletes or runners, especially those starting a new program. They also impact individuals who increase volume too quickly, have very repetitive movement patterns like running or jumping, or who train on hard surfaces like concrete. We also see an increase in reported shin pain in dancers, military personnel, and individuals with flatter feet and excessive foot pronation. Shin splints are VERY common, affecting 10-20% of runners and up to 30% of active military members.
How do you treat it?
We place a large emphasis on patient-specific care at Evolve Physical Therapy. First and foremost, we would rule out more severe pathology including stress fracture. We would then focus on offloading the sensitive structures. Shin splints are one of the few injuries where we may recommend a short break from running to help manage pain and sensitivity.
Common contributing factors to shin pain include tightness through the calf muscles, limited strength or loading capacity of anterior and/or posterior tibialis, and poor foot and ankle stability. Poor hip strength and stability may also contribute to biomechanical dysfunction and increase in pain. Treatment would include decreased tissue loading, appropriate strengthening, addressing underlying mobility and/or stability deficits, and progressive re-loading of structures. Similar interventions can also be preventative, as discussed in a ChoosePT article.
What should I expect at Physical Therapy?
A thorough subjective examination or discussion of your symptoms including:
- Description of symptoms including severity, chronicity, and triggers
- Running history – including training volume, terrain, intensity, and any pending races or events. Emphasis on any recent changes in activity especially volume.
- History of prior injury especially of the lower extremity
A physical examination to help identify what structures or movement patterns are contributing to your pain including:
- Footwear assessment
- Static and dynamic foot posture assessment, including arch strength + stability
- Assessment of foot and ankle mobility; hip mobility
- Examination of global lower extremity strength including foot, ankle, hip, and knee
- Gait and running assessments, including high-speed video analysis
- Jumping and landing mechanics, with emphasis on shock absorption patterns
Appropriate treatment and patient education which may include:
- Tissue offloading – through activity modification, change in footwear, orthotics, and/or taping
- Manual therapy targeting lower leg, foot, and ankle mobility – soft tissue and joint mobilizations if appropropriate
- Specific lower leg strengthening and progressive loading, targeting strength and stamina for improved tolerance to higher volume
- Global strength and stability targeting core and hips
- Modifications to jumping and landing mechanics for both double leg and single leg tasks – running is repeated single leg landings!
- Long term management with home program to further progress strength and mobility, and help mitigate future injury
For a thorough evaluation and individualized treatment, contact us at Evolve Physical Therapy today!
Melisa Abesa is a California transplant who has come to love the Pacific Northwest. Since graduating with her Doctorate of Physical Therapy from the University of Southern California in 2014, she has practiced in the Portland/Salem area. She is a huge advocate for patient empowerment, individualized care, and a holistic approach to health and wellness.
As a board-certified clinical specialist in orthopedic physical therapy, she enjoys working with a large variety of orthopedic and sports related conditions, with special interests including runners, headache treatments, post-operative care, and adolescent athletes.