By Anna Walsh – Adelaide based physiotherapist
For those of you unfortunate enough to have suffered from shin splints, you’ll agree it can be very frustrating. Not only do training methods and frequency have to be modified, the condition is quite slow to resolve. Commonly experienced at the start of the running season, doing too much too soon with poor conditioning, or changing from soft to hard training surfaces. A thorough assessment, activity modification and patience are imperative to get you back to pain-free track work.
Actually, “shin splints” is not a very specific diagnosis for shin pain, as there are three main sources of pain.
Most commonly, MTSS will be noticeable at the start of training, ease once your body warms up, then ache once training has finished. Other activities involving impact can aggravate it, such as hopping, stairs, and skipping. You may start to use the unaffected leg for take off and landing in jumping events.
There are a huge number of possible contributing factors that can lead to shin pain, so it’s best to get yourself assessed by a health professional who knows what they are looking for. Physiotherapists, podiatrists and osteopaths can all play a role, as can acupuncture and a handful of self treatment techniques. The single most effective way for you to speed up the tissue healing is regular ice massage. I’ve found the easiest (and least messy!) way to achieve this is to put a polystyrene cup 3/4 full of water into the freezer. Once frozen, you can carefully peel back the top rim of the cup so that a small part of the ice block is exposed. Holding the bottom of the cup, you can easily apply your ice block to the sorest part of the shin, with reasonably firm pressure. Ten to fifteen minutes of ice massage daily, as well as straight after training sessions, should help settle down any re-aggravation.
Early diagnosis is extremely helpful to avoid progression of the pain towards the bony damage end of the spectrum. Rest is critical for tissue healing. Around two to three weeks of no running or weight-bearing training is advised, to reduce tibial impact loading. Cross training, such as swimming, cycling and deep water running is important to maintain fitness in this time. Physiotherapy treatment will address predisposing factors including biomechanics, dynamic evaluation of running technique and inappropriate footwear. Whilst pronation (“rolling in” of the subtalar joint under the ankle) is a normal part of the walking and running gait cycle, if you have over-pronation or prolonged pronation (past mid-stance) it can lead to early fatigue. This reduces the shock absorbing ability of the shin muscles which would normally help absorb ground reaction forces. Therefore more shock is transmitted to the shin bones. Abnormal pronation may be caused by leg-length discrepancy, tight calf muscles (both gastrocnemius and soleus), tight hamstrings, hip flexors and ITB, weakness of ankle invertors, gluteals and quadratus lumborum in the trunk. Therefore it is strongly recommended to get a thorough assessment done by your physiotherapist to address these issues.
It is true what they say, prevention is better than cure! So try to avoid sudden changes of training surface. Maintain fitness in the off-season. Keep good balance between the muscles at the front and the back of your shins. Check your shoes give you appropriate cushioning and biomechanical support. Screening assessments can be done through your coach or physiotherapist to identify areas for self massage, stretching and strengthening to keep your kinetic chain functioning in an effective, efficient and pain-free manner. Happy running.