This article is by Jo Knock the physiotherapist in London at the Angel Wellbeing Clinic. Our physiotherapist in London looks at shin pain, how it is diagnosed and how it is treated.
Pain in the front of the shin is often referred to as Shin Splints. It’s correct name is Medial Tibial Periostitis, or more plainly said, inflammation of the medial part of the shaft of the tibia bone. Two theories have been proposed to account for this injury: tibial bending and fascial traction. I will address the more common theory and the one which I believe to be the cause - fascial traction.
As tension in the muscles (tibialis posterior, flexor digitorum longus, and the two calf muscles : gastrocnemius and soleus muscles) which lie along the postero-medial aspect of the shin increases, so too does strain in the tibial fascia. Simply put, this means there is a direct link between increased tightness of the posterior lower leg muscles and medial tibial periostitis aka shin splints. Do not be fooled though, simply stretching the calf and lower leg muscles will unfortunately not be enough alone to ‘heal’ you of this condition.
What causes Shin Splints
• Sudden increase in impact activities
• Not an adequate warm up before impact activity
• Too much training / training overload, especially on hard surfaces
• Over pronation of the foot in dynamic activity resulting in overload to the tibia
• Inappropriate or incorrect foot wear
• Tight calf muscles preventing correct movement of the foot during all phases of the gait / running cycle
• Poor recovery time / not enough recovery time in between workouts.
• Biomechanical deficits further up the chain such as poor gluteal and lateral pelvic stabiliser strength (see the video section for some fantastic gluteal strengthening exercises)
Signs and symptoms
• Pain and tenderness on the inside of the shin, when palpating along the medial tibia
• Pain at the commencement of impact activity, which usually decreases once you are warmed up, then returns (often worse) once you have finished activity or the following day.
• Pain worse with a harder or tilted (sand, side of the road) surfaces
• Constant tightness in calf muscles or muscles of the lower leg despite loads of stretching
Initial period of rest plus / minus the use of anti inflammatory treatment including the use of ice and non-steroidal anti-inflammatories (always be guided by your GP or pharmacist for medication). You will need to ensure you undertake stretching for all lower limb muscles, especially the calf muscles.
Manual therapy by your London physio and guided rehabilitation comes into play after the initial period of rest. With your guided rehabilitation you will begin reconditioning the muscles with cross training and non-weight bearing activity then have a gradual return to weight bearing and impact activity as pain and symptoms permit
In addition to physiotherapy treatment, footwear can be assessed and changed as appropriate and sports massage can be very beneficial to relieve muscle tension and off load the fascial stress that can create shin splints.
In old school treatments there used to be a suggestion of strapping or taping the shins to reduce the stress, however current AAA standard research and reviews of scholarly articles shows no benefit at all in strapping the lower leg. This is to say there is no evidence to support either the use of braces or strapping for shin splints, so don’t waste your money on them!
If you are experiencing these symptoms and it is preventing you from enjoying your activities maybe you should see our physiotherapist in London at the Angel Wellbeing Clinic. If you want to make an appointment with the physiotherapist at our London clinic click below.