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Shin Splints by Jon Tobey
Shin Splints by Jon Tobey
Shin splints is a term used to describe pain that is in the front of your lower leg below the knee and above the ankle. Shin splints are usually caused by overuse or irritation of the muscles or other tissues in the lower leg, or from a stress fracture. There are two different types of shin splints anterior shin splints and posterior shin splints. Anterior shin splints are the most common type and it occurs with overuse of the anterior tibialis muscle. Posterior shin splints are due to a tight gastrocnemius-soleus complex and a weak or inflamed posterior tibialis. In posterior shin splints pain will be felt when the foot is dorsiflexed with eversion. Exercises including running, field sports and aerobic dancing classes could further the problem. (Colby & Kisner, 575)
Shin splints involve three components, the fibula, tibia and anterior compartment of the lower leg. If shin pain occurs from repetitive trauma this is known as shin splints. There are three specific conditions to refer to when analyzing the shins condition. The first is a stress fracture which is a hairline crack in either the tibia or fibula. Medial stress syndrome is when the muscles that attach to the medial side of the tibia are inflamed. Compartment syndrome is when the anterior compartment in the lower leg which contains the muscles that dorsiflex the foot or the lateral compartment which contains the muscles that plantarflex the foot, become painful and cause shin splints. (Rouzier, 2006)
Symptoms of shin splints include pain in the front part of your lower leg. This pain could arise while during activity or at rest. If a stress fracture is present in the tibia, the patient will experience pain when touching the part of the bone that is fractured. If a stress fracture is present in the fibula then pain will be felt on the lateral side of the lower leg. If the patient experiences pain along the edge of the shinbone, this may be a sign of medial tibial stress syndrome. At times patients with compartment syndrome will feel pain in the same area, along the shin bone, they also may experience numb, cold or weak feet due to the swollen muscles in the compartment irritating the nerves and blood vessels. (Rouzier, 2006) Other symptoms that may be experienced include lumps and bumps over the shin bone, redness over the inside of the shin and a recurrent dull ache along the tibial shaft. (Walden, 2005)
There are not too many ways to medically treat shin splints. In most cases they go away after the muscle has recovered. One medication recommended is an anti-inflammatory to reduce the swelling in the shin and to reduce the pain. Surgery is another option, surgery may be used if the patient is experiencing shin pain from compartment syndrome or a tibial stress fracture. During this surgical procedure the tissues that form the covering of the compartments are opened up to reduce the pressure in the compartments. (Rouzier, 2006) In most cases a basic rehabilitation program is all that is needed to correct the disorder. (Rouzier, 2006)
When a patient develops shin splints they should immediately apply an ice pack to their shins for 20 to 30 minutes every three to four hours until the pain goes away. Ice massages will also help the pain go away, just rub an exposed ice cube over the leg for five to ten minutes. At times arch supports for the shoes are also recommended to correct over-pronation. A rehabilitation program will also be given to allow the shin to heal properly. This program will involve two phases, the management of overuse/repetitive trauma syndromes: protection phase and the controlled motion and return to function phases. During the protection phase the patient will use methods including cross-friction massage, muscle setting contractions, electrical stimulation. Range of motion in pain-free motions will be taught along with teaching the patient what activities to avoid that will produce pain. The patient will also use supportive tape on the arch of the foot in order to provide relief of the symptoms. (Colby & Kisner, 575)
Before the controlled motion and return to function phase the patients shin will be examined for abnormal alignment, muscle flexibility and strength imbalances. During this phase the patient will work on stretching range-limiting structures including the gastrocnemius-soleus and tibialis anterior. The patient will begin to work on improving their muscle performance beginning with isometric exercises and eventually progressing to resistive dynamic exercises of the foot and ankle during open and closed chain activities. The patient will also begin to work on muscle endurance in the muscles of the foot and ankle. These techniques along with patient education will allow the patient to return to normal activities while preventing a reoccurrence of the injury. (Colby & Kisner, 577)
Shin Splint Exercises
When performing cardiovascular exercise an individual needs to be aware of what will provoke shin splints. Any type of high impact exercise for a long period of time, like jogging or running on a treadmill will provoke shin splints. An exercise with little to no impact should be used to ensure that the patient increases their cardiovascular levels without any future complications. It is also important for the patient to start with a light warm up and stretch prior to activity. (Ryan, David)
A) Elliptical Trainer: 20-30 minutes, 2x a week. The elliptical trainer will allow for the patient to be involved in a cardiovascular program without provoking shin splints.
B) Recumbent Bike: 20-30 minutes, 2x a week. The recumbent bike will allow the patient to work on their cardiovascular endurance without the high impact of a treadmill. This also will allow the patient to have variety in their program.
Increasing flexibility and range of motion is extremely important for patients with shin splints. Prior to doing any type of activity including strength training and cardiovascular exercise the patient should develop a strict stretch program. This will allow for more flexibility in the gastrocnemius, soleus and the tibialis anterior and reduce the risk of reoccurring shin splints.
A) Shin Stair Stretch: With the patient standing on stairs have them let their toes off the stairs with their heels still on the stairs they will then push their toes downward while pressing their heels to the stairs. Hold 30 seconds, 5 sets. (Ryan, David)
B) Dorsiflexion Stretch: This will stretch the gastrocnemius and the soleus of the lower leg. Have the patient put one foot forward, while keeping the other foot in back with the heel on the floor. Keeping the knee of the back leg extended, have the client push off a wall and shift all their body weight forward putting the stretch in the back leg. Hold 20 seconds, 2 sets. (Colby & Kisner, 584)
C) Plantar Flexion Stretch: This will stretch the tibialis anterior of the lower leg. With the patient long sitting, they will attach tubing to a fixed object and then to the tip of their foot. They will then move back until the tubing is tight pulling the tip of the foot toward the floor. Hold 20 seconds, 2 sets. (Colby & Kisner, 584)
Increasing strength and muscular endurance is extremely important when a patient has shin splints. Having the proper balance in your lower leg musculature will allow the muscles to not become overworked. The muscles worked should include the gastrocnemius, soleus and the tibialis anterior.
A) Plantar Flexion with Tubing: With the patient long sitting and the injured leg resting on a rolled towel they will begin to elevate their heel off the ground and pull the tubing wrapped around their foot tight. The patient will then hold both ends of the tubing and have the patient perform plantar flexion against the tubing resistance. 12-15 reps, 2 sets. (Colby & Kisner, 584)
B) Towel lift: With the patient sitting in a chair and their feet on a smooth surface have them grip a rolled towel and practice lifting it off the floor. This exercise will help them develop the supportive muscles in the bottom to their feet and the front of their shins. Repeat lift 100 times. (Ryan, David)
C) Abduction with Eversion: With the patient sitting in a chair with their foot on the floor have them place a towel under their foot. Place a weight on the medial side of the towel and have them slide the towel with their foot laterally. 5 reps, 2 sets. (Colby & Kisner, 585)
D) Eversion with Elastic tubing: With the patient long sitting, have the patient place a loop of tubing around both feet and have them evert both of their feet against the resistance of the tubing while keeping the knees still. 12-15 reps, 2 sets. (Colby & Kisner, 585)
E) Dorsi Flexion with Tubing: With the patient long sitting and the injured leg resting on a rolled towel they will elevate their heel off the ground. They will then tie elasticized material to a fixed object and put the other end at the top of the foot. The patient will then perform dorsi flexion against the tubing resistance. 12-15 reps, 2 sets. (Colby & Kisner, 585)
Improving a patients balance and stability can help work the stabilizer muscles in the lower leg which will ultimately support the other muscles that may be overworked. These exercises will improve the client’s ability to perform regular activity without provoking shin splints.
A) Balance Board: Have the patient rock back and forth and side to side while they maintain their balance. They will then progress to one foot. If shins begin to hurt the exercise should be stopped immediately. (Colby & Kisner, 586)
B) Balance Board Ball Tosses: Have the patient stand on the balance board and maintain their balance. Once they are steady throw a medicine ball to them and have them catch it and throw it back. They will progress by using a heavier ball. 10 tosses, 2 sets. (Colby & Kisner, 586)
C) Walking on an Unstable Surface: The patient will go through a drill on sand if possible. The patient will begin by walking forward then backwards then to their right side laterally and then to their left side laterally. This will allow them to work all the stabilizer muscles in the lower leg and allow them to be involved in regular activity with fewer symptoms. Through the drill 4x, 10 steps in each direction, 2 sets.
When a patient has reoccurring shin splints it is necessary to provide them with proper education to prevent future complications. This includes teaching them how to properly warm up, stretch, exercise and treat shin splints if they occur. The patient should always start of their exercise routine with a gentle warm up activity, followed by a light stretch of the tight muscles including the gastrocnemius, soleus and tibialis anterior. The patient should also stick to the routine provided in order to prevent future complications and should hire a certified personal trainer to make sure that they are progressing the exercises properly to avoid a plateu and that they are doing the exercises with proper form. The strength training and cardiovascular exercise program should include non-impact exercises with gradual progressions to minimal impact exercises. Proper foot wear should always be worn to ensure that the foot is supported properly which if not provided could provoke shin splints. The patient should also know how to treat shin splints by allowing recovery time for them to heal, icing the area, and taking anti-inflammatory medication. With these guidelines to follow the patient should experience fewer symptoms of shin splints over time and eventually be pain free. (Colby & Kisner, 576)
References
Colby, L.A. Kisner, C (2002) Therapeutic Exercise foundations and Techniques. F.A. Davis Co. Philadelphia.
Rouzier, Pierre (2006) Clinical Reference Systems: Shin Pain. McKesson Provider Technologies. http://web.ebscohost.com/ehost/detail?vid=20&hid=7&sid=9f214a70-2991-4baa-a5da-af92bdfb8e14@sessionmgr108
Ryan, David. Bodybuilding: Shin Splints Learn to Run Pain Free. http://www.bodybuilding.com/fun/drryan1.htm
Walden, Mike (2005) Update: Running Injuries. Vol. 71 (1) pg. 24-27. http://web.ebscohost.com/ehost/detail?vid=8&bk=1&hid=13&sid=806e94a9-b121-4fe5-b46d-aa2a35e91ea3@SRCSM2
About the Author
Jon Tobey is a Certified Personal Trainer and Nutrition Coach at the Salem Athletic Club in Salem, NH. He specializes in Weight Loss, Toning and group training including: Boxing Boot Camp and regular Boot Camp Training.
http://www.sac-nh.com/contact_tobey.php
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