The Curse of Shin Splints.
NOTE: Andrew wrote this article and its his one year anniversary with TC Physiotherapy Wahooo... Thats why we have a picture of Andrew with his cake.
People often ask me what causes shin splints and how do I fix them. The truth is, the injury is actually quite a complex one so I never have a quick answer or cure. I decided to address the issue this week and have been discussing the subject on our Facebook page all last week with a few tips and tricks to help you along and improve your pain.
Medically known as tibial stress syndrome, shin splints generally occur in athletes/ walkers who have recently intensified or changed their training routines. The increased activity overworks the muscles, tendons and bone tissue around the shin bone. If you have shin splints, you might notice tenderness, soreness or pain along the inner or outer side of your shinbone or in the muscle either side of the bone and mild swelling in your lower leg. At first, the pain might stop when you stop exercising. Eventually though if you keep going do the same type of training at an increased frequency and intensity it will probably get worse and become constant.
What’s Causing the Pain.
We know that the soft tissue and muscles around the shin bone get angry/ inflamed and literally start to pull on the shin bone they are connected to. The situation becomes a vicious circle if we don’t get it under control quickly. If we keep doing what we are currently doing the tissues and bones get further stressed and more painful. With most injuries that don’t happen suddenly there are several factors at play and there is always a root cause. Poor biomechanics or how our body moves and interacts is the main reason. We also need to look at footwear, running technique, type of training and previous injury history. I usually get my patients to record themselves running (if they are a runner). I can then spend a bit of time analysing their running technique from that point on. We also do a series of tests in the clinic to assess posture, joint mobility and overactive or underactive muscles. This will always give us a good picture of the root cause and allow us to make the necessary changes.
3 objective markers we look at in most detail are:
1. The ability of your hip to be able to flex and extend in 3 dimensions – we often find people may have very poor hip mobility which means they can’t absorb the ground reaction forces affectively or some on may even have too much mobility and can control their bodies when their foot lands.
2. Poor posterior knee stability – the back of your knee contains a junction where your calf muscles in your lower leg and hamstrings in your upper leg meet. It is imperative there is a good working relationship between the two sets of muscles because when we run or walk the muscles and this junction are going to absorb the ground reaction forces when we heel strike on the ground and in turn when we push off they have to be able to load affectively to be able to push you off the ground again. The ability to do this can easily tested in the clinic.
3. Foot and ankle mobility – Again if our ankle can’t plant or push off the ground effectively we tend to absorb the shock in our shin bone. Ideally when we run we should land on our midfoot and not our heel. In this position, the foot acts better as a spring. When we heel strike the leg is extended and we are sending a large force through the heel into our knee and up in to our hip. Remember depending on the runner you may hit the ground 700 hundred to 1,000 times every km. That’s a lot of shock absorption to take!
So what do we need to do to fix it?
1. Firstly, if the muscle and shin bone is sore and angry we need to settle it down with ice and rest.
2. Stop running and walking on it, you will only make it worse. Don’t hammer the hammer.
3. You need to mobilise the 2 muscles in particular, the two at the front of the shin, the tbialis anterior and posterior. These need to be able to slide effectively with other muscles in the area and on the shin bone to stop that shearing force.
4. Walk as often as you can in bare feet. These will get the smaller muscle and fascia in your arch stronger and allow to absorb the forces I have discuss earlier.
5. Get assessed, a good physiotherapist will tell you the root cause of the problem or where you are going wrong when it comes to running technique.
6. You need hands on treatment, and a lot of it. We use several different techniques to reduce the pain and repair the tissues damaged, these include Active Release technique, Graston and Dry Needling, the latter being highly effective.
7. Practice mid foot striking. At first if the pain allows just start hopping with both feet, simple but effective!
Key point to take home is not to leave it go too long when you start to feel the pain. Remember you are doing something wrong in the first place to cause it, so don’t keep doing it. Find out what it is and you will return to running or walking quicker and not have to worry about the whole scenario happening over and over.
Check out our Facebook page on TC Physiotherapy for videos demonstrating exercises to help relieve the pain you are experiencing.