Shin Splints

Shin Splints is a general term given to pain that occurs after activity between the knee and ankle mostly occurring at the front or inside of the leg around the shin. We see this presentation frequently at the clinic and we quickly set about discovering the tissues that are causing the symptoms.  

It is important to firstly rule out other “red flag” causes of the symptoms such as:

1. Compartment Syndrome 
2. Stress fracture 
3. Nerve entrapment 
4. Vascular injury i.e. DVT     

Causes 

Changes to your exercise regime will change the load on your tissues i.e. muscles, ligaments and bones. These tissues will react to that change, this is called an “adaptive response. “  If this change in load is too fast, the tissue does not have time to adapt fully before you are loading the muscle again with the next exercise session. If this continues the repeated trauma will result in injury. 1.

Treatment 

So when investigating the presenting symptoms we first look for the damaged tissue. This will mean looking at individual bones, muscles, ligaments, fascia and the attachment areas of all of these structures. Once the damaged tissue has been identified we will then look at changes in the patient’s routines that coincide with the onset of symptoms such as changes in training programme cycles, cross training activities, to changes in shoes. What has the patient done differently that would cause the injury? 

We would also look at the patient’s biomechanics for the particular exercise they are doing to see if there is any weakness causing excessive pressure on the legs. For example, how the patient controls pronation of the foot on loading the lower extremity when running and are the muscles firing in the correct sequence and with sufficient strength to support running? Running style is a big risk factor for shin splints particularly heel striking gaits .It is also important to look at the correct footwear that complements their running style to reduce the stress on their leg tissues. 

Finally putting together a comprehensive treatment plan. 

1. Remove or modify the trauma i.e. change the running gait  
2. Reducing the inflammation and promoting healing of the damaged tissues  
3. Dealing with risk factors i.e. advice on nutrition, poor shoes, running style and exercise plan. 
4. Treating the whole body – not only treating the injury but looking at ankle, knee, hip and back function and control. Muscle chain strength and firing patterns can also be looked at.    

This is a comprehensive approach that has proved very effective and will be adapted to each patient and their circumstances. We are constantly improving and adapting our approach as new research and treatment method develop so you can be confident you will receive the best treatment and advice available.       

1.   Loading of healing bone, fibrous tissue, and muscle:  Implications for orthopaedic practice