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Do you have shin splints?
“Shin splints” also known as medial tibial stress syndrome (MTSS), is a term used for leg pain along the inside bone of the shin typically with overuse or repetitive actions like walking, jumping or running. It's a common injury in athletes, dancers, footballers and running sports.
Shin splints typically have pain down the shin on the inside (MTSS) or the top side of the shin bone (tibialis anterior tendinopathy), and are tender to touch. Both MTSS and Tibialis Anterior tendinopathy tend to be sore when you start exercising, and ease up as the exercise continues. When you stop moving, the discomfort restarts. In some cases the pain can be constant, even at rest.
The causes:
The causes of shin splints generally comes from a form of “overload” - either too much activity too soon, or a change in surface or footwear that the body has not acclimatised to. Flat feet and high arches can also contribute to the biomechanics of walking/running style that might put load into these structures of the lower leg. Some examples of shin pain can be:
It's the start of summer and you start wearing flip flops around the house, and grocery shopping. Even though it's not that taxing, its a change in footwear, with a slow (long) walk that your body isnt used to doing in flip flops
You are starting football preseason and you have to do a lot more running on a hard/dry footy oval when you have had a few weeks off exercise in the offseason, doing a high load your body hasn't prepared for.
It's a special occasion night, and time to wear the new suit shoes or high heels you bought, but you have to walk a long way away, or stand for long hours and your legs get sore the next day.
You are in the deep end of marathon training, but it's raining so you decide to do a session on a treadmill instead - this change in surface and technique can flare your lower legs and calves.
These are 4 real life examples that we see in the clinic often. Each of these examples shows a change in “something” if that's load, distance, duration, footwear, surface or foot mechanics.
How can we fix this?
Shin splints can take a while to settle down, as sometimes it comes from a technique issue. Walking/running is an innate movement to all of us, but it's actually something that needs to be trained well to prevent injuries. In the running world, running technique is paramount to preventing shin splints. Cadence, (which we will talk about below) foot strike, push off are all components of the gait (walking) cycle, but how good we are at managing this force, is the difference between those suffering from lower limb injuries and those managing well.
Sometimes rest doesn't make this injury better. We want to strengthen and modify around your pain. If you rested vs not rested, you might still be in discomfort 2 weeks later with similar pain, which is very frustrating for a lot of people to hear.
What is the best ways to address leg pain in shin splints?
Proper supportive footwear, and / or the use of orthotics if required
Strength training into your lower limb, bottom and thigh. How strong your hip, leg and calf is will dictate how your leg lands when you walk/run/jump. So strengthening these muscles is KEY to fixing this issue.
Gradual return to exercise - modifying load so the body has the opportunity to understand and acclimatise towards its new load. We want to avoid spikes in exercise load.
Osteopathy manual therapy to help decrease the tension in the lower limb and hip muscles to allow freedom of movement to help strengthen the leg and alleviate pain.
For running/walking based activities, we briefly spoke about cadence above, so;
What is Cadence and how can it help me?
Cadence is how many steps you take in a minute. If you have a running watch this can tell you live data, otherwise you can count how many times your Right leg lands in 15 seconds (then times it by 4) to manually calculate how many steps you take in a minute roughly.
When we run, we want to take small quick steps. This reduces how much time our foot is on the ground for - meaning less ground reaction forces going through our body, and ideally, less chance for injury. Generally, we want to be taking around 170-180 steps a minute when running. (a running watch can help!)
Working on cadence is a great way to limit those that have calf and lower limb based injuries.
We can train cadence as well with sprint training or uphill running - although noting that these are both things that may flare up a sore shin, so it's best to do this when you are not injured to help your technique.
It can take a fair bit of time to change our running/walking style - it's such a standard thing to be able to “walk/run” however, in competitive sports, running is actually something we have to do well and efficiently to minimise injury.
What about non running injuries?
It might be harder to address in sports like dancing where we can’t really change your footwear or surface, so managing load, and building strength is paramount here. Same with football boots and hard surfaces, sometimes we are not in control of these environments, as your footy oval might be very dry and hard after a cricket season.
However we can control wearing flip flops or slippers, hard boots or high heels! So think of your footwear and if you can use an insert from the chemist or from your podiatrist, and how we can minimise the load/impact of walking in these types footwear or wear your runners/supportive shoes everywhere until your foot has has some time to heal/modify to the load you’re putting in it!
What are some good home measures we can do?
The best way to help this is to
Foam roll your calf, front shin, and leg
Lacrosse ball into your arch/foot
SEATED calf raises (with load)
STANDING calf raises (with load)
Don't be afraid to load the calf. Walking is already 4x our body weight of load into our legs, and running is 8x our body weight! Our calves need load to strengthen it, to help improve. Speak to your osteopath about a dedicated de-loading, re-loading strengthening program, and what individualised measures need to change for you and your injury.
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