Can a physio help with shin splints?

If you are a runner there is a good chance you may have experienced shin splints at some point in time, maybe when you were first starting out or when you started training for a longer event? Shin splints is a fairly common condition in runners and can range from a small niggle that goes away by itself up to severe pain that stops you from running for weeks. In order to know how to manage shin splints it is important to have an understanding of what it is.  

What are shin splints?

Shin splints, aka Medial Tibial Stress Syndrome, is a condition that affects the tibia (shin bone) and muscles attaching into it. It is commonly felt along the inside of the tibia and can be very tender when pressed. It often occurs in those who have had a spike in either their training intensity or frequency. For example, running 5km a few times a week and then suddenly increasing the distance as you have registered for a half marathon in 2 months time. Other factors that may be involved in developing shin splints are: running surface, change in shoes, biomechanics leg muscle strength.  

How to manage shin splints?

Management of shin splints mainly involves modifying your activity until the symptoms settle and then gradually building up to running again. This may not necessarily involve stopping running but just reducing it to a pain free level. For example, rather than doing a 20 minute continuous run,  it may be more beneficial doing 3 x 5 min runs with rest in between.

It could also be worthwhile considering other forms of exercise to keep up the fitness levels, such as bike riding. Ice or strapping can also be used for pain management in the early stages. Shoe choice and running surface also come into play here. Finding a shoe with a thicker and softer sole may help to reduce the impact load, as well as running on a firmer surface to reduce the load on the calf.   

What can a physio do?

If these management strategies are unable to settle the symptoms down then it may be time to look at the biomechanics of your run. This will also involve assessing the capacity of the lower leg muscles, such as the calf. If you are trying out forefoot running then this may be a contributing factor as this considerably increases the load put through the calf and achilles tendon. Two of the main muscle groups to look at would be the calf complex (involving the soleus and gastrocnemius) as well as the intrinsic muscles of the foot (the smaller muscles).

As shin splints can often happen after a significant increase in activity it is thought that part of the issue is the calf muscles are not strong enough to meet the required load. Likewise, the foot intrinsic muscles may not be able to support the foot. This would lead to excessive loading somewhere along the chain. A physiotherapist can assess the strength of these muscles and address the weaknesses will help the leg to deal with the increased loads.  

Lastly, it is also important to look up at what the rest of the body is doing. The pain may be in the shins but the problem may be coming from elsewhere. Trunk and pelvic control is important in running as a majority of our body weight is in our trunk. If we have poor trunk / pelvic control then we may be overloading some body areas excessively, leading to a injuries somewhere else in the body. It is therefore also important to train to improve strength around the pelvis and trunk.  

So, what now?

The first part of the management of shin splints can be done without any help, however if it continues to hang around and stops you from running then a physiotherapist can help you to work out what the underlying problem is and effectively address the issues. They will be able to look at your running training loads, running technique and assess your strength and control and then develop a training program to address any relevant deficits. In this way you will hopefully be back to pain free running again and meet your running goals!