Shin splints

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By: Nicklas Falkesgaard Pedersen, Fysioterapeut at Protreatment

What is shin splints?

The inflammation of the shin is a frequently occurring overload damage, which is particularly evident in sports with running and or jumping and is especially a problem if you are training in a hall or on other hard surfaces. Thus, it is a fairly typical overload damage among handball players.


The inflammation of the shin is characterized by a pain that sits around the lower 2/3 parts of the shin bone. The pain can be felt all the way up along the shin bone, and can be both on the inside and outside of the bone. The most frequent occurrence, however, is on the inside of the shin bone.
The pain is in the transition between the shin and the tendon to the muscles that are very close to the shin bone. On the inside of the shin bone it will be the muscle called tibialis posterior that is affected. Tibialis posterior helps the large calf muscles press the foot downwards, but especially plays an important role in supporting/assisting the inside of the arch in the foot.
In this video you can see more about the tibialis posterior muscle:


Inflammation of the shin is, as mentioned, an overload injury or a so-called overuse injury. The hallmark of all overload injuries such as jumper's knees, runner's knees, Achilles tendon inflammation and, also, inflammation of the shin, is that the pain practically never appears acutely, as one will experience it with e.g. a pulled muscle or an ankle sprain.
You typically don't experience overload injuries until after you have been physically active, and in the beginning the pain will disappear if you take a break from training. If you continue to exercise in the same way, or perhaps even increase the strain, you will find that the pain takes longer and longer to disappear after physical activity, just as you will experience soreness when you wake up in the morning, which will diminish as your muscles warm up. In the same way, you can experience that the shin inflammation hurts in the beginning of the workout, but disappears as you get warm. The pain will then come again when you cool off, and if you continue undeterred, the pain will over time evolve, and you will have a harder and harder time warming up the injury until one day you experience the pain to be markedly present throughout the workout, and now so intense that it becomes difficult to carry out an entire workout. Once there, the pain will often also affect you in your everyday life, even if you can no longer be active with your sport.

How do I know if I have inflammation in my shin?
If you are familiar with the following, then there is a high probability that your have inflammation in your shin:

  • Severe pain reaction when touching the inside of the lower part of the shin 
  • The feeling that there are small, very sore "knots" in the tissue close to the bone
  • Painful shocks in the same area during running and jumping
  • The pain can be fully or partially warmed up during exercise
  • pains in the hours or the day after physical activity


Why do I get inflammation in the shin?

An overuse injury is caused by the fact that a structure is pressured more than it can hold, which creates an inflammation of the tissue, which over time develops into pain in the inflammation of the tissue. The most common cause of inflammation/pain is when you either start a new sport or resume after a long break. Here, the tissue will require some time to adapt to the new load it is being subjected to. Another frequent cause is if you increase your workout volume. An example could be if you go from playing handball three times a week to five times a week. Here you expose the muscle to the same loads, but it is now much more frequent and for a longer time.  The muscles and tendons do not recover as they normally do, and must perform again before it is fully ready for it, which can eventually evolve into an overload damage.
The two examples above can be avoided by always being mindfull when you change something in the way you train. If you take care as you slowly build up the volume of the training, the risk of getting an overload injury is minimal.
However, there are still many who suffer from shin inflammation, although they may not have changed anything significantly in their training, and here the cause does not necessarily exist in their training volume, but rather in the way they strain the foot. A very frequent cause of shin inflammation is hyperpronation in the foot (flatfoot). If you tend to shift onto the inner arch of the foot when walking and running, then the stress on tibialis posterior will be much greater than if you have neutral or supinated feet, which increases the risk of the tendon becoming overloaded and inflamed. Hyperpronation can be caused by the way you are built, but may also be caused by restrictions and weaknesses around your ankle, knee or hip, which makes you fall in more when you strain your foot. It will always be a good idea to seek out a physiotherapist who can do a thorough examination and identify the cause of your pain.
You can often benefit from a looking into whether or not you have the most optimal running shoes, or if you should find some that support the arch of your foot better. Another possibility can be trying with inlays that support your arch, thereby reducing the stress on tibialis posterior. There are quite a few of physiotherapists who make soles in their clinics and if they do not, they can probably tell you where you can get them made.


Can I train my way out of shin inflammation?

You can do exercises that strengthen both the arch of the food and the tibialis posterior. A stronger arch can diminish your hyperpronation, which will take some stress of tibialis posterior. Isolated strength training of tibialis posterior will theoretically also help, as it is better at handling the demands of the training. My personal attitude/experience, however, is that training of these two structures will rarely create much progress.
First of, it is difficult to train them in isolation, as the training you will want to do is rarely transferable to the activity you need to do. Even if you do 3 x15 repeats of a strength exercise for tibialis posterior 4 times a week, then there is still a long way to go to the thousands of activations the muscle must be able to endure during runs and jumps during handball for example. Furthermore, it is incredibly difficult to train the foot arch, if you have a significant congenital or acquired (due to weaknesses or restrictions) tendency for hyperpronation.
What you can do, is to identify the cause of your pain by a physiotherapist, who can then find the appropriate exercises that can help alleviate the pain and overload of your tibialis posterior. A typical example will be weakness near the hip, which means that you fall more into the knee (knock-kneed) when running, which gives an increased pronation in the foot and thereby an increased stress on the tibialis posterior. Training of the weak structures, combined with the treatment and, possibly, a sole inlay results, in my optics, in a greater chance of being painless than if you focus solely on strengthening the arch and tibialis posterior.
In the video you can see an example of a runner lacking stability around the hip, knee and foot, resulting in hyperpronation and risk of developing shin splints or other types of overloads:

 

Can treatment get rid of my shin splints?

In the early phase of a shin splints, you may well experience that a combination of treatment, rest and slowly intensifying workouts can eliminate your pain altogether. In the chronic conditions it may be harder to get rid of the pain with treatment, and often you will not be able to settle for treatment alone.

However, there are plenty of therapy that can have a soothing effect on your pain, but what works for one person may not work for someone else. I have, for example, had several patients who have experienced good effects with acupuncture, while others said it did not have any effect. I myself am mostly in favor of working manually around the injured area, although it can be very painful! - and I will always combine the treatment with the correcting possible dysfunctions, which can affect how the muscle works, both through treatment and training.
Whether you get massages, laser, acupuncture or something completely different, it can never hurt with treatment. So try your way and see what works best for you. - but always remember to focus on the cause of the problem and not just the symptom!


Can compression products alleviate my shin splints?

Compression products can reduce the vibrations that occur in the tissue during physical activity. These small repetitive vibrations, which the muscles are exposed to every time you take a step during the run, can create small microtrauma in the muscle fibers. This can be one of the causes of your soreness after a hard workout. When you have shin splints, the pain will often be present as you land on the foot, and the pain comes as a shock through the area of the inflammation. A good compression sock will be able to reduce the vibrations in the tissues which appear when you take a step and can thus have an effect on the pain. In addition, there are many who experience a soothing effect if the area of the shin splints is kept warm, and for this, there can also be something to gain from using compression socks. I think, in particular, the compression products are justified if you practise sports on hard surfaces, such as running or handball, as the impact here will be more pronounced than on soft surfaces.


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