Katherine Mullen, DC, MS
What are Shin Splints?
We’ve all at some point made the ambitious goal to sign up for a 5k or half marathon, but have not run more than a few miles in the past few years. Training should be no problem and it’s just a few miles a day, right? Well...with increased mileage and not running frequently in the past, we soon become very familiar with shin splints, which can lead to a hiccup in the training plan. Shin splints, also known as Medial Tibial Stress Syndrome (MTSS), is a painful condition that stresses the medial (innermost) part of the shin bone and overloads the surrounding muscles and tendons. It is one of the most common causes of lower leg pain from overuse and repetitive stress from exercise, and is typically relieved with cessation of activity. It is most commonly associated with running, but can arise with any activity that involves running or jumping, as well as standing for long periods of time on hard surfaces. It is important to note that if shin splints are not treated properly, they can turn into stress fractures.
A systematic review by Newman et al. found the following risk factors to be associated with MTSS:
Fewer years of running experience
Females are more likely than males to suffer from shin splints
Previous history of shin splints
Overpronation of feet/flat feet
Prior use of orthotics
Common symptoms of shin splints include a deep ache and pain with pressure around the shin bone. Red flags include symptoms of increased pressure and/or fullness within the muscle, cramping, numbness, tingling, or weakness in the lower leg, which could indicate a condition called Chronic Exertional Compartment Syndrome (CECS), which is a medical emergency. CECS is when there is an increase in pressure within a compartment, causing muscular swelling as a result of exercise. The buildup of pressure causes a decrease in blood flow, causing muscles and nerves to be able to get the proper nutrients they need.
Muscles Overloaded With Shin Splints
Shin splints can result from repetitive stress on the tibia, but also from dysfunction of the surrounding muscles: tibialis posterior, tibialis anterior, and soleus just to name a few. The job of the tibialis muscles are to help with dorsiflexion (bringing your toes up towards your nose) and inversion of the foot (rotating the foot inward). The tibialis posterior in particular is an essential component in stabilizing the foot. The job of the soleus is to plantarflex the foot (point the foot down). These movements are all essential to the gait cycle. When they are unable to do their job due to dysfunction, it leads to pain up the kinetic chain. So how do we resolve the pain if the muscles aren’t doing what they’re supposed to?
Management and at Home Care
Rest: Stop aggravating activity for at least 2-6 weeks, depending on the severity of symptoms. If you return to activity before giving your body time to heal, it is going to become an endless cycle and if treated improperly, it could result in stress fractures.
Soft tissue mobilization: helps decrease muscular tension through pin and stretch, Graston, scraping, IASTM, cupping, massage, dry needling, etc.
Chiropractic extremity adjustments: to help establish better movement in the foot
Rehab: once the pain starts to dissipate, this is one of the most important steps because it works on the dysfunction. Therapeutic exercises that are targeted towards the feet and small intrinsic muscles of the foot can help more in the long term. First consult your practitioner to make sure the following exercises, which can be found on our YouTube Channel, are right for you.
Newman P, Witchalls J, Waddington G, Adams R. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med. 2013;4:229–241. Published 2013 Nov 13. doi:10.2147/OAJSM.S39331
Galbraith RM, Lavallee ME. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2009;2(3):127–133. Published 2009 Oct 7. doi:10.1007/s12178-009-9055-6
Katherine Mullen, DC, MS is a chiropractic physician with a masters in sports medicine. She has a special interest in the treatment of athletes through chiropractic and rehabilitative care. Stay connected with Dr. Mullen on Instagram @washparkchiro or @drkatherinemullen_dc