Shin Splint Physical Therapy

If you are running, jumping and sprinting at high volumes and begin to experience pain along the inside of the shin bone, you may be developing shin splints. While it is tempting to ignore the discomfort and push through your training, shin splints is a condition to be taken seriously and a physical therapist trained in sports and orthopedic injuries can help you recover fully. Read on to learn more about this condition and why you want a physical therapist in your treatment corner. 

MEDIAL TIBIAL STRESS SYNDROME

The medical term for shin splints is medial tibial stress syndrome. This longer name helps explain exactly what is happening when shin splints develop. “Medial tibial” refers to the inner side or medial side of the tibia/lower leg bone which is often referred to as the shin bone. The muscles and tendons involved in shin splints attach along the middle or lower part of the inside of the tibial bone. The term “stress syndrome” denotes that shin splints are an overuse syndrome caused by repeated stress to the tendons and bone in that area. 

Shin splints are not the only cause of pain along the inside of the lower leg but should be considered by healthcare providers when a patient presents with complaints of pain along the middle or bottom third of the inside of the tibia. Sharp pain may be felt when their PT or doctor presses along the affected area and a deep ache in that area may be experienced during activity. In the early stages of shin splints the discomfort is present at the beginning of exercise and usually lessens or disappears as an athlete warms up. As it progresses though, symptoms will persist during activity and eventually can become bothersome even at rest. 

Unlike a traumatic injury to the tibia like falling and breaking or hitting the bone, medial tibial stress syndrome is considered an overuse injury that usually develops in athletes, military personnel or active persons who run, jump, or sprint at high volumes. Dancers, runners, tennis players and basketball players are some of the athletes at highest risk for developing shin splints. They may notice the onset of these symptoms after increasing the volume or time spent performing these activities. 

SHIN SPLINTS ARE MORE THAN A MUSCLE PROBLEM

So what is happening to the lower leg in the case of shin splints? Shin splints are the result of microdamage that accumulates along the attachment point of several lower leg muscles. Repeated contractions of these muscles, such as that which occurs in a runner training for a marathon or a dancer rehearsing for a show, pull on the outer layer of the tibial bone causing microdamage and inflammation of the bone. Without sufficient time for the bone to recover between bouts of activity, this microdamage can accumulate leading to the development of medial tibial stress syndrome or shin splints. Most commonly the posterior tibialis, soleus and flexor digitorum longus muscles are implicated in this condition. 

Many athletes will try to push through the discomfort of injuries and conditions like shin splints but we want to help you understand why you should take treating this condition seriously. Unlike other muscle or tendon conditions like a muscle strain or tendonitis, medial tibial stress syndrome is considered to be an early bone stress syndrome. The repetitive pulling of the muscles involved in shin splints along their attachments to the medial tibia bone can begin to cause a stress reaction in the bone. This means that without appropriate modification to activity or technique, shin splints can progress to a bone stress injury or stress fracture. 

Bone stress injuries occur in response to repetitive submaximal loading without sufficient recovery time. This repetitive stress to the medial tibia exceeds the bone’s elastic resistance causing structural fatigue and eventually what we know as a stress fracture. Early stress fracture symptoms mimic early shin splint symptoms quite well and it can be extremely difficult to tell how seriously the bone is affected with shin splints. If left untreated, a bone stress injury will worsen and become a significant disruption to your life. Casting or splinting, modified weight bearing and even surgery may be required to promote healing of a stress fracture. 

IT’S TIME TO TURN TO YOUR PHYSICAL THERAPIST

Long term healing from shin splints can be tough if you don’t understand what caused the condition to develop in the first place. A physical therapist experienced in orthopedic injuries, however, is a great resource to help you recover from this condition and prevent its return later on. Resting from activity can help reduce the likelihood of shin splints progressing into a full blown bone stress injury but it does nothing to ameliorate the likelihood of symptoms recurring once you return to your previous level of activity.

A physical therapist will ask you about your symptoms, your injury history, your activities and your training schedule to try and identify aspects of your lifestyle or training that may be predisposing you to developing shin splints. They will also perform a physical examination to identify impairments that may be contributing to this condition. For example, the presence of a flattened arch or excessive hip motion during activity can predispose someone to developing shin splints. Limited range of motion in the hip and ankle can also contribute as does the presence of a higher BMI in athletes. 

Activity modification, meaning reduction in load bearing activities, is a very important part of allowing the microtrauma involved in shin splints to heal. Stopping all activity, however, is not necessary and may lengthen the time needed to return to full activity. Your PT can guide you through an exercise program to minimize losses in fitness and performance while allowing the bone and tendons to heal. They may utilize modalities like ultrasound or dry needling to promote local healing. While this area is healing your PT will create a treatment plan to improve strength, range or motion, motor control or coordination deficits that may be contributing to the extra stress on your tibia during activity and can recommend a return to activity program that will help you resume activity without reinjury. Dealing with shin splints can be frustrating but with the guidance of a great physical therapist you can feel confident you are taking the best course of action. Call to schedule an evaluation with one of our physical therapists today to learn how you can recover from shin splints for good. 

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