Today we are going to cover the podiatrist’s 101 of shin pain.
This includes: What shin pain actually is, why it happens and treatment options of how to kick sore shins to the curb.
What is shin pain or shin splints?
As with most conditions associated within the lower limb, most presentations involve an overload of the tissue. For shin pain, this is specifically surrounding and including the shin bone.
Quite often shin pain is classed under the broad diagnosis of Medial Tibial Stress Syndrome (MTSS) where pain is experienced throughout the lower two thirds of the shin.
Presentations of shin pain can encompass the tibia itself, the periosteum surrounding this bone as well as the muscles, tendons and attachments of the tibia.
More specifically when diagnosing MTSS or shin pain we can typically classify this based on tissue or structure actually being affected and the severity.
A simplified classification of such is below:
Bony stress reaction or fracture to the tibia
Here we have a breakdown of bone integrity of the main weight-bearing bone in the shin. This is a more severe presentation which unfortunately females are 1.5-3.5 times more at risk of experiencing.
Inflammation of the fibrous sheath surrounding the tibia (periosteum)
This involves the outer lining of the tibia becoming edematous (swollen and inflamed) and is considered a mid level presentation. However if not managed appropriately can escalate to a boney reaction of the tibia.
Overload of muscles in lower leg
Where the musculature which control the movements of the lower leg, foot and ankle experience an imbalance in capacity vs demands. Common tissues involved are the tibialis anterior, tibialis posterior, soleus and extensor digitorum longus. Generally this is considered a lower level.
Why do we get shin pain/splints?
As mentioned above, the overriding reason that we experience pain to the shins is as a result of demands being placed on the structure are greater than that it can handle.
Typically when talking about MTSS, this will be a result of an increased repetitive loading of the lower limb.
As a podiatrist, clinically the main contributing factors we see contributing to this are:
Training errors
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Spike in loading “Too much too soon”
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Incorporation of higher intensity activity
Deconditioning
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Decreased strength in the major stabilising musculature can lead to overload and pathology but also then creates further increased demands on boney and tertiary structures.
Biomechanical factors
Here we undertake and assess your biomechanical, gait and movement screening to identify movement patterns contributing to the specified tissue.
Common findings often associated with shin pain are:
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Overstride
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Poor control of ankle deceleration
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Increased rate of pronation
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Knee Valgus
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Contralateral hip drop
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Reduced Ankle joint range
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Poor ground clearance
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Loud ‘slappy’ gait
External load modifiers such as footwear.
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Shoes which are too old. Generally once footwear has been exposed to 600km of loading the integrity of the shoe is diminished and therefore demands more from stabilising structures.
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Also recent changes to footwear can modify specific loading and therefore contribute.
How do you treat shin pain?
Strength
This is essential. If the muscles which control the moment of your lower limb, foot and ankle are not strong enough then there is always going to be a limitation on activity levels and intensity before pain will occur.
Therefore increasing the strength of the major stabilsing musculature allows for them to be able to tolerate the work required.
Short term deloading
May be required depending on severity of presentation and pain. Here the focus is to allow for recovery of tissue and reduction in symptoms.
Although we may be taking a step back from your desired activity, this doesn’t mean we aren’t doing anything. Here is our chance to implement the above strength based work to prepare these structures for their return and continued exposure to activity.
Offloading
Utilising specific characteristics in footwear and orthotics to reduce load on specific tissue can enable continued activity in more comfort or be used in certain high intensity, repetitive loading circumstances.
Orthotics:
Can be a really effective option due to our ability to be able to redistribute load and decrease rates of loading on the exact tissue which is being affected.
Shoes:
In a similar mould to orthotics. Depending on contributing biomechanical factors, often stable lightweight options can assist with control and ground clearance.
Gait retraining
Here, specific alterations to running technique can be implemented to deload specific tissue. A couple of the main considerations involve:
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Increasing cadence, reducing stride length and vertical oscillation
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Transition to a mid or forefoot strike decreases loads to the font of the shin and in chronic or consistent presentations can be beneficial.
When can I get back to activity post shin pain?
The question on everyone’s lips.
A couple of specific tests conducted in clinic involve:
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30 second hop test
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Affected side’s strength markers being within 90% of the uninjured limb
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Calf raise strength being within expected age based range
Implementation of a return to run or activity guide in combination with a strength program once symptoms have settled is an essential step in enabling not only initial activity but also pain-free sustained activity.
If you have any questions about this or want to reach out for help please get in touch.