Shin Splints: The Bane of Pre-Season

Firstly, shin splints are painful, and completely inconvenient.

Just when you think you’re screaming along, tearing into pre-season training, or you’ve finally gotten off your couch to kickstart your fitness goals for the new year, you get pain in one or both shins. So what the hell are shin splints?

Well, there are two common types:

1. Compartment syndrome/soft tissue related shin pain
2. Medial tibial stress syndrome (MTSS)

Both can be caused by a multitude of different factors including but not exclusive to:

• Running/impact load

  • How often you are running/jumping/exercising

  • How long your sessions are/how far you run

  • How intense your training is?

  • Running technique - e.g. cadence, step length

• Rest

  • How much time is there between running/training sessions?

  • How much sleep do you get?

  • What other exercise do you do between these sessions?

• History

  • How much have you trained in the previous weeks/months/years

  • Has there been any recent change to your training?

  • Have you had shin pain before?

• External factors

  • Changes in running/playing surface

  • Change in footwear

  • Change in sport/coaching

I typically see patients presenting with shin pain after a sudden increase in running or training load. Pre-season sport is commonly a factor or programs like a bootcamp. Symptoms generally begin quite mildly, but over time can become persistent and more severe. This is the best time to address the pain, before it begins to affect your training and becomes chronic.

How do we differentiate between the two types of shin pain?

1. Compartment syndrome/soft tissue related shin pain

This is commonly felt in the outer part of the shin at the front, although it can be felt in other areas. If you press on the area it will be sore in the muscle belly (where it’s soft). Compartment syndromes can also be associated with sensation changes in the shin and foot, often related to nerve tissue or blood vessel compression. This can cause pain radiating down to the foot, pins and needles or numb sensations, or even burning pain in the shin or foot.

2. Medial Tibial stress syndrome (MTSS)

This differs from compartment syndrome in that the discomfort can be felt on the inner part of the shin. This is known as the medial border of the tibia. If you feel your symptoms in this area, it indicates that there is some kind of stress response in the bone. This can range from a mild response (inflammatory changes in the outer layer of bone) to severe (bone bruising or stress fractures).

What can a physio do for shin splints?
My physiotherapy sessions always begin with a thorough assessment of your history, training, and any concerns that you have. I like to give people a platform to voice any concerns and problems. Once I’ve established your relevant history and have identified any relevant clues as to what might be contributing to your problem, I’ll then take you through a thorough physical examination. This would usually involve an assessment of your movement, strength and getting my hands on the area to double check what hurts.

What does my physiotherapy management involve?
Firstly, I like people to understand why things hurt, what the causes might be, and what they need to do to get better. This is a joint decision-making process, meaning I need to provide you with the best possible, evidence-based care, but I also need to include your preferences for exercise, your goals, and include things in your rehab that you might enjoy. If you understand why you’re doing the things I’ve prescribed, and you enjoy what you’re doing, you’ll be more likely to stick to the plan.

My physiotherapy management typically involves modifying your training. If you’re running too much, can we reduce your load to the point that your symptoms settle without completely stopping? If you do need to stop running/training, can we replace it with some other type of training? i.e. exercising a different body part, swimming/cycling or using cardio machines. I always assess the body parts above and below the affected area, so in this case I will assess your hip, knee, ankle and foot to check for any discrepancies or weaknesses. Some people might need to strengthen their hips or get better at absorbing impact through their calf.

Time! This is one of the most important factors to your recovery. Unfortunately, shin splints can be a lengthy recovery. If you are consistent with your exercise program, if we can progressively reintroduce and increase your running/training volumes, most people will recover fully and to their pre-injury training and performance levels. However, there are a small proportion of people who don’t recover fully. We have to remember that pain and injuries are complex and as mentioned previously, can be multi-factorial. Other things that can affect your recovery include:

• Poor or inadequate diet

• Stress, fears, and anxieties

• Behaviours that may limit healing e.g. overtraining, inadequate recovery between sessions

• Co-morbidities such diabetes, obesity or heart issues

In Summary:

1. Avoid increasing running and training loads too quickly

2. If you develop shin pain, get assessed early by physiotherapist

3. Talk with your physio about a plan that suits your goals, but also considers best-practice and scientific evidence

4. Stick to the plan, but be adaptable

5. Let time, rehab and the plan do their thing

6. If pain persists, look deeper and outside the box