• Manual therapy, stretching exercises and ASTYM to calm down tight, inflamed tissue.
• Strengthen the ankle complex and improve dynamic balance and strength so running and walking is better tolerated.
• Modalities to avoid further re-injury of the offending muscle by ways of taping and/or orthotic and shoewear recommendations.
Whether the burst of inspiration comes from officially registering for that marathon next year and making the goal concrete, a New Year’s resolution, weight-loss challenge, or simply the weather becoming more conducive to comfortable long runs… with little warning, that good-intentioned enthusiasm for self-improvement manifests as annoying shin pain.
The diagnosis of “shin splints” is one of those umbrella terms that may be inaccurately used to describe a number of very different lower leg injury issues. True shin splints are more accurately referred to as medial tibial stress syndrome (MTSS). It’s important for every runner to understand whether:
A) they’ve simply pushed it a little too hard and need rest/rehab to fix their stride and identify training errors to avoid suffering from medial tibial stress syndrome (ie true shin splints)
B) if this shin pain may have developed into something more serious like a stress fracture or compartment syndrome.
The American Medical Association’s definition of shin splint syndrome: pain and discomfort in the leg from repetitive activity on hard surfaces, or due to forcible, excessive use of the foot flexors… limited to musculoskeletal inflammation … is a good start, but doesn’t necessarily provide answers for the runner trying to kick this nagging issue.
What To Do First
– If you start getting pain on the inside of your shins, the first step is stopping whatever brings on the pain. By definition, medial tibial stress syndrome should start healing with a little rest (essentially removing the offending “stress”)
– If serious signs like discoloration, numbness/tingling, or throbbing pain continue long after you stop running, your best bet is to see your physician ASAP, as it may be more severe than simple shin splints.
– Say you take a little break from running, start feeling better, then try running again, and the pain returns? Call your doctor of Physical Therapy to nip this thing in the bud before it gets out of hand.
Not sure what you might have? Use the chart below as a guide:
Differentiating what you have
Medial Tibial Stress Syndrome aka “Shin Splints”
Possible Causes and Risk Factors
– running/jumping athletes: a) training errors such as drastic increases in distance, intensity, or duration of exercise; or b) worn out or inappropriate footwear
– flattening of the arch in standing (over-pronation)
– being female
– being a male with smaller calf girth
– nutritional, hormonal, or anatomical abnormalities
How PT Can Help
By doing a thorough physical evaluation and discussing your symptoms, training schedule, etc, your physical therapist will help identify potential causes and set up a plan. The general goal? to calm down the tissues and fix the issues.
– to address the CAUSE (and get you back to pain-free running sooner):
prescribing rest, icing
specific, gentle stretches for the involved muscles
arch taping to support the over-stressed muscles
manual therapy to restore normal joint mobility or IASTM to break upadhesions and promote healing
video gait analysis looking for things like overpronation or overstriding that might be putting excessive stress on your lower leg muscles (followed by clear instructions for how to modify your running form)
footwear or orthotic recommendations
specific strengthening of the feet, ankles, and/or hips
Running injuries and guidelines for preventing them are complicated and variable as scientists continue to learn more about specific causes and risk factors. One rule most runners are familiar with is to gradually increase distances by no more than 10% each week. An a study to be printed in October’s issue of my favorite publication, the Journal of Orthopedic and Manual Physical Therapy (JOSPT), put the 10% rule to the test by following 873 new runners for 1 year. A significantly higher number of certain injuries [patellofemoral pain (runner’s knee), iliotibial band syndrome, medial tibial stress syndrome, patellar tendinopathy (jumper’s knee), greater trochanteric bursitis, and injury to the gluteus medius or tensor fascia latae] were sustained by runners that increased >30% over a 2 week period than by runners who limited their progressions to <10% over 2 weeks. This may suggest a modified “5% rule” as more effective prevention. That said, this 5-10% rule was not linked to other injuries included in the study such as plantar fasciitis, Achilles tendinopathy, calf injuries, hamstring injuries, tibial stress fractures, and hip flexor strains. Read more at: http://www.jospt.org/doi/abs/10.2519/jospt.2014.0506#.VCvWcStdXmV
Galbraith R.M. and Lavalee M.E., ‘Medial Tibial Stress syndrome: conservative treatment options’, Curr Rev Musculoskelet Med.; September 2009, 2(3):127-133.
Moen, M. H., Tol, J. L., Weir, A., Steunebrink, M., & De Winter, T. C. (2009). Medial tibial stress syndrome. Sports medicine, 39(7), 523-546.
Moen, M. H., Bongers, T., Bakker, E. W., Zimmermann, W. O., Weir, A., Tol, J. L., & Backx, F. J. G. (2012). Risk factors and prognostic indicators for medial tibial stress syndrome. Scandinavian journal of medicine & science in sports, 22(1), 34-39.
Moen MH, Holtslag L, Bakker E, et al. The treatment of medial tibial stress syndrome in athletes: a randomized clinical trial. Sports Med Arthrosc Rehabil Ther Technol. 2012;4:12.
Nielsen, R. O., Parner, E. T., Nohr, E. A., Sørensen, H., Lind, M., & Rasmussen, S. (2014). Excessive Progression in Weekly Running Distance and Risk of Running-related Injuries: An Association Modified by Type of Injury. Journal of Orthopaedic & Sports Physical Therapy, (Early Access), 1-25.
Alice earned her Doctorate of Physical Therapy from USC in 2007, and have practiced Physical Therapy for 12+ years in the Outpatient Orthopedic Setting. Certified in ASTYM, she also has been a featured expert on Physical Therapy on numerous publications including health.com, healthline.com and yahoo.com.
This place is amazing. I am so happy I found Stride Strong PT. Alice pays attention to all of the details, she watches every single move I make, my posture, and the way I move through every exercise. She is very knowledgeable, she was able to pin-point the problems in my back and she has a plan to help me become stronger where I need. The place is brand new, huge, and has nice exercise machines. I tried a few physical therapists in the area, and Alice is TOP, second to none, and I feel super lucky to have found her. Highly recommended!!
Dr. Alice at Stride Strong is one of the best PTs I have come across. Her attention to detail and assessment of the root cause of injury is very good. She is excellent in evaluating pain patterns and giving a training schedule for a rehab & injury prevention, she is extremely knowledgeable. I would strongly recommend Stride Strong to anyone looking for PT. It is easily the best PT clinics in Hillsboro area.
I recently had a massage from Joel at the Hillsboro location. He was able to work on an ongoing issue I have been experiencing with my back after a sports injury, and I left feeling so much better. The whole facility looked incredible, and everyone I met was friendly and welcoming. I would highly recommend Stride Strong for massage and physical therapy.
Dr. Sydney is by far the absolute best physical therapist I've worked with ever! Her expertise in designing highly effective and efficient exercise plans is beyond compare. I feel so much better as my strength and function increases. She comes up with the most brilliant and fun ideas to motivate. To my delight she even offered to come to my home in Vancouver and work with me on my own equipment including a Stott Pilates Reformer. Talk about going above and beyond! Couldn't be more grateful I found her!!!
A full hour of a dedicated PT professional's time without aides or techs? That's just one of the things that sets this clinic apart from others. Competent, professional, and amiable, Dr. Alice Holland and her team are the best in the area. While I generally see them at the Cedar Mill Clinic on Cornell, situational constraints took me to their new Hillsboro clinic today near Intel Jones Farm. Beautifully furnished, spacious with easy parking and access. May you continue to grow and thrive, Stride Strong!
After foot surgery I went to Stride Strong for therapy with Alice Holland. She helped me reach my full mobility again by continuously introducing new and challenging exercises. The entire staff is friendly and professional. They are always on time and do not rush. I look forward to doing 1/2 marathons again and riding my recumbent trike. Thank you Stride Strong for your care and high level of expertise.
The best physical therapy ever. Both JP and Sydney were a great PT, they helped me understand how I can help treat my injury and how it may have caused. And also they informed about so many techniques that I can use to help my injuries or any other injuries I get in the near future. They are both friendly and nice to talk too, and verbunformative. And there is also Krystal, she is the best front desk receptionist ever, she is nice and friendly and can easily manage your schedule based on the patients comfort if they want to schedule or not. She can help and she replies fast to any patients email. And she is easy to talk to. Thank you Stride Strong Physical Therapy.
Mary Szal here: I've had three sessions with Brittany at the Hillsboro location. I can say that she has been the most effective and instructive physical therapist I've ever experienced. Her personality, energy, knowledge and results are top notch.
Awesome place for PT. Hillsboro location has plenty of parking and very spacious. I had the pleasure to work mostly with Dr. Alice Holland and JP. I came in with a shoulder injury and thank goodness they understood what I was going through. They are the best of what they do, I would recommend Stride Strong to anyone who needs PT.