Stride Strong PT’s Formula
- 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:
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: https://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.
- Journal of Orthopaedic & Sports Physical Therapy, 2014, Volume: 44 Issue: 10 Pages: 748-748 doi:10.2519/jospt.2014.0506
By Dr. Nicholas Chamley, DPT