By: Dr. Jill Murphy, DPT, LAT, CSCS
Springtime means a few things, green grass, mud puddles, and track season for the younger folks, and the bug to get out for a run in the fresh air for us older folks. The transition from treadmill to pavement, or worse yet, from couch potato to running is fraught with injury risks, particularly to the shins. Why? The main bone in the shin called the tibia is accustomed to a certain amount of loading, called foot strikes, per day. Any significant increase in the number of foot strikes increases the stress on the tibia, causing the easily recognizable pain felt typically at the inside of the tibia that most people refer to as “shin splints.”
The cause of shin splints, known by those in the medical field as medial tibial stress syndrome or MTSS, is quite simple. First, an inflammatory process is created by excess stresses on the bone near the attachment of several lower leg muscles. If the foot strikes continue at the same pace, the loading stresses cause the next step of MTSS, that being actual bone loss as the cells that break down bone (osteoclasts) become more active than the cells that make the bone (osteoblasts) can keep up with. If a runner continues weight bearing activity, running through the pain, the risk becomes very high for actual fissures in the bone known as stress fractures to appear. These stress fractures can only be detected by bone scan early on, since X-rays are unable to show the fractures until they have been present for 3 weeks. Once stress fractures are present, any loading in weight bearing can actually cause the bone to break, sometimes into tiny pieces, along the stress fracture lines, creating large fragments of shattered bone that will end a season for sure, and possibly a running career.
So how can you prevent MTSS? Increase loading slowly and reasonably, with the best guideline as a 10% increase in either distance or intensity (increasing speed or adding hills to your route). Also, be sure to look for softer surfaces to run on to ease the transition to the pavement, such as grass or a soft gravel shoulder. Select running shoes appropriate for your foot type. If you tend to be an over-pronator (your arch falls down or flattens when you bear weight), choose motion control shoes. If you are a severe over-pronator, you may require a neutral shoe with a custom or off the shelf orthotic customized to your precise problem to reduce your risk of MTSS and other lower extremity and low back injuries. If you are not able to utilize orthotics, arch taping might be of assistance in preventing MTSS according to the research. Obtaining and maintaining a healthy body weight also reduces your risk of MTSS, as does reducing your overall stress level and getting adequate sleep each night. Other things that increase your risk of suffering an MTSS injury is being female, being a novice or very experienced runner, and having a history of a previous running injury whether MTSS or some other injury.
What should you do if you begin to feel pain in your shin? Recognize the pain as a warning sign to decrease your activity, change your work-out to non-weight bearing activities like swimming or biking, and/or possibly rest completely until your pain subsides. Never try to “run through the pain.” Icing to reduce inflammation at the shin is effective, as well as some physical therapy interventions like soft tissue mobilization in and around the area of pain, flexibility exercises, and strengthening exercises targeting the stabilizing muscles in the hips, abdominals, and feet. Utilizing a Doctor of Physical Therapy to help direct your return to activity is also a smart idea, as most patients make the mistake of writing off this injury as simple “shin splints,” and end up with a season-ending injury that could have been appropriately treated with a slow and steady return to activity in several weeks if addressed right away.
MTSS is a bummer, but doesn’t have to ruin your training schedule or track season if you utilize rest and icing such as 10 minutes of an ice cup massage several times per day early in the injury process. If you tend to get “shin splints” year after year, it would be wise to schedule an appointment with a physical therapist to determine ways to prevent you from experiencing MTSS this season BEFORE you experience symptoms. We have many options to offer, from orthotics to specific exercises based on your specific needs that we can specifically identify during your physical therapy visit.
If you have questions about your shin pain and would like to schedule a complementary injury screening, please contact us at 920-215-2050. You can also save time by scheduling an appointment for an initial evaluation right away within 24 hours of your call at MotionWorks Physical Therapy, since most insurance companies no longer require you to see your doctor before coming to physical therapy.