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Oh my giddy good golly! It’s Friday afternoon, I’m sat in a pub (sober!) and I’ve given myself the task of explaining this little lot. I’ll have truly earned my pint this evening when the clock ticks to beer o’clock if I pull this one off!
So where do I start. Well how about the beginning. So shin splints is one of the reasons yours truly finds himself sitting here writing this. It was one of my first injuries that sparked my interest in the wonderful world of Physio.
I’ll paint the picture. I was studying a pointless degree (I don’t like to talk about), I was playing a lot of squash to keep sane and a friend of mine had the condition a year or so previous so I knew what it meant – please note psychological aspect here.
I had to shave my mildly hairy legs aged 21, wear zinc oxide type and did it make any difference. Absolutely none! At the least the Physio was free at Uni. Otherwise I’d have really annoyed that I’d have wasted beer money!
So What Are These Mythical Shin Splints?!
Shin splints is just a lay expression. It probably best translates as “I’ve got a hurty bit in my shin somewhere.” Just as an aside here I use the word hurty as many of my clients do. Having just met people as they talk about there injury you can always tell which ones have young kids by the use of the word “hurty” when describing their condition!
As with all things Physio we like to categorise these into the following 3 conditions. We have Medial Tibial Stress Syndrome (MTSS), Anterior Compartment Syndrome and Deep Posterior Compartment Syndrome. Non of which mean anything of course to your average Joe. Read on to find out more…
You can read more here at the NHS site to find a medical description of these conditions.
Where Does It Hurt?
Medial Tibial Stress Syndrome is usually felt along the inside of the shin. In a specific area, or possibly two, somewhere along the length of the tibia. Most commonly it’s in the “distal third” that means the lower third of the tibia.
Deep Posterior Compartment Syndrome usually presents as pain along the whole length of the inside of the tibia. The deep posterior compartment comprises of the muscles that curl your foot, toes and big toe downwards. Namely Tibialis Posterior, Flexor Digitorum Longus and Flexor Hallucis Longus.
Anterior Compartment Syndrome is normally pain along the whole of the outside shin muscle. These are the muscles that lift your foot, toes and big toe up. These are called Tibialis Anterior, Extensor Digitorum Longus and Extensor Hallucis Longus.
Most likely you fit into the “too much too soon” brigade! Either you’re making a comeback or you’ve recently increase the duration and / or the intensity of your exercise. It’s not that your body can’t cope with the demand you’re putting on it. It’s just that it needed a bit longer to adapt to the increased demands.
You could fall into another category in that you’re returning from another injury. This would suggest there’s a compensatory movement pattern which is leading to overuse of the muscles involved in causing the pain.
Simply put the way your body works (i.e. movement patterns) is not sufficiently well adapted for what you want to do with it.
Are There Any Complications?
Yes. Stress fractures. Please don’t read that as “if I have shin splints then it will develop into a stress fracture”. These are the exception rather than the rule. I’ve only seen a couple in 11 years out of hundreds of cases of shin splints. But it is a risk.
Generally speaking if your condition is getting progressively worse then you’ll need to seek advice and treatment anyway. If your pain is fairly low grade there is a smaller chance you will develop a stress fracture. But we’d still advise to get things checked out earlier rather than later.
Just a word of warning here. There is a rare but potentially urgent case that needs to be mentioned. If the front of your shin literally feels like it’s about to explode and you’re in so much pain you can’t walk – just pop yourself up to A&E would you? It’s rare, I’ve never seen it, but I feel I should just mention it. If you’re in doubt just give us a call and we can advise what’s best to do.
Why Does It Hurt?
Now you’d think I’d learn by now in these blogs to stop asking questions we don’t know the answers to! As with many of these things we don’t truly “know” which structures are causing the pain. Traditionally it was hypothesised that pain was caused by the fascia or connective tissue.
Either by the pulling on the covering of the bone, the periosteum, too much. Or the covering of the muscle, the perimysium. The latter being due to the a large, quick expansion of the muscle tissue underneath.
As with all these things it is very hard to prove categorically what is causing anyone’s pain at any given point (see previous article on pain on our Brighton site). In our experience these ideas seem a bit too simplistic, and what is usually contributing to people’s pain is a much more complex web of bio-mechanics.
What Should I Do About It?
Come and see us of course! We’ll asses exactly where your body is doing something funky to put extra pressure on those poor overworked muscles. Once we’ve altered the movement patterns things should fall nicely into place.
And if you don’t come and see us, see someone else! The quicker you get this looked at and sorted the easier, and cheaper (!), it is to sort out.
Are There Any Exercises That Can Help?
Maybe. As mentioned previously every single condition is unique which is why we suggest getting it assessed and treated by appropriate professionals such as ourselves. There are a couple of structures that are consistenly tight which commonly contribute to the pain. But the question remains why are these over working and tight?
Traditionally calf tightness has been linked with shin splint conditions. It is though that a lack of dorsiflexion (that is the movement when you bring your shin over the front of your knee by pushing you knee forwards). As such calf stretching can help in some cases.
Looking at things from a slightly newer perspective and one which can work for all kinds of shin pain is quadricep stretching. The quadricep is continuous with the anterior compartment as shown here and so can take pressure of the problem area. Equally if you look here you can see how the femoral nerve continues into the inside of the tibia and can be the nerve that feels your pain. But what’s causing your quads to be tight?!
The truth is that after 11 years, and no more shaving of legs (!), each case of “shin splints” I have seen has been entirely unique. You can try the exercises mentioned above, you can read all you can on-line about them and that might help. But the best way to get this annoying of all conditions sorted for good is to get it properly assessed and treated by a professional to understand why you have this condition right now.
We’d love you to choose us to help you get fully fit again. If you’d like to talk to us about shin splints or any other condition then please call is now on 01793 613352 or email us at info@SwindonSportsTherapy.co.uk. If not us then choose someone else. But please do get it sorted, you wouldn’t want it to develop into a stress fracture now would you!
This post first appeared on our Brighton Physio site.