Why do my shins hurt?

I was inspired to write this blog article after seeing a bunch of high level athletes at my football club develop persistent shin splints during pre-season. Some of these injuries are still reccurring during the season and have had some debilitating outcomes on performance.

As a Podiatrist and an athlete, I would love to help you manage (and preferably avoid!) shin splints and provide you with some tips and insights into treatment strategies.

  1. What are Shin Splints?

Shin splints, technically known as medial tibial stress syndrome (MTSS) refers to a dull aching pain experienced along the posteromedial border of the tibia/shin bone and is usually elicited with the onset of exercise or in the mornings.


Muscles become overworked, creating microtears in the muscle belly and bone tissue. Shin splints are commonly encountered in high intensity sports requiring sudden changes in direction and can also present as an overuse injury in runners and sprinters.

Excessive forces that the muscles are placed under cause the muscles to swell therefore increasing pressure on the tibia/shin bone.

Common symptoms:

  • Pain is commonly experienced on the front and on the medial/inside of the shins.
  • Pain is worse in the mornings and after exercise
  • Pain decreases as you warm up and stretch
  • Tight calves
  • Pain going up hills and sprinting
  • The area may be painful to touch

2. What causes shin splints?

Shin Splint is a common overuse injury that is caused by a combination between poor lower limb biomechanics and also excessive pressure through the region.

“Too much too soon” is a common phrase used when referring to the cause of shin splints, meaning that a sudden increase in physical activity can lead to overuse injuries in muscular structures.

Overpronation (rolling in) of the foot is another common cause of shin splints as this creates a muscle imbalance in foot pressure on the medial (inside) of the foot. This creates stress on the shinbone.

Other causes:

  • weakness in the glutes
  • worn-out and under-supportive footwear
  • training on hard surfaces
  • weakness in ankles
  • tight calf muscles/Achilles tendons
  • participation in high-intensity sports requiring sprinting or sudden changes in direction such as football, netball, basketball, soccer.

3. What can I do to treat my shin splints?

Depending on the severity of the condition and the stage of the shin splints, as well as how long you have had it for and the intensity of pain, I have outlined some strategies to treat your shin splints.

Tools that are required:

  • Lacrosse ball/ massage ball
  • Red theraband (medium resistance)
  • Foam roller

Modification in training load:
It is important to adjust training load, surfaces, intensity and frequency.

  • Training surfaces: In the early stages, try to avoid running on the road and opt for surfaces such as trails, grass and the treadmill in order to reduce the shock and load going through your legs.

  • Hills and sprints: Ensure that sprints and any hill work is avoided whilst the pain is still present as this can place more pressure underneath the area.


PHASE 1: Stretching & mobility
Depending on the symptoms and severity of the condition, stretching and mobility techniques are a great starting point.

  • Elevating and icing for 10 mins following training sessions

  • Calf stretches: Bent leg against the wall and also off a step, holding this for 15-20 seconds (see photo)

  • Glute stretches

  • Calf holds: Facing a wall and touching with your fingertips, go up onto your toes and hold for 30-40secs. Repeat this twice. There has been plenty of research behind this exercise being effective for pain-relief. (See photo)

  • Massage ball: Small rolls up and down and left to right can relieve taut bands in the tibialis anterior muscle and calf muscles.

  • Roller: Using the roller over the calf muscles and tibialis anterior muscle using the technique above can also assist with tight areas.

  • Avoiding hills and sprints: Whilst there is still pain, these should be avoided as they place more strain on the calves and shins.
     

PHASE 2: Strengthening

Usually the best rule of thumb is to commence strength training once the pain has subsided and is below a 5/10. Strengthening exercises are a great way to build up the capacity in the calf muscle and tibialis anterior leg muscles in order to physically prepare them for a full return to the sport.

By restoring the ability of the muscles to withstand more load and power, this can prevent the shin splints from reoccurring.

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Calf raises: Facing a wall and holding with fingertips, go up onto your toes and back down. Start with 10-15 reps x 2 sets and increase reps and sets when this becomes comfortable.

If there is pain performing these resort to isometric calf holds- holding at the top on toes for 30secs x 2 sets.

Single leg calf raises: Following the instructions outlined above, these can be performed on one leg in order to increase the load through the structures.

Theraband exercises:

  1. Dorsiflexion/plantarflexion: This targets the anterior (front) and posterior (back)  muscle compartments. Lying down, place theroband at base of toes and point toes upwards and downwards. Repeat 10-15 times x 2 sets to start with. 

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2. Tibialis Posterior: Also strengthens the calf musculature, specifically the tib post tendon. Tie a knot in the theraband

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How can I prevent this from reoccurring?

It is important to read your body and to allow yourself to rest when you experience niggles, aches and pains that prevent you from completing a full training session or run.
 

  • Manual therapy: Frequent soft tissue massage and dry needling through calves and tibialis anterior.

  • Self-massage: through the calves and tibialis anterior muscle using a roller and a massage ball.

  • Stretching: Following a stretching program to release calves, hamstrings and quads to offload pressure from the shins.

  • Strengthening program: This may involve theraband exercises: plantarflexion/dorsiflexion, isometric calf holds and then progressing to calf raises if there is no pain

  • Supportive footwear: Shoes with cushioning and arch support.

  • Modifications in training surfaces: Reducing running on the road and instead mix it up by running on trails, grass and the treadmill whilst there is still pain/discomfort.

  • Decrease the amount of hills and sprinting whilst there is pain.