Shin Splints Treatment Adelaide

Shin Splints Treatment Adelaide

Shin splints are a general diagnosis for pain experienced at the front of your lower leg. Shin splints are often brought about by running and sports that involve jumping. There are two types of shin splints. In both types of shin splints you get similar symptoms but they are quite different in their origin and how they are treated.

Medial Tibial Stress Syndrome – MTSS

Medial Tibial Stress Syndrome (Shin splints type 1) , as the name suggests, is caused by pain along the inside ( medial ) part of the shin bone (tibia). The pain gradually develops over time whilst running. Often the pain is so severe that you can’t continue to run. The shin splints pain is sharp whilst running or during jumping activities.  Once you stop the pain decreases a dramatically and after about 15 minutes is almost completely gone. Your shins will be tender or painful to touch along the middle third of the inside of the shin bone (tibia). This type of shin splint might commence with the onset of a new activity and/or a sudden or rapid increase in distance run. An increase in your body weight and also running on hard surfaces can also predispose you to this type of shin pain.

So what causes this pain?

Shin splint pain is caused by the soleus muscle where it attaches to the tibia along the inside edge. This muscle lies deep to the Gastrocnemius – your bigger, bulkier muscle on the back of your leg. Both your soleus and gastrocnemius together form your calf muscles. The Soleus muscle is made up of slow twitch muscle fibres.  This means it is active in endurance activities such as running, walking and your standing posture. If your soleus muscle gets tight and overworked from sudden increases in running distance or when starting a new activity, the muscle begins to pull at the attachment along the medial border of the tibia. This, along with the forces and resulting inflammation to the tibia bone itself is what ends up causing the pain on the inside of the shin. As your muscle become tighter in response to the pain more more stress is placed along the muscle attachment at your tibia (shin bone). This can result in a cycle of pain and tension that continues until healing can occur – through physiotherapy treatment, dry needling, stopping running or sports or modification of the activities to provide enough time for proper healing.

Exertional Compartment Syndrome (Shin splints type 2)

This type of shin splints is also associated with a rapid increase in running distance, or the beginning of a new running activity altogether. The pain with this type of shin splint is mostly worse running down hills. The pain is a deeper, aching pain. Sometimes if can lead to foot slapping during running. If you stop running the pain does not go away immediately and can still be extremely painful at rest 15 minutes after stopping. The pain is felt on the outside of the shin bone (tibia) and is often described as fullness or increased pressure feeling in your leg. This is called an exertional compartment syndrome.

What causes exertional compartment syndrome (ECS)?

The cause of the pain is an increased pressure in the anterior compartment of your lower leg. This compartment is formed between the tibia and fibula, theses are the two bones in your lower leg, and a thick layer of fascia around the front of the shin. Your Tibialis Anterior muscle lies within this compartment as well as the muscles that extend your toes. When you are running, these muscles help to lift your foot and your toes up enough to clear the ground whilst in the swing phase of your run. This muscle also helps to gradually lower your foot and toes back to the ground after heel strike at the beginning of the stance phase of running. When you contract any muscle, there is an increased requirement for blood to supply enough nutrients to keep your muscles moving. This increased blood supply to the muscle will increase the size of the muscle. This function is normal and usually goes unnoticed. If the size or overall volume of the muscle increases too much, especially when the muscle is held tight like in the front of your lower leg (anterior compartment), it can result in an increase in pressure and this will cause pain. The pressure in the anterior compartment can get so high that it affects the muscles ability to function at all.  This is why you may experience your foot slapping the ground while running.

Physio Treatment for Shin Splints

In order to decrease the pain of shin splints or MTSS, the amount of pulling that the Soleus muscle exerts on the tibia must be lowered. Your City Physio physiotherapist will treat your soleus muscle with soft tissue techniques.  The techniques will help break up scar tissue, release adhesions between muscles and restore normal muscle tone. By using these techniques, the tension on the tibial attachment of the Soleus is lowered thereby decreasing the pain at that area. Your Physiotherapist may also use dry needling to length your muscles and to treat the inflammation at the site of the bony atttachment. A biomechanical analysis of your walking/running will also be useful. Some predisposing factors to shin splints include over pronation, rearfoot varus deformity and leg length discrepancy. It is often a multifactorial approach to treatment that is used to mimimise your recovery time. Recurrence rates can be greatly minimised too. Footwear and training program analysis will also be performed to make sure they are tailored to your specific needs.

It is suggested that you do not increase your running distance by more then 10% per week in order to decrease the likelihood of developing shin splints or MTSS.

The treatment options for ECS are similar to those for MTSS as poor running biomechanics, inappropriate footwear, and over tight muscles can predispose you to this type of injury. Dry Needling, and other soft tissue techniques over your tibialis anterior, calf muscles, foot and toe extensors as well as the compartment fascia can help lower the pressure in the compartment and therefore decrease the pain from this.

Stress fractures and how to avoid them

If shin splints/ MTSS goes untreated for a long time and the activity is not modified appropriately, then there is a chance of developing a tibial stress fracture. This Stress Reaction can lead to a visible stress fracture on X-ray films. If you have a stress fracture present this will requires about 6-8 weeks of restricted physical activity and a significant amount of physio rehabilitation. The key here is to not let shin splint go untreated.

Acute Anterior Compartment syndrome

A more severe condition that can develop is called an Acute Anterior Compartment syndrome. This is a medical emergency. The pressure in the compartment can go so high that it cuts off your blood and nerve supply to your muscles, ligaments, and bones in the lower leg and foot. The only treatment option is a surgical procedure called a fasciotomy. A fasciotomyis performed by  a surgeon who will cut open a long section of the anterior compartment of your lower leg to decrease the pressure. Symptoms of this acute condition are extreme pain, swelling, numbness and no muscle control in the foot. These symptoms are similar to those of ECS except they are far more intense. The intensity only ever increases over time so get to a hospital quickly if you are experiencing these symptoms.

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