Description:

Pain along the inside (medial) or outside (lateral) border of the shin bone (tibia). There are muscle attachments that connect along the tibia. As the muscles pullon the bone, it causes stress and eventually irritation along the inside border of the shin. The area of pain depends on the muscles being overused and stressed.

Symptoms:

• Pain usually worsens with activity
• Swelling may occur
• Tender to the touch along the border of the tibia
• The exact location of the pain can be difficult to pinpoint

Possible Causes:

• Poor foot biomechanics: Pronation is a necessary function of the foot. Pronation allows the foot to disperse shock, reduce the impact felt on the body up the chain, and adapt to the surface of the ground. However, overpronation is an excessive amount of pronation, in which the arch can collapse with each step. Overpronation can cause the foot to flatten out and the tibia (shin) to internally rotate, which in turn causes the knee drift medially (inward). which can pull on the muscles attached to the tibia and cause them to become irritated. Conversely, a rigid foot might not allow for proper shock absorption and may stress muscles and tendons above the foot, especially on the lateral (outer) side.
• Improper footwear: If you overpronate, your arch can collapse as you walk or run, causing the shin to rotate and the knee to drift medially. Putting a medial arch support under your foot doesn’t allow the foot to flatten and the shin to internally rotate. Maintaining proper foot alignment also allows for better alignment in the knee, hips, and low back to reduce stress on the shin bones and connected muscles. Being in a shoe that does not match the shape of your foot can cause your foot to hang off of the platform or have too much extra room inside the shoe. Both of these can lead to excessive movement and stress the muscles attached to the shin.
• Overuse: Whether you are on your feet all day at work or just starting an exercise program, it is likely that lower leg will be stressed more than usual. This injury often occurs from doing “too much too soon.” It is often seen in new runners or runners who are beginning again after a long break. Be sure increase your level of activity slowly when beginning a new program or changing an existing one.
• Tight calf muscles: You have two calf muscles, the gastrocnemius and soleus. The job of the calf is to plantarflex the foot (push off on your toes). If the calf muscles are too tight, they can pull on the muscles attached to the tibia, causing pain and inflammation.
• Heel striking and overstriding: Landing hard on your heel in front of your center of mass can cause excessive braking and friction, which leads to added stress on the bones, joints, and muscles.

Self treatment options:

• Support: Make sure that you wear proper shoes for your foot biomechanics. If overpronation is determined to be a possible cause, you might consider a supportive shoe or adding removable insoles (i.e. Stabilites, Orange Insoles, Powersteps) to shoes you currently have that might not be supportive enough. It is also important to to ensure that your foot is not oversupported, which can cause increased stress on the legs, knees, and hips. Adding more support should not be a permanent fix. It is important to include stretching and strengthening exercises in your treatment plan Note: Shin splints can eventually lead to a more serious injury. We always recommend seeing a physician or attending our Free walk-in Injury Clinic on Wednesdays from 5:30-7:00pm for more information.

• Stretching:

Calf stretches: It is important to stretch the tight calf muscles. See below for Gastrocnemius and Soleus stretches.

Foot stretches: The movement of the lower leg starts with foot strike, so it is important to address the foot as well as the calf muscles. Try massaging the foot and calf with a tennis ball, Foot Rubz, or massage ball to help loosen the muscles and fascia.

• Strengthening: Once the pain dissipates, it is important to strengthen in order to prevent the symptoms from returning. See below for pictures of some suggested exercises (note: you may have added benefit from doing these exercises barefoot):
• Single leg balance, ankle alphabets, toe flexion/extension, dorsiflexion with resistance band
• Slowly begin to add back in some barefoot walking around the house, as tolerated
• An unstable core could also contribute to increased lower leg stress. See the exercise sheet for core strengthening ideas.
• Rest: “Play it by pain” – use pain to dictate your level of activity.
• Free Clinics: Most people walk and run in a way that puts excessive braking and friction on their joints, muscles and tendons. Take a FREE Good Form Running and/or Good Form Walking clinic to have your form analyzed! Our Stretch, Strengthen, and Roll class will cover common muscle imbalances and how to correct them.
• Be patient and consistent: treating Shin Splints pain can be a long process. Be consistent with the recommendations and you should start to notice improvements in 2-3 weeks.
• Products: Insoles, massage ball, foam/hand roller, compression socks or sleeves

Exercises

Calf Stretches:

Gastroc: Stand with your right foot back. Keep your knee straight, and forward leg bent. Keeping your heel planted on the floor, toes facing straight ahead, lean forward from the ankles toward the wall. Hold for 30 seconds, and then switch legs

Soleus: Stand with your right foot back. Put a slight bend in your back knee, and forward leg bent. Keeping your back heel planted on the floor, toe facing straight ahead, lean forward from your ankles toward the wall. Hold for 30 seconds, and then switch legs.

Ankle Alphabets:

While seated, write the alphabet using your foot and ankle motions A → Z. Progress to perfoming these exercises standing on one foot

Dorsiflexion with Resistance Band:

Tie one end of a resistance band to a stationary object and the other to your forefoot. Dorsiflex the foot by slowly pulling the forefoot toward your shin. Hold for 3-5 seconds and slowly let the band pull the foot back to a plantarflexed position. Repeat 15-20 times per foot multiple times per day. Progress by using a stiffer band, performing the movement more slowly, and dorsiflexing the toes throughout the exercise.

Toe Extensor Stretch:

This stretch can be done either while sitting or standing. While sitting, simply use one hand to push the toes down while providing counter pressure with the opposite hand. When done correctly, you will feel the tendons and muscles on the top of the foot stretch and the knuckles on top of the foot will become more prominent. While standing, point the foot downward and flex the toes while applying pressure. You will feel the stretch on the top of the foot and possibly into the shin. The more vertical the foot is, the deeper the stretch will be. Hold this stretch for 20-30 seconds.

Single Leg Balance:

Balance on one foot for 30 seconds while barefoot. If this is too easy, close your eyes and tilt your head back! Advance to single leg squats by bending your knee, being sure it does not drift to the inside and the hips remain level.

Toe Flexion and Extension Exercise:

Push your big toe into the ground, while lifting your 4 smaller toes. Hold for 3-5 seconds, then push your 4 smaller toes into the ground while lifting your big toe off the ground. Do not allow the ball of the foot to rotate. Repeat 10x each foot many times throughout the day.

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