Shin Splints
Second in our series of common sports injuries are the dreaded shin splints (also known as medial tibial stress syndrome). Shin splints are actually a great example of the pain being located in a different place from the actual problem, a concept that I will continue to harp on again and again! In a shin splint, the posterior tibialis muscle is torn (micro-tear, not a full-blown tear) away from the tibia, leading to deep pain along the shins, hence the name shin splint.
Let’s take a look at the anatomy of the involved parts first: The posterior tibialis muscle (or tibialis posterior, whatever floats your boat!) is one of three muscles that make up the medial (or inside) compartment of the lower leg (the other two being the flexor digitorum longus (FDL) and the flexor hallucis longus (FHL). It is responsible for pointing your foot downward and to the inside. It also plays a role in stabilizing the ankle. This muscle starts at the upper portion of your tibia and fibula and travels down the inside of your leg to attach onto a couple of the smaller bones in your foot. Because it lies so close in relation to the FDL and FHL these muscles certainly can also play a role in shin splints.
Why Does it Happen?
In most cases, shin splints are caused from too much training too soon. An example of this would be your average Joe that makes a new years resolution to get off the couch and back to running after years of inactivity and starts off with a heavier workload than he should (and probably in some old worn-out running shoes).
The other factor in shin splints is coming from the ankle. Again, in most cases the Stress in Medial Tibial STRESS Syndrome, is related to over-pronation. The word pronation was used in our last blog post, but lets take a second and talk about what pronation is. Pronation is the combination of three movements in the ankle and foot: Dorsiflexion (your foot pointing upward, Abduction (your foot moving towards the midline of your body), and Eversion (think of a pin being placed from the back of the heel bone through the foot. Now imagine your foot being able to rotate on this pin, with the big toe moving downward and the pinky toe moving upward. This is eversion).
As I stated in the last blog entry, pronation is not a bad thing. In fact it is absolutely vital to your ability to walk. However, in people with flat feet, weak or hyper-mobile ankles, or both, pronation happens too quickly, too forcefully, and this leads to more stress than the muscles and ligaments surrounding the foot and ankle can handle and will lead to injury over time.
What Can Your Sports Chiropractor Do?
Your sports chiropractor will start by taking a history of your previous injuries, and past and current activity level, as well as an examination of your gait, and tissues surrounding the area to ensure that you indeed do have shin splints. Stress fracture is also a possibility with these symptoms and the only definitive way to determine if you have one is by getting a bone scan.
Manipulation
By manipulating the bones in your foot/ankle and even knee, your sports chiropractor may be able to improve the biomechanics of your gait, allowing the bones in your foot to glide more smoothly in contact with each other.
Myofascial Release
Your sports chiropractor may use some form of myofascial release to treat the pain in your shins. Active Release Technique is a highly effective form of soft tissue treatment for this particular problem and should be performed on the posterior tibialis as well as surrounding muscles from the origin to the insertion. This will help break fascial adhesions between the muscles themselves as well as promote circulation and blood flow to the area which in turn leads to faster healing.
Orthotics/Arch Support
Arch support may be needed in the interim as activity continues. I should note that arch support itself is not going to do anything to strengthen your foot, but will at least put it in a better position to hold up against the stress placed on your ankle when running. This will help slow down the pronation process like I described earlier in the article.
Rock Tape
Rock tape is a useful tool for treating a number of sports injuries and I personally tape my patients more often than not after treatment to help reinforce what we just did. Rock tape firstly helps reduce pain by virtue of being on your skin (think rubbing your elbow after you hit your “funny bone” on something). It also helps light up the part of your brain responsible for wherever the tape is, which leads to better movement without you even having to think about it!
What Can you Do at home?
Rehab/Exercises
A useful tool in treating shin splints involves strengthening the muscles/tendons that are involved. Work on single leg stance progressions with good ankle posture (not allowing your ankle to roll in/pronate). Hold for 1 minute on a stable surface, performing three sets. When you master that, move to an unstable surface such as an airex pad or pillow cushion. It gets a lot harder, but you will notice a quick difference!
Ice Massage
Freeze some water in a Dixie cup at home. Once the water is frozen, peel the some of the paper cup away and rub the ice along the area of discomfort on your shin. The ice will help with the pain and you can apply as little or as much pressure as you want to help massage the area as well.
New shoes/shoe modification
As with all foot/ankle problems your shoes will need to be looked at to ensure you are wearing something that is not doing you more harm than good. Your shoes may be good, but orthotics (custom or generic) might be helpful.
Compression with activity
This will be a common theme in most posts, but relative rest is important here. If you must continue with activity, wrapping your shins with a compression sleeve or an ace bandage will help make the pain manageable.
As the Crossfit Open gets under way we will momentarily shift our focus to some crossfit injuries, management and rehab as well as some good warm up and cool down techniques. Be on the look out for that soon!
- Dr. Drew