"Too Much, Too Soon" might be a fitting title for a classic film (starring Errol Flynn and Dorothy Malone, 1958), but it also perfectly describes the most common cause of shin splints. These painful conditions often develop when we push ourselves too hard, too quickly—whether by increasing distance, intensity, or duration without allowing our bodies the necessary time to adapt to the new demands.
Our Success Rate is Over 90%
Our approach to treating shin splints using manual therapy and exercise achieves a success rate of over 90% in reducing pain and restoring function. This high success rate is due to the combination of targeted manual therapy techniques and a structured exercise program that addresses the underlying causes of shin splints.
Article Index:
Symptoms of Shin Splints
Shin splints typically start with a vague ache along the inner part of the lower leg, specifically around the tibia. Key signs include:
Pain at the beginning of a run that eases as you continue but often returns by the end.
Early on, pain might disappear with rest, but as the condition progresses, you may feel discomfort during both activity and rest.
When pain becomes constant, it's crucial to see a healthcare professional to rule out more serious conditions like stress fractures or compartment syndrome.
Shin splint pain is usually spread across soft tissues such as fascia, tendons, and muscles, making it challenging to pinpoint the exact location on the tibia.
Causes of Shin Splints
Shin splints are often caused by the repetitive stress and impact of running, which can place two to three times a runner's body weight on the shins. When the dorsiflexor muscles—those responsible for lifting the foot and controlling its movement—lack sufficient strength, elasticity, and flexibility, they struggle to absorb these forces effectively.
Key contributing factors include:
Running on hard or uneven surfaces: This increases the stress on the shin muscles.
Worn-out shoes: Shoes with inadequate support can lead to improper foot mechanics.
Biomechanical issues: Problems like hyper-pronation (excessive inward foot roll), variations in foot arch height, and unequal leg length, often due to pelvic rotation, can exacerbate the condition.
These biomechanical challenges disrupt natural foot movement during running, increasing the strain on the shin muscles and leading to shin splints.
Is It Really Shin Splints?
When dealing with medial tibial stress syndrome (shin splints), it's vital to accurately diagnose the condition and rule out other issues like stress fractures or compartment syndrome.
Stress Fractures: These are overuse injuries where bones develop small, incomplete fractures due to repetitive force, unlike fractures from direct trauma.
Distinguishing Symptoms: Early in shin splints, pain often eases after running a few kilometers, while stress fractures typically worsen during activity, starting mild and becoming progressively unbearable.
Progression: As shin splints advance, the pain can become severe and constant, making it difficult to distinguish from a stress fracture, highlighting the importance of early professional assessment.
Sports practitioners use advanced diagnostic tools to differentiate shin pain conditions accurately. Routine X-rays often fail to detect stress fractures, making bone scans or MRIs the preferred methods due to their higher sensitivity.
Stress Fractures: While a standard X-ray might miss a stress fracture, a bone scan or MRI can clearly reveal fractures in the tibia. Stress fractures usually present with localized tenderness on the tibia, in contrast to the more diffuse pain of shin splints. Female athletes with irregular or absent menstrual cycles are particularly vulnerable to stress fractures due to energy imbalances leading to low estrogen levels, which can compromise bone health.
Understanding the specific symptoms and using the right diagnostic tools is crucial for distinguishing between these conditions and ensuring appropriate treatment.
Understanding Compartment Syndrome
Compartment syndrome is a serious condition that must be ruled out when diagnosing shin pain. It occurs when excessive pressure builds up within the muscle compartments of the lower leg, restricting blood flow and depriving nerves and muscles of vital oxygen and nutrients. This can lead to significant pain and, if left untreated, permanent damage.
Types of Compartment Syndrome: This condition can be acute, often resulting from trauma, or chronic, typically developing from repetitive activities like running.
Lower Leg Compartments: The lower leg is divided into four compartments—anterior, superficial posterior, deep posterior, and lateral—each encased in tough fibrous tissue (deep fascia) and bone. Understanding the anatomy of these compartments is crucial for accurately diagnosing and treating conditions like shin splints and compartment syndrome.
Recognizing the symptoms and getting a timely diagnosis can be key to preventing serious complications from compartment syndrome.
Chronic Compartment Syndrome
Chronic Compartment Syndrome, or Exertional Compartment Syndrome, is generally not a medical emergency and can often be managed effectively with manual therapy techniques such as MSR (Motion Specific Release). In runners, the pain associated with this condition typically starts within the first 15 minutes of running and subsides within an hour after stopping. A medical practitioner may measure the pressure within the muscle compartments to confirm the diagnosis.
Acute Compartment Syndrome
Acute Compartment Syndrome, however, is a potentially life-threatening condition requiring immediate medical attention. Delays in treatment can result in serious complications, including infection and even limb amputation. This condition usually arises following traumatic events such as fractures, crush injuries, burns, or intense exercise, particularly involving eccentric movements (muscle lengthening under tension).
Important Note: If there is any suspicion of a stress fracture or compartment syndrome, it is crucial to seek immediate medical assistance.
Muscle Strength & Shin Splints
The strength of your shin muscles, particularly the dorsiflexors, plays a crucial role in preventing and managing shin splints. When these muscles are weak, they struggle to absorb impact and control foot movement, leading to increased stress on surrounding tissues and a higher risk of shin splints. Strengthening these muscles is critical to both preventing injury and speeding up recovery.
Next time you're around runners, listen closely. That slapping sound you often hear as feet hit the ground? It’s a sign of weak dorsiflexors. These weak muscles fail to control foot motion properly, making runners more prone to shin splints. Targeted conditioning exercises can help strengthen these muscles, reduce that slapping sound, and lower the risk of injury.
Slow vs. Fast Running
Interestingly, slower runners tend to make that slapping sound more often than faster runners. Despite the greater force they exert, elite runners are quieter and less injury-prone. This is because they have strong, elastic dorsiflexor muscles, which give them better control over foot movement during landing. Their efficient "shock absorbers" effectively dissipate the impact of each stride, reducing the risk of shin splints.
Some of the quietest and most efficient elite runners are East African marathoners, particularly those from Ethiopia and Kenya. These athletes are renowned for their almost silent strides, a testament to their incredibly strong dorsiflexor muscles. Many have developed these muscles by running barefoot from a young age, likely contributing to their dominance in major marathons worldwide.
Take, for example, the 2009 Paris Marathon, where Tadesse Tola from Ethiopia finished first in just 2 hours, 6 minutes, and 40 seconds. His quiet, powerful stride allowed him to maintain an impressive speed throughout the race.
So, what's the secret behind this efficiency?
Elite runners recycle about half of their energy through elastic recoil, a mechanism similar to a spring that loads and releases with each stride. The strength and elasticity of their dorsiflexor muscles play a crucial role in this energy conservation.
Moreover, the impact on your legs is closely linked to your stride frequency. Increasing your stride frequency by just 10% can significantly reduce the impact forces on your tibia, lowering the risk of developing shin splints.
Examination Process
A comprehensive examination for shin splints is essential for accurate diagnosis and uncovering any underlying issues. Healthcare professionals will conduct orthopedic tests to evaluate the musculoskeletal system, perform a lower extremity neuro exam to assess nerve function and complete a vascular exam to ensure proper blood flow. Imaging studies, such as X-rays, bone scans, or MRIs, may be recommended if necessary to assess the injury further and rule out conditions like stress fractures or compartment syndrome. This thorough evaluation helps in developing a customized and effective treatment plan.
The following demonstration video showcases various tests to assess shin splints. The tests address the shin area and surrounding regions for a complete evaluation.
Knee Examination
Effective Orthopedic Assessment Procedures - This video provides an overview of the frequent causes of knee pain and demonstrates how to identify them through orthopedic examination techniques.
Ankle and Foot Examination
This video employs orthopedic tests to assess several prevalent ankle and foot conditions encountered in clinical practice. These conditions encompass Ankle Sprains (inversion sprain), Cuboid Syndrome, Talar Dome Lesions, 5th Metatarsal Fracture, Syndesmosis injury, Achilles Tendon Tendinopathy, Morton's Neuroma, 2nd Metatarsal Stress Fracture, Plantar Fasciitis, and Bunions.
Peripheral Vascular Examination - Key Points
A peripheral vascular examination serves as an important method for identifying indications of vascular-related pathologies. Recognizing and addressing PVD may help prevent cardiovascular and cerebrovascular complications. This video covers several standard procedures routinely performed in clinical practice.
Treating Shin Splints
Most cases of medial tibial stress syndrome (shin splints) can be effectively managed without surgery using a combination of strategies tailored to each patient's needs. Treatment typically occurs in two phases: the acute phase and the sub-acute phase, each with specific interventions to ensure optimal recovery and prevent further complications. These interventions include rest, icing, compression, elevation, stretching, strengthening exercises, and manual therapy.
Acute Phase of Shin Splints
During the Acute Phase, the primary focus is reducing pain and inflammation. Here are some key recommendations:
Rest: While athletes may resist this advice, rest is critical for recovery. A break of 2 to 6 weeks is often necessary to allow healing.
Ice Therapy: To reduce inflammation, apply ice for 15 to 20 minutes, 4 to 6 times a day. Limiting sessions to 7 to 9 minutes for direct ice massage, 3 to 4 times daily.
Compression: Using a compression sleeve or wrap can help minimize swelling. Ensure it's snug but not so tight that it restricts circulation.
Elevation: Elevating the legs, especially at night, can help reduce pain and swelling. Keep the legs above heart level for the best results.
Gentle Stretching: Incorporate light stretching into your routine, careful not to push to the point of pain. Effective exercises include the Tibialis Anterior Stretch and Sam's Daily 5, which target the larger kinetic chain.
Tibialis Anterior Stretch
This particular stretch for the Tibialis Anterior incorporates dynamic (with movement) and static (without movement) stretching techniques. It helps prevent and treat injuries, including shin splints and plantar fasciitis.
Sam's Daily Five Stretches
Sam's Daily Five stretches address the broader kinetic chain often linked to shin splints. This series of stretches targets critical muscle groups crucial in preventing and managing shin splints, including the calves, hamstrings, adductors, deep hip rotators, and hip flexors. Incorporating these stretches into your routine can help alleviate the tension and imbalances that contribute to shin splints, promoting recovery and preventing recurrence.
Manual Therapy for Shin Splints
Early intervention with manual therapy can significantly improve the treatment of shin splints. The following technique is commonly used during both the acute and sub-acute phases of shin splints. Consistent application of this therapy throughout these phases is crucial for effective recovery and long-term relief.
Increasing Ankle Mobility - 4 Point Dorsi Flexion Protocol
Dorsiflexion, the movement where the toes are drawn closer to the shin, is crucial for managing shin splints. The shin muscles play a key role in lifting the foot off the ground during the Swing Phase of a stride (concentric contraction) and absorbing impact shock during running. Enhancing ankle mobility through the 4-Point Dorsi Flexion Protocol can help reduce the strain on the shin muscles, promote better foot mechanics, and aid in the prevention and recovery of shin splints.
Sub-Acute Phase - Return to Running
As you transition back to running, it's crucial to take a cautious approach to prevent re-injury and ensure a smooth recovery. Gradually increasing your activity level while paying close attention to your body’s signals will help you rebuild strength and endurance without aggravating your shin splints. During this phase, focusing on proper form and maintaining flexibility can significantly enhance your recovery and reduce the likelihood of future injuries.
Intensity: Reduce your previous training intensity by at least 50%. Avoid pushing through pain, as it can hinder recovery.
Cross-Training: Engage in low-impact activities like aquatic running or cycling to maintain fitness while minimizing stress on the shins.
Terrain: Avoid hills and uneven surfaces during recovery. While hill training can be beneficial, it should be postponed until your shin splints fully heal.
Mobility Training: Incorporate appropriate flexibility and self-myofascial release exercises. Here's an example of a commonly recommended technique to support recovery.
Releasing the Shins
This exercise is highly beneficial for runners and individuals dealing with shin splints. The video demonstrates effective techniques for relieving myofascial restrictions in the shin muscles using tools like foam rollers, a tiger tail, or even a rolling pin. These methods help to release tension in the Tibialis Anterior and Peroneus Longus/Brevis muscles, promoting better mobility and reducing the discomfort associated with shin splints.
STRENGTHENING
Incorporate eccentric calf exercises, like Eccentric Calf Raises, into your routine to build strength and resilience in your calves. Additionally, core stability exercises that focus on the hips, abdominals, and gluteal muscles should be included to improve overall muscle balance and support, which is crucial for preventing and managing shin splints.
Calf Strengthening - Eccentric Calf Raises & Pulsations
Eccentric Calf Raises are a highly effective exercise for building calf strength while reducing the risk of injury. Once you've mastered these, you can progress to dynamic calf pulsations, which are excellent for boosting sports performance and power. Since this is an advanced exercise, make sure you can easily perform standard Eccentric Calf Raises before incorporating the pulsation variation into your routine.
Foot & Ankle Strengthening
This exercise routine is designed to target the key muscles involved in shin splints, including the flexors, extensors, and both the internal and external foot rotators. Using a Theraband for resistance, these exercises help strengthen the foot and ankle, enhancing stability and reducing the strain on your shins during activity.
Balance Training for Shin Splints
Incorporating balance training is essential for neuromuscular re-education, enhancing joint and postural stability, and reducing the risk of recurring injuries like shin splints. Below is an advanced balance routine recommended after completing the initial exercise program. This routine focuses on further strengthening and refining neuromuscular control and stability to prevent future injuries and support long-term recovery.
Improve Your Balance - Advanced
Balance exercises are crucial for improving your ability to control and stabilize your body, which is vital in preventing and managing shin splints. These exercises can help reduce injury risk, support rehabilitation, and boost sports performance for people of all ages. However, the advanced balance exercises demonstrated here should only be considered after you have consistently performed the beginner exercises for 2 to 4 weeks. This progression ensures your body is adequately prepared to handle more challenging routines, further strengthening the muscles and neuromuscular pathways that protect against shin splints.
Treatment Frequency for Shin Splints
The treatment frequency for shin splints is carefully tailored to the severity of the condition to ensure optimal recovery. Here’s our approach:
Acute Shin Splints:
Initial Phase: Two times per week for 15-minute sessions or one 30-minute session per week for 2-3 weeks.
Reassessment: If positive results are seen in 2-3 weeks, continue with weekly appointments until full resolution or until progress plateaus. If results are minor, extend treatment for two more weeks, then reassess. If no progress is made after 2-3 weeks, an appropriate referral will be made.
Chronic Shin Splints:
Initial Phase: Weekly visits, choosing two 15-minute sessions or one 30-minute weekly session for 2-3 weeks.
Reassessment: As with acute cases, if positive results are seen within 2-3 weeks, continue weekly sessions until the condition resolves or progress plateaus. If improvement is minimal, continue for an additional two weeks before reassessment. If no progress is made, an appropriate referral will be provided.
Patients can choose between two 15-minute or one 30-minute session per week based on their preferences and needs. This flexible approach ensures that each patient receives a customized care plan, optimizing healing and preventing future issues.
Why Choose Our Approach for Shin Splints
Our comprehensive approach to treating shin splints consistently achieves a success rate of over 90% in reducing pain and restoring lower limb function. Here’s why our method stands out:
Established Expertise: Developed by Dr. Brian Abelson, our approach is grounded in over 30 years of clinical experience, including successfully treating more than 25,000 patients. As a marathon runner for over 30 years, Dr. Abelson brings firsthand understanding and specialized knowledge of running injuries, ensuring you receive the highest standard of care for shin splints.
Thorough Assessments: We conduct detailed evaluations to identify all contributing factors, including muscle imbalances, biomechanical issues, and training errors often contributing to shin splints.
Advanced MSR Procedures: Our Motion-Specific Release (MSR) techniques precisely target areas of fascial restriction and muscle tension, providing effective and focused relief to alleviate shin pain and enhance recovery.
Customized Exercise Programs: We design individualized exercise plans that improve tissue mobility, strengthen the shin muscles, and restore proper foot mechanics, supporting your recovery and preventing future injuries.
Logical, Evidence-Based Approach: Our treatment protocols integrate manual therapy, exercises, and supportive measures, ensuring a comprehensive and lasting solution. We establish clear timelines and regular re-evaluations to track progress and adjust the treatment plan as needed.
Choose our proven, patient-centred approach for effective, long-term relief from shin splints. Take the first step toward your recovery with confidence.
References
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
Why Choose Our MSR Courses and MSR Pro Services?
Elevate your clinical practice with our Motion-Specific Release (MSR) courses and MSR Pro services, designed to provide a comprehensive, evidence-based approach to musculoskeletal care. Here’s why you should join us:
Proven Methodology: Developed by Dr. Brian Abelson, an international best-selling author with over 30 years of clinical experience, MSR integrates the most effective elements of osseous and myofascial therapies. With a success rate exceeding 90%, our approach helps set a new industry standard.
Comprehensive Training: Our courses blend rigorous academic content with innovative techniques. You’ll master essential areas like orthopedic and neurological examinations, myofascial treatment, fascial expansions, and osseous adjusting and mobilization.
Extensive Resources: As an MSR Pro subscriber, access a vast library of over 200 MSR procedures, fillable PDF forms, instructional videos, and in-depth articles. From patient intake to tailored exercise prescriptions, our resources equip you for clinical success.
Tailored Support: Refine your diagnostic skills and expand your treatment techniques with ongoing support through over 750 videos, including 200 technique videos, 250 exercise videos, and 160 MSK articles. This extensive library features over 50 musculoskeletal condition articles, all designed to support you in clinical practice. Our resources are dynamic, with regular updates to articles, technique videos, and new additions to our educational curriculum.
Innovation and Growth: We emphasize continuous learning and innovation, giving you the tools to adapt and thrive in complex clinical scenarios. Our courses and resources are designed to foster professional growth, keeping you at the forefront of musculoskeletal therapy.
Unlock your practice's full potential with our MSR courses and MSR Pro services. Achieve outstanding clinical outcomes and join a community of forward-thinking practitioners dedicated to excellence in patient care.