What is “Shin Splints”?

Shin splints is the common name for pain in the lower leg. It needs to be differentiated from compartment syndrome, tendoperiosteal reaction and the most common cause, Medial Tibial Stress Syndrome (MTSS). The pattern of pain will determine the diagnosis.

1. Compartment syndrome involves increasing pain with increasing effort that subsides when blood flow requirements reduce. Blood flow increases, the muscle gets bigger but the compartment it sits in is fixed volume. If too small, the muscle gets strangled and blood flow is unable to keep up with the needs for exercise and hence pain. The common complaint is increasing pain when running which subsides when you slow down or stop.

2. Tendoperiosteal reaction is at the tendon attachment of the muscle to the shin, often tibialis posterior.

3. MTSS is a deeper boney stress reaction and requires a prolonged period of rest or zeroG running if available. Pain will be present during activity and will limit tolerance to running. If ignored, small risk of frank fracture of tibia (e.g. long jump or triple jump will do it). Patient’s typically feel pain on the inside of their shin, around the lower half, usually deep to the calf muscles (i.e. not at the front!). If you have pain walking the next day in the shin then you have a more considerable problem than just pain running.

How and why does it occur?

Like many conditions we treat as Physiotherapists, MTSS usually occurs when training volume is increased faster than the body can adapt to the new load. Too much, too soon after too little, for too long. This results in degradation of the surface of the bone where the muscles attach causing inflammation and pain. If the athlete persists through pain, MTSS can progress to a bone stress injury or stress fracture.

In children, we often see this at the start of sports seasons, especially sports that require jumping and impact such as basketball, AFL and netball. In adults, we see this more often in recreational runners.

How can Physiotherapy help Shin Splints / MTSS?

Firstly, we will assess you and your pain to rule out the differential diagnoses. Through this assessment, we will weed out the likely cause of your pain and then address all contributing factors.

As mentioned previously, too much too soon is the most common cause, so you may need a period of reduced load, usually 1-2 weeks if in the early stages of MTSS. Other common factors include:

• Poor strength in muscles that attenuate impact forces (calves, quads, glutes).

• Running technique: typically overstriding, or bounding gait.

• Poor hip and knee control.

• A quick transition from supportive footwear to minimalist footwear.

We will then address these factors, typically through training load advice, exercises, and potentially running or jumping technique changes to halt inflammation and reduce pain.

Tik tok told me I just need to strengthen my tibialis anterior!

The recent explosion of running and gym “influencers” on social media has resulted in copy, paste misinformation in the name of creating content. One thing I (Aaron, the one with Tik Tok not Nick), have noticed is a trend to recommend tibial anterior exercises to “bulletproof” your shins and get rid of your shin splints. This advice is wrong… The tibialis anterior is not the cause of shin pain because MTSS pain doesn’t originate from the tibialis anterior periosteum and the tibialis anterior is not an impact attenuating muscle, it’s primary role in gait is foot clearance.

What if my pain is at the tibialis anterior?

More likely compartment syndrome but other possibilities include tenosynovitis of tibialis anterior or toe extensors, referred from lumbar spine, peroneal nerve irritation or even fibulae stress reaction.