Cardiff Sports Massage Clinic

The first thing to say is that shin splints aren’t one particular injury but a generic term for pain and discomfort along the shin and lower leg. Generally speaking there are two types of pain. “anterior” and “posterior”. The most common of these is posterior, which is technically referred to as medial tibial stress syndrome (MTSS). MTSS is an inflammation of the tibialis posterior muscle that runs along the inside of the shin. Anterior shin splints are an inflammation of the tibialis anterior muscle which runs along the front and outside of the shin.

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With both types of shin splints, a dull, diffuse pain is typically felt during or after a run. Many new runners will experience shin splints as they start to run, but this pain should go away after their body gets used to the stresses of running after a few days or weeks. If the pain does not go away or becomes more constant or sharp, it is possible that shin splints can develop into a stress fracture, which is something that needs too be avoided at all costs. There are many ways to prevent shin splints from progressing and it is important to seek advice early rather than let the pain get worse.

Anterior Shin Splints

Anterior shin splints are located on the front (or anterior) part of the shin bone and involve the tibialis anterior muscle. The tibialis anterior lifts and lowers your foot. It lifts your foot during the swing phase of a stride, (so is very important to runners). Then, it slowly lowers your foot to prepare your foot for the support phase.

If your anterior shin pain increases when lifting your toes up while keeping heels on the ground – you are likely to suffer from anterior shin splints. Medically anterior shin splints can also be referred to as anterior tibial stress syndrome (ATSS).

Posterior Shin Splints

Posterior shin splints are located on the inside rear (or medial/posterior) part of the shin bone and involve the tibialis posterior muscle. The tibialis posterior lifts and controls the medial aspect of your foot arch during the weight bearing support phase. When your tibialis posterior is weak or lacks endurance your arch collapses (overpronation), which creates torsional shin bone stresses.

If you feel pain along the inside rear of your shin bone – you are likely to suffer from either posterior shin splints or tibia stress fractures. Medically, posterior shin splints and tibial stress fractures can also be referred to as medial tibial stress syndrome (MTSS).

Causes:

Improper progression of training. This could be people who have just started running and done too much too soon.

Change in running surface. Constantly shifting from road to grass to hills and so forth. This will aggravate the muscles around the shins.

Flat arches or overpronation during walking / running (posterior shin splints)

Improper footwear. A common cause of shin pain is running in the wrong shoes.

Running in old shoes that are past their life. I see this everyday as a sports massage therapist, people who need to change their trainers months ago, still running in a pair of shoe that have died.

Tenoperiosteum

All the bones of the body are covered in a ‘shell’, called periosteum. The tendons, which job is to connect the muscles to the bones, attach on to this periosteum. This area at which the tendon connects to the bone is known as tenoperiosteum.

Almost all cases of so called ‘shin splints’ have some element of inflammation of the tenoperiosteum. Inflammation of different tendons leads to pain in different areas of the shin.

Bone

Damage to the shin bone usually occurs in the lower portion of the shin bone (tibia). The bone damage may only be mild/intermediate, such as a simple stress reaction, or may be a severe stress fracture. Except in the worst cases, bone damage is not visible on normal x-rays. A bone scan or MRI may be recommended if your Therapist or doctor need to exclude or confirm a bone injury.

Best Treatments for shin splints:

Rest / cross training to allow the inflammation to go down

Sports massage therapy

Ice

Stretching of the calf & hamstring muscles

Strengthening of the lower leg muscles

Proper footwear

Arch support through use of an insert

Use of a compression sleeve during activity

Proper progression of running

Tape (this is generally a masking of the pain)

In severe or chronic cases, custom orthotics are indicated

Foam Roller

The best Treatment for Shin Splints.

Phase 1 – Early Injury Protection: Pain Reduction & Anti-inflammatory Phase

As with most soft tissue injuries the initial treatment is – RICE Rest, Ice, Compression/protection and elevation.

In the early phase you may be unable to walk or run without pain, so your shin muscles and bones need some active rest from weight-bearing loads. Your therapist will advise you on what they feel is best for you.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.

Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.

As you improve a sport tape style supportive taping will help to support the injured soft tissue and provide some stress reduction for your shin bone. This will help to de-load the area.

Phase 2: Regain Full Range of Motion

If you protect your injured shin muscles while they heal and strengthen. This may take several weeks. As long as you haven’t tried to push through he pain. During this time period you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that will re-tear in the future. A good remodelling would include small movements and lots of stretching and strengthening exercises.

It is important to lengthen and orientate your healing scar tissue via sports massage, muscle stretches, neurodynamic mobilisations and specific exercises. Deep tissue work or even frictions can be used here.

Your Massage therapist will guide you and help you.

Phase 3: Normalise Foot Biomechanics

Shin splints commonly occur from poor foot biomechanics eg flat foot.

In order to prevent a recurrence, your foot will be assessed in some cases you should visit a specialist foot clinic to get special shoes. In some instances you may require a foot orthotic (shoe insert) or you may be a candidate for the Active Foot Posture Stabilisation program.

Your massage therapist cardiff will happily discuss the pros and cons of both options to you.

Phase 4: Restore Muscle Strength

Your calf and shin muscles will need to strengthened to enable a safe resumption of sport or training. These will include loading and postural work, usually in the gym but also can be performed at home.

Phase 5: Modified Training Program & Return to Sport

Most shin splints occur due to excessive training loads. Running sports place enormous forces on your body (contractile and non-contractile).

In order to prevent a recurrence as you return to sport, your Cardiff Sports Massage Therapist will guide you with training schedules and exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.

Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

Your sports massage therapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.

If you are experiencing any of these symptoms then why not book into my clinic? Sports Massage Cardiff Clinic