Rehabilitation

Shin Splints. What can we do about it?

shin splints, injuries, sports therapy, common injuries, running injuries, Seventy9 Sports Therapy, injury clinic, Farnham, physiotherapy, sports massage, injury prevention, rehabilitation, sports therapy, sports injury clinic, strength, mobility

Medial Tibial Stress Syndrome (MTSS) – commonly referred to as ‘Shin Splints’ – is pain along the medial side (inside) of the tibia (shin), commonly affecting athletes who’s sport/activity involves running and jumping. MTSS is the most prevalent lower leg injury in the active population, and is the most common lower limb complaint that we see in clinic. But why do we get it, and what can we do about it?

A static pronated foot posture and high navicular drop test score (the Navicular Drop Test is a means of quantifying the amount of foot pronation in runners) are among potential risk factors highlighted for the development of MTSS. These are not causes on their own, however, as MTSS symptoms are typically developed in line with a sudden increase in intensity or volume of aggravating exercise.

Prevention Tip #1 is to slowly progress both volume and intensity of running and jumping!
A lack of flexibility in the lower leg muscles, including the gastrocnemius, soleus and toe flexors, increase the possibility of developing MTSS.

Prevention Tip #2 is to stay on top of your mobility! It is not uncommon to find tibialis posterior dysfunction in patients who have developed MTSS symptoms. This is primarily due to it’s role in decelerating the rate of navicular drop, as well as influencing the timing of mid foot pronation during gait. As a high navicular drop is commonly sited as a risk factor for the development of MTSS, tibialis posterior strength and mid foot control under active stability conditions form an important component of the MTSS assessment process. Neal, Griffiths, et al (2014) showed that there is very limited evidence of a small effect that a static pronated foot posture is a risk factor for MTSS, and as such conversations around “high arch vs flat foot” in a static position should take place as part of a multi-factorial assessment; MTSS is developed under dynamic conditions, therefore the bulk of the assessment process should centre around active positioning of the foot.

Treatment of MTSS can be categorised as:

  1. what we can affect in the clinic (muscle length/flexibility, education of gait)
  2. passive modalities (orthotics, taping)
  3. what you can do at home to rehabilitate and prevent further flare-ups (targeted strength work, exercise modification, training load modification).

Of these, the biggest positive effect you can have is adherence to a well-structured rehabilitation programme.

Prevention Tip #3 is to be accurate and consistent with your rehabilitation! Improving mid foot strength is vital to controlling navicular drop, though it is not uncommon to address hip strength/control at the same time as reduced control of hip internal rotation will incorrectly position the foot on ground contact, negatively influencing the rate and timing of pronation.

A simple and effective exercise to both rehabilitate a symptomatic leg and prehabilitate an asymptomatic leg is banded arch corrections. All you need is a looped exercise or strength band attached to something sturdy (foot of the bed, radiator). The band will pull you into eversion (flat foot), whilst you action the foot into inversion (neutral/arched foot). It’s really important to control the motion smoothly and slowly back down to the flat foot position; this eccentric (muscle lengthening under load) load causes the tissue damage leading to the MTSS pain symptom, and this exercise aims to improve the load tolerance of this action. Also of high importance is to maintain contact with the floor through the ball of the big toe; we are aiming at tibialis posterior load rather than toe flexors!

See the video of the exercise on our YouTube channel here!

 

References:

Becker, J., James, S., Wayner, R., Osternig, L., Chou, L.-S., 2017. Biomechanical Factors Associated With Achilles Tendinopathy and Medial Tibial Stress Syndrome in Runners. Am J Sports Med 45, 2614–2621. https://doi.org/10.1177/0363546517708193

Griebert, M.C., Needle, A.R., McConnell, J., Kaminski, T.W., 2016. Lower-leg Kinesio tape reduces rate of loading in participants with medial tibial stress syndrome. Phys Ther Sport 18, 62–67. https://doi.org/10.1016/j.ptsp.2014.01.001

Hamstra-Wright, K.L., Bliven, K.C.H., Bay, C., 2015. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med 49, 362–369. https://doi.org/10.1136/bjsports-2014-093462

Kim, T., Park, J.-C., 2017. Short-term effects of sports taping on navicular height, navicular drop and peak plantar pressure in healthy elite athletes. Medicine (Baltimore) 96. https://doi.org/10.1097/MD.0000000000008714

Neal, B.S., Griffiths, I.B., Dowling, G.J., Murley, G.S., Munteanu, S.E., Franettovich Smith, M.M., Collins, N.J., Barton, C.J., 2014. Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis. J Foot Ankle Res 7, 55. https://doi.org/10.1186/s13047-014-0055-4

Newman, P., Witchalls, J., Waddington, G., Adams, R., 2013. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med 4, 229–241. https://doi.org/10.2147/OAJSM.S39331

Rathleff, M.S., Kelly, L.A., Christensen, F.B., Simonsen, O.H., Kaalund, S., Laessoe, U., 2012. Dynamic midfoot kinematics in subjects with medial tibial stress syndrome. J Am Podiatr Med Assoc 102, 205–212. https://www.ncbi.nlm.nih.gov/pubmed/22659763

Reinking, M.F., Austin, T.M., Richter, R.R., Krieger, M.M., 2017. Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Sports Health 9, 252–261. https://doi.org/10.1177/1941738116673299

Saeki, J., Nakamura, M., Nakao, S., Fujita, K., Yanase, K., Morishita, K., Ichihashi, N., 2017. Ankle and toe muscle strength characteristics in runners with a history of medial tibial stress syndrome. J Foot Ankle Res 10. https://doi.org/10.1186/s13047-017-0197-2

Winkelmann, Z.K., Anderson, D., Games, K.E., Eberman, L.E., 2016. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J Athl Train 51, 1049–1052. https://doi.org/10.4085/1062-6050-51.12.13
Yates, B., White, S. (2004). The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. American Journal of Sports Medicine, 32(3), 772–780. https://www.ncbi.nlm.nih.gov/pubmed/15090396

Leave a Reply

Your email address will not be published. Required fields are marked *