What Are Shinsplints?
Specifically a condition called Medial Tibial Stress Syndrome ( MTSS ). The pain associated with shinsplints is a result of fatigue and trauma to the muscles, tendons and fascia, where they attach to the tibia and fibula. In an effort to keep the foot, ankle and lower leg stable, the muscles exert a greater force on the tibia and fibula, which results in the tendons and fascia being partially torn away from the bone.
The causes of shinsplints will involve either overload, or biomechanical problems.
OVERLOAD occurs when the unconditioned participant suffers excessive impact forces, such as when running on hard surfaces, poor footwear, exercising on uneven ground, or simply excessive activity, are often contributing factors. As the muscles and tendons tire, they lose their ability to absorb shock force, which leads to a breakdown of lower leg structures.
BIO-MECHANICAL PROBLEMS
The primary biological innefficiency is ‘flat-foot’ ( fallen arches ), which also causes excessive pronation, which is the tendency of the foot to flatten, and then roll inward as you run/step forward. This makes the lower leg bones ( tibia and fibula ) twist, thus over-stretching muscles, tendons and fascia in the lower leg. Estimated 95% of the population have excessive pronation. If you have ‘flat feet’, then beware of over-training, as you are a likely candidate for shinsplints. Flat feet indirectly results from tight/shortenned hip flexors, and weak external hip rotators.
Excessive supination can cause shinsplints. This is the opposite of pronation, and refers to the outward rolling of the foot during normal motion. Both pronation and supination are natural motions at different phases of the gait, but shinsplints occur when either of these motions become excessive.
When either of these conditions is present, then ankle mobility is poor. We always think of poor ankle mobility as just poor calf flexibility, and that by doing more calf stretching we will fix our problems. Unfortunately, ankle mobility is more complex than that, although it is true that we should keep our soleus/achilles tendons supple, as poor dorsiflexion of the foot can be the main cause of our shinsplints. It is more likely, however, to be only a contributing factor.
Referring back to excessive supination, we need to investigate the hip rotator muscles, as excessively tight external hip rotators encourages excessive supination of the foot.Having said that, the femur ( thigh bone ) is usually internally rotated, along with the kneecap. The piriformis is usually the main culprit, causing excessive external foot rotation ( foot – splay ). The gluteals will always be implicated, probably glute medius more so than maximus, but this is not always the case. By addressing the shinsplint problem, we will be preventing a highly likely ACL tear from occurring further down the track. Please understand that either internal OR external hip rotator imbalances can cause shinsplints. People prone to shinsplints are also likely to get achilles tendinopathy in the future .
When treating hip rotator imbalances, you must also address any quad-dominant movement patterns. Look for tight hip flexors – stretch them regularly, along with the quadriceps . Expect to find de-activated glutes, and include re-activation exercises in your program. This might surprise you, but you won’t need to spend as much time stretching the hamstrings – focus primarily on strengthening the hamstrings, and stretching the hip flexors. Remember, the goal is to re-balance the muscles – hamstrings are too lengthened, whereas, hip flexors & quads too short/tight.
Knock-knees is another sign that you could be a candidate for shinsplints, so avoid over-training while treating the imbalances.
Hyper-extended knees is another sign – femur is usually internally rotated with ankle pronation which stresses the external hip rotators, causing knee pain and eventual injury.
TREATMENT : Rest, Ice, Compression, Elevation, Referral to an appropriate professional for an accurate diagnosis. Do this for 48 – 72 hours. Thereafter, physiotherapy, heat and massage. It’s a good idea to spend a few minutes massaging before, and after exercising. A foam roller is a common tool used by most personal trainers everywhere, these days. Use it on your hip rotators for a couple of minutes before and after workouts. I much prefer a tennis ball for the glutes and hamstringsLastly, rehabilitation to strengthen and condition the soft tissues affected.
PREVENTION
1. Ensure you get adequate recovery between workouts.
2. Avoid over-training – gradually condition your legs
3. Ensure you warm up sufficiently – 10 minutes, then moderate intensity for at least 10 minutes before near maximum efforts
4. Use periodization in your training plan
5. Ensure adequate cool – down before ending the session – 5 – 10 minutes @ 50% intensity
6. See a podiatrist for a complete foot strike and running gait analysis
7. Orthotic inserts if necessary
8. Select good running footwear to minimize excessive pronation/supination
9. Address any muscle imbalances – especially ankles and hips
10. Include activities that promote eccentric strength in the calf because of the load when the calf is dorsi-flexed. For example, soft surface running, stair or incline running.
