Shin splints, medically known as medial tibial stress syndrome (MTSS), is a common overuse injury affecting the lower leg, particularly among individuals who engage in activities like running, jumping, or walking regularly. This condition manifests as a dull, aching pain along the inner side of the shinbone (tibia), worsening with activity and often persisting even after exercise has ceased.

Symptoms typically include:

• Aching pain along the inner side of the shinbone (tibia).
• Pain that worsens with activity and improves with rest.
• Pain that may warm up over the course of an activity but becomes worse after stopping.
• Tenderness to touch along the shinbone, typically in an area greater than 5cm in length.
• Pain that may persist for hours or days after exercise.

Shin splints are an overuse condition, meaning that they are caused by an increase in the amount of load put into the shinbone.

During activity, the muscles in the lower leg pull and traction on the shinbone to transmit force. At the same time the shinbone absorbs force from the ground as we walk, run and jump. The combination of these forces and the accumulation of these forces over time is thought to cause an overload on the outer layers of the bone.

Like muscle, our bones are constantly undergoing breakdown and regrowth in the background. This is how we get stronger bones through exercise. However, shin splints can occur when the amount of breakdown exceeds the rate of regrowth and repair.

It is important to consider load. This can simply be defined by the amount of activity performed, which could be walking, running, sport. However, we can break it down further into the following variables:

• The intensity of the activity – the speed or incline
• The duration of the activity
• The frequency of the activity – how many times per week

The human body is adaptable to load, however, this requires time and training. You may be susceptible to shin splints if you have suddenly increased your load via any of the factors above and don’t allow adequate rest. For example, if suddenly take up a sport you haven’t played for years and are running long distances several days per week.

Other factors that could contribute to developing shin splints include:

• Footwear and surface: Harder surfaces and footwear with less cushioning will transmit greater forces into the legs.
• Biomechanical factors: Muscle imbalances of the calves and hips have an association with shin splints. Reduced endurance of muscles may lead to a change in running technique during activity.
• Running technique: Overstriding with a lower step rate has been associated with higher risk of shin splints. Overpronation or drop of the arch may create higher risk of shin splints.
• Higher body weight: A higher body weight will mean greater force is transmitted through the lower leg during activity.

Diagnosing shin splints first involves a subjective assessment to get a thorough understanding of the nature of the condition. Information about the symptoms, when they started, training load and activity are all important in identifying shin splints.

The physical examination will include assessing the location and severity of pain, range of motion, strength of the leg muscles, specific functional test and observation of walking and running technique.

A stress fracture and shin splints are similar conditions that can often be confused for one another. A stress fracture is a later stage on a continuum of bone stress injuries. Shin splints if left unmanaged can eventually develop into a bone stress injury. can occur on the front side of the shin bone. A stress fracture has similar symptoms, but key differences are that pain is more pinpoint (less than 5cm area in length), pain always worsens during an activity and does not warm up.

Imaging is often not necessary for shin splints as it will not change the management of the condition. However, in cases where a stress fracture is suspected, imaging may be helpful to rule these out or to inform prognosis and recovery times.

Physiotherapy plays a crucial role in managing shin splints by addressing the underlying causes and promoting recovery through a comprehensive treatment plan. There are several strategies that when used in conjunction can effectively manage shin splints

• Load Management: We can evaluate your current activity levels and workload to determine if there’s an imbalance between these and your body’s capacity to recover. We can work with you to adjust the intensity, duration, and frequency of physical activities and create a structured plan to rest from certain activity and return to others. Cross training is often an effective strategy to de-load structures in the short term. If you are typically a runner, trying out cycling or swimming as an alternative may help to reduce the load on your shins while maintaining your fitness.
• Exercise: We can design a tailored exercise program to strengthen muscles of the hip, thigh and lower leg so they are better able to absorb and transmit forces during activity. Exercise can also target flexibility and other biomechanical factors.

An example of an exercise that target the muscles of the calves:

• Calf raise: Stand at the edge of a step or box on one or two feet and raise up onto the balls of your feet as high as you can, and then lower down as low as you can to feel a stretch in the calf. Aim for 3 sets of 6-15 repetitions at a slow and controlled pace.

Another example of an exercise that would target the hips:

• Split squat: Stand in a split stance, one foot forward and one back, about a shoulder width apart. Bending your front knee and driving your back knee towards the floor lower your entire body, allowing your back heel to come off the floor. Aim for 3 sets of 6-15 repetitions with each leg forward at a slow and controlled pace.

• Pain management: Several techniques can be used to help manage symptoms and reduce pain and inflammation:
  • soft tissue massage of the muscles in the lower leg
  • dry needling of the muscles in the lower leg
  • taping
• Return to activity: We can help guide you through a gradual return to activity and increase your fitness, strength and mobility to meet your goals. We can provide a structured plan for returning to your activity that will account for progressive loading, adequate rest and modifications to activity.
• Injury Prevention: Through the above strategies and progression of your exercise program we can give you the tools to self-manage your shin splints in future. We can also help you to prevent future reoccurrence altogether by addressing potential risk factors.

If you’re struggling with pain, don’t let it hinder your daily activities and enjoyment of life. Contact us today to schedule a comprehensive assessment and personalised treatment plan.

Our experienced physiotherapists are here to help you recover quickly and prevent future injuries.

Call us now on (02) 4721 1222 or book an appointment online.

Shin splints can disrupt your active lifestyle, but with the right guidance and treatment, you can regain pain-free movement and prevent future setbacks. Early intervention can lead to quicker recovery and a return to pain-free activity, so if you or anyone you know are dealing with shin splints, consider booking in with one of our physiotherapists.