'SHIN SPLINTS'

This term has been used to describe any pain between the knee and ankle on the front of the shin. The pain associated with shin splints is usually of a soft tissue origin involving microtears of muscle tissue (tibialis posterior and/or tibialis anterior) and/or chronic avulsion of the periosteal-fascial junction.

What are the causes?

1. Biomechanical:
   a) prolonged or excessive pronation (flattened arch) of the foot places extra strain on the muscles controlling forefoot pronation (shin muscles; tibialis anterior and posterior) and rear foot pronation (medial one-half of soleus).
   b) increased strain on a muscle can lead to damage at any point along the muscle including the site of origin on the bone 
   c) local fatigue of tibialis anterior and posterior due to extra strain decreases their ability to act as “shock absorbers” during weight bearing consequently transferring the stress directly to the tibia (shin bone).
   d) over striding places extra strain on the tibialis anterior and posterior.

2. Training: progressively intense training program may be the cause of increased muscle strain.

3. Muscle: inflexibility of the calf muscles (gastrocnemius and soleus) decrease ankle flexibility. 

4. Training Surfaces: walking, running and jumping on hard surfaces places extra strain on the tibialis anterior and posterior and subsequently stress may be transferred to the tibia.

5. Footwear: shoes may not provide adequate shock absorption and foot control.

Signs & Symptoms:
•    predominant symptom is an aching pain felt on or around the tibia.
•    pain is initially felt only on exertion (i.e. towards the end of a run, but if more severe can progress to earlier during  activity,  
    on walking and even at rest.

Treatment:

• control of prolonged/excessive forefoot and/or rear foot pronation with orthotic devices.

• modification of training sessions to meet physiologic conditioning of the tibilias anterior, posterior-and soleus.

• substitution of the detrimental activity with alternative activity to achieve training effect but decrease strain on damaged
  tissue.

• anti-inflammatory medication /physiotherapy treatment  for reduction of inflammation and pain.

• alternative training surfaces.

• selection of a shoe that provides adequate shock absorption and forefoot/rear foot control.

• flexibility exercises for gastrocnemius and soleus.

• ice, massage along the shin

Exercises:

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