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Running Related Musculoskeletal Injuries – Medial Tibial Stress Syndrome (Shin Splints)

By FitHubADL | In News | on July 28, 2017

What is it?

Inflammation and pain along the front of the shin caused by repeated contraction of the calves and foot flexors leading to micro tears of the muscles acting on the Tibia. In most cases, the calves (Gastrocs & Soleus) are overactive & the muscles at the front of the shin (Tibialis Anterior) are weak. This creates a cyclic imbalance of strain during activities that involve ground forces (shock landing/ impact) applied to the lower limb. Other contributing factors include incorrect footwear, pronated feet and weakened anterior lower limb muscles.

How to Treat

It is recommended to place high impact activities (such as running/ jogging/ jumping) on hold during recovery period, as these movements counteract the benefits/aim/ effect of treatment.

Footwear

Not all shoes provide the same level of support, and the type of footwear you choose can affect posture of the foot and potentially disrupt the muscles mechanical ability to disperse shock forces. If you have flat feet (complete arch collapse) then motion control shoes provide a more rigid structure to align the foot in a more ideal position. These shoes typically have a stiff heel and straighter shape, with a firm midsole to provide support to the fallen arch. If your feet have a mild degree of pronation, aim for support/ mobility style training shoes. These shoes have more flexibility and cushioning than motion control shoes, but still have a firm midsole to offer support in reinforcing the arch.

Orthotics

If your feet are pronated (collapsed inner arch), the use of orthotics to help lift the arch may be beneficial. Most footwear stores should stock an array of varying shoe inserts, although a podiatrist can tailor customised inserts more appropriate to individual presentations.

Stretching & Strengthening

Provides a more long-term effect as it directly targets the muscle foundation, correcting the imbalance between anterior and posterior muscle groups. Try to incorporate exercises that passively stretch the shin muscles, such as:

  1. Sit on your heels, and leaning the torso back, using your arms behind you to both support the torso & control the amount of pressure being applied. This targets both the quadriceps and the shin muscles.
  2. Walk around on your heels with toes lifted, or alternatively stand on a raised step with and gently drop one heel off the step to stretch the calves & engage the Tibialis Anterior. You can perform this as a single leg exercises, by keeping one foot firmly on the step, bending the knee to allow the other foot to drop, or you can perform with both legs simultaneously. Avoid lifting heels beyond neutral, as this will tighten the calves and contribute to the occurrence of shin splints.
  3. Lean your hands against a wall at eye level with feet in a staggered position behind the body. Lean into the wall and bend the front knee, keeping the heel of the back foot on the floor. This stretches the heel cord of the Achilles.

Recovery Duration and Getting Back on Track

Long term management of medial tibial stress syndrome includes preventative measures, such as avoiding over-training at the start of a training program or resumption of activity. Stress injuries have a higher occurrence rate if the strength, endurance and flexibility of the acting muscles is insufficient to withstand the forces applied to them. Adequate nutrient intake is also important to maintain appropriate bone marrow density for the reduction in bone stress injuries and support the caloric requirements of physical demands placed on the body overall.

Returning to activity or sport should be gradual. As mentioned above, “too much too soon” carries an increased potential of re-injury or prolonged recovery. Start slow and adhere to low levels of intensity in the initial stages, possibly aiming for 50% of baseline effort. Acknowledge that decreased performance is a normal physiological response after a period of inactivity, and be mindful of symptoms that may indicate the potential of injury re-occurrence. If this happens, allow an additional week or so for recovery and further reduce the training exertion efforts. Gently increase loading capacity over the course of a number of weeks if symptoms have not returned. Although some degree of shin splint re-occurrence is possible, full unrestricted activity may be achievable within 3-6 weeks.

Written by Rachel Buchanan

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