Medial Tibial Stress Syndrome (MTSS) or “shin splints” is one of the most commonly reported lower limb injuries by competitive and recreational athletes. Recent research has shown that shin splints affects approximately 20% of the running population, with the majority of sufferer’s partaking in long distance training/competition.
What causes the pain?
Currently, there is two widely accepted theories on the cause of shin splints:
- The bony bending/bowing theory
- The traction theory
The bony bending theory suggests that during running, the Tibia (shin bone) bends due to the stress placed upon it. This bending causes small amounts of strain in the bone that enables it to adapt and get stronger (a good thing!!). When this strain exceeds the adaption process the shin bone becomes overloaded (a bad thing!), subsequently leading to injury and pain.
The traction theory states that shins splints is caused by the continual contraction of the muscles (Soleus, Flexor Digitorum Longus & Tibialis Posterior) that attach to the inner border of the shin. As these muscles contract during running, they place a traction stress on the shin bone, which results in inflammation at their attachment onto the bone, causing pain.
Am I at risk?
Current research has identified several risk factors leading to an increased likelihood of developing shin splints. These include:
A previous history of shin splints
- Prior orthotic use
High Body Mass Index (BMI)
Decreased running experience
Decreased running cadence (step rate)
- Over striding
Crossover running style
Increased vertical oscillation (ground clearance)
How do I know if I have shin splints?
To diagnose shin splints accurately, two symptoms must be present:
- Exercise induced pain along the distal 2/3 of the medial Tibial border
- Recognisable pain produced by pressing the medial Tibial border, which spans a distance of 5cm or more.
If you are experiencing symptoms not typical of shin splints such as cramping, pain spanning less than 5cm, burning pain, numbness or pins and needles, you should seek a thorough assessment by a physiotherapist to properly diagnose and treat your condition.
Treatment – Technique Technique Technique!!!
Arguably one of the biggest contributors to the development of shin splints in a runner is their running technique, particularly their lower limb mechanics. One of the quickest ways to reduce shin splints related pain is to address the technical aspects of running that can contribute to increased stress across the Tibia and associated musculature. What you should focus on is:
- Cadence – Normal cadence should be between 165-185steps/min. Decreased Cadence causes increased ground contact time resulting in prolonged pronation and excessive tibial torsion stress.
- Over striding – Excessive stride length results in poor tibia positioning upon heel strike, increasing Soleal traction and reducing force absorption ability.
- Cross Over Gait – Landing across the midline of the body causes excessive tibial torsion and pronation, reducing proper force attenuation.
- Vertical Oscillation – Increased vertical oscillation during running increases Tibial impact forces and often results in a loud foot strike.
How do I improve my technique?
Increase your cadence!! – This is by far the biggest bang for your buck. Increasing your cadence by approximately 10%:
Reduces lower limb impact forces by 20%
- Reduces vertical oscillation
Reduces ground contact time
Reduces stride length
The best way to achieve an increase in your cadence is by using GPS watches, phone applications or by simply running on a treadmill.
Eliminate a crossover running style – On a track, run straddling a line across 2 lanes or alternatively, try and maintain a space between your knees with every stride.
How to beat shin splints using strength
Strength exercises for shin splints should aim to improve the localised muscular capacity of the calf complex as well as the bone load capacity of the Tibia. This is best addressed with weight bearing functional exercises that mimic running postures.
One of the most important and often forgotten muscles of the calf complex is the Soleus. The soleus muscle is vital for absorbing excessive loads placed on the Tibia during running by minimising excessive pronation as well as resisting the bending forces experienced by the Tibia due to ground impact.
The best Soleus exercise that runners can do is the Bent Knee calf raise (pictured above). To perform the exercise correctly:
Bend your knee as far forward as possible, keeping your foot flat on the floor
- Keeping your knee bent, raise yourself up onto your toes
Lower your heel back to the ground
Perform 3 sets of 15 repetitions in a slow and controlled manner.
As always, if you are having problems, please do not hesitate to contact one of our experienced physiotherapists.
B.Sp.Ex.Sc., M.Physio., M.Physio (Sports & Musculoskeletal) APAM
Stephen completed his Masters of Physiotherapy at the University of Sydney in 2012, following a Bachelor’s Degree in Exercise & Sports Science. In the pursuit of advancing his clinical knowledge and skills to better treat his patients, he undertook a Masters of Sports and Musculoskeletal Physiotherapy, which he completed in 2016.