Fix Your Shin SplintsSep 13, 2022
The fancy term for shin splints is Medial Tibial Stress Syndrome (MTSS). The hallmark of this condition is pain on the front of your shin due to the moyfascial connective tissue attachment at the backside of the tibia (shin bone) that worsens with activity. It represents about 15% of all running injuries and is very common in athletes and soldiers in the military. When we engage in exercise/training we apply stress to our body in hopes that we will have a positive adaptation to that session. This is represented by Hans Seyle’s General Adaptation Syndrome (GAS) concept (figure 1).
Figure 1: General adaptation syndrome - Phase 1 to phase 2 is a representation of being exposed to a new stimulus (weight training, running, etc) and from "B" to "C" is the recovery. Phase 3 is if you stay consistent with the exposure to that stimuli. Phase 4 is if you don't stay consistent with exposure to the stimulus.
If you want to get stronger, you increase volume/load in your training program, there is microtrauma to the muscle; it is repaired through recovery and that tissue comes back stronger. Simultaneously, your bone density increases as well. MTSS (shin splints) are a result of the Terrible T’s, which are too much, too soon, too long. The bone (tibia) is unable to repair and remodel from the load. Realistically, the best way to eliminate shin splints is graded exposure to load, that way the body can adapt appropriately. I realize that ship has sailed if you’re reading this. The best thing we can do is ensure that we optimize the force dampen mechanisms of our lower extremity, which are:
- Big Toe
In this blog, I’m going to take you through a self-assessment for function of the lower extremity to hopefully identify culprits and exercises (video) to reduce stress being placed on the shins (tibia).
Self Assessments (summarized from the video)
To assess the big toe, we want to be seated and cross our leg over. With one hand grasp the metatarsal (proximal bone forming joint) and with your other hand, dorsiflex (push bottom) of toe. We are look for 40-60º of range of motion for this joint.
Figure 2: Big toe dorsiflexion assessment
Hyperpronation (fallen arches when loaded) is a common functional finding amongst shin splint sufferers. To assess this, we will come up to one leg and then rotate in and out to see how far the medial longitudinal arch falls.
Figure 3: Hyperpronation of the medial longitudinal arch assessment
For ankle dorsiflexion, we're going to assess this in a half kneeling position with the upside foot one fist length away from the wall. From this position, try and press the knee to the wall without the knee caving in (if you have hyperpronation, you'll want to do this), while keeping the heel glued to the ground. Ideally, we want to see your knee touch the wall (30-40º).
Figure 4: Ankle dorsiflexion test
For plantarflexion, you're going to come to single leg stance while using the wall as a support system. From here, try and press your heel up towards the ceiling (calf raise) without rolling over to the outer toes.
Figure 5: Plantarflexion assessment
First we're going to assess internal rotation of the knee. We can do this by sitting on the edge of the seat with your feet flat on the ground and directly underneath the knees. Knees should be about shoulder width apart. Without moving the knee, rotate the foot in as far a you can go. We should be able to rotate in about 20º. Come back to neutral and then try and rotate the foot out for external rotation of the knee. This should be about 20º as well.
Figure 6: Seated internal rotation of the knee assessment
Figure 7: Seated external rotation of the knee assessment