Shin Pain: Here’s what you need to know to Recognize it early!

Shin splint is pain that is felt along the front of your lower leg, with the pain concentrating between the knee and ankle. The medical term of this condition is referred to as medial tibial stress syndrome (MTSS).

Shin splints usually affect people who are involved in moderate to high-levels of physical activities. The chance of developing shin splints increases if you participate in strenuous physical activities which require repetitive jumping/ pounding (e.g. sprinting/ long distance running) or start-stop movements like soccer or basketball. The pain can come at the beginning or in the middle of the physical activity.

Shin splint is an accumulative stress injury in the lower limb. The pain is due to the traction and pulling stress to the structure (muscles and bones) around the shin. The repeated impact and pounding stresses the bones and muscles of the lower limb, causing the muscles to swell, increasing pressure against the shin bone. This causes pain and inflammation along the shin bone.

The repeated impact-loading on the lower limb can result in miniature cracks in the bones of the lower limb. If given sufficient rest time, the body would be able to repair the cracks. However, if there is inadequate rest time in between activities, these minute cracks can result in a stress fracture of the affected shin bone.

Risk factors for Shin Splints

There are various activities and pre-disposing factors that increase your risk of getting shin splints. These risk factors are as follow:

• Foot structural issues (e.g. flat foot)
• Weakness of the hips/ buttock/ lower limb muscles
• Lack of flexibility in the calves/ hamstrings muscles
• Poor training methods (sudden increase in mileage/ speed/ downhill running)
• Too much running on hard surfaces (concrete) or uneven terrain (trail running)
• Wearing shoes with inadequate cushioning/ support

How can physiotherapy help?

It is very important to differentiate if the pain is coming from the muscle or the bone. Your Singapore physio will ask specific questions to help determine the structures involved. Do try to take note of the pain behavior: does the pain come in at the start and subside after a while? Does the pain come on only in the middle of the run/ activity? Does the pain come and stops you from continuing with your run? Your physiotherapist will analyze all the different contributing factors and treatment would include:

• Release of the tight and overused muscles of the lower limb
• Analysis and correction of walking/ running posture
• Recruitment of specific foot posture/ muscles
• Activation and strengthening of specific lower limb muscles
• Recommend the use of suitable foot orthotics if required

How can I help myself and can shin splints be avoided?

Early detection and treatment is key because when shin splints affect the bone, it is considered quite severe. There are also other precautionary steps that you can take to minimize the chance of getting shin splints.

• Wearing shoes with good insole support when exercising
• Minimize running/ training on hard or uneven terrains
• Increase your exercise intensity gradually
• Warm up and stretch properly before exercising
• Strengthen your lower limb muscles, particularly the bum, hamstrings and calves muscles
• Do not try to force and push through the pain during exercise
• Rest and ice your shin when required after sporting activities

Consider varying the types of exercises done and train different muscle groups each time you exercise. Your workouts should be more varied to prevent overuse to any particular muscle group. You should also stop their exercise if the pain becomes too severe.

How long will it take for me to recover?

Muscle related shin splints usually take 3-6 weeks to recover. Bone related shin splints can take up to 3 months for you to be pain-free.  It is important that you do not rush back into returning to their training immediately. You can consider taking up a non-impact activity so that it does not aggravate your shin splints while they heal, or even when you are starting to return to your sport. If you are a running, try taking up swimming or start an aggressive interval bike training program as a form of cross training to ease back into higher levels of physical training.

However, if your shin splints do not respond to the common treatment methods mentioned above or if you are experiencing any of the symptoms below, it would be advised for you to consult the doctor.

• Pain in the shin even when at rest/ not exercising
• A shin that is visibly/ badly swollen

Your doctor might suggest for diagnostic tests like x-rays or imaging scans if they suspect you might be suffering from more serious issues other than shin splints.

If the above symptoms is familiar to you, hit the whatsapp button at the side to speak to our friendly physiotherapist, or if you know someone who is suffering from this, do share with them this article so that we can send them on their way to full recovery.