Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Shin Splints Physical Therapy Guide

What Are Shin Splints?

Medial tibial stress syndrome (shin splints) is the most common cause of shin pain in athletes and active individuals. It is primarily an overuse injury whereby repetitive strain of the Tibialis Anterior places traction forces on the sheath surrounding the bone, resulting in pain and inflammation of the tibia bone. Shin splints are often an injury resulting from increasing running mileage too quickly, excessive training on hard surfaces and running on your toes as in sprinting repetitions. Shin splints frequently affect individuals who engage in moderate to heavy physical activity such as cross country, tennis, soccer or basketball. Sometimes the pain of shin splints can be so intense that you must stop the activity you are performing. Shin splints are a cumulative stress disorder. Repeated stress placed on the bones, muscles, and joints of the lower legs prevent your body from being able to naturally repair and restore itself, it is for that reason that seeking medical assistance and completing the exercises described below is so important!

What Causes Shin Splints?

There are a number of different factors which can increase the likelihood of developing shin splints. These include:

Overload: Increasing your training or exercise too quickly is one of the more common causes of shin splints. Recovering from an injury and doing “too much too soon” often leads to complications and developments of disorders such as shin splints.

Foot Pronation: Pronation is the movement that occurs when the foot rolls inwards. Pronating too much can cause the arch of the foot to flatten and causes the lower leg to rotate inwards. This increases the stress on the soft tissues of the lower leg resulting in pain and inflammation.

Foot supination: Supination is the movement that occurs when the foot rolls outwards. Over-supinating also causes poor biomechanics and may put added pressure the lower leg and ankle. It is very important therefore, to get your running/gait analysed by a professional to determine if this is the problem.

Poor footwear: Wearing the wrong type of shoe for your running style or simply wearing shoes that are too old and have lost their arch support can cause injury.

Poor flexibility: Poor biomechanics of the ankle joint can place much more stress and tension on the soft tissues, muscles and tendons of the lower leg when running. The calf muscles and and the anterior shin muscles may need stretching.

What Are The Risk Factors?

Shin splints are a very common injury found in individuals who participate in sport that involves a lot of high endurance running activity. Whilst running, the Tibialis Anterior muscle activates to dorsiflex the ankle, however repetitively stressing this muscle beyond its fatigue threshold is a very common risk factor for developing shin splints, this is due to the muscular imbalance, weakness and inflexibility of the ankle and lower leg muscles. Other shin splint risk factors include:

  • Overload: increasing activity, intensity, and duration too soon.
  • Improper footwear.
  • Performing high impact exercises on hard, non-compliant surfaces places additional stress on the lower leg bones and soft tissue.

Shin Splint Signs & Symptoms

The symptoms of shin splints often come on gradually and consist of pain over the inside lower part of the tibia or shin bone. There is usually a pain when commencing exercise which often eases as the session continues, however the pain often comes back worse later on in the day. Pain can be worse the next morning but may ease off over time with gentle use.

People with shin splints will experience some of the following symptoms:

  • A dull achey pain in the front part of the lower leg (shin).
  • Pain that develops gradually during exercise.
  • Pain on either side of the shin bone.
  • Muscular pain, normally in the calve and anterior shin muscles.
  • Tenderness along the inner part of the lower leg
  • Swelling in the lower leg
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Foam Rolling Shin Splints!

Deep massage of the tight gastrocnemius is a fantastic (yet painful) treatment intended to speed up the recovery process of shin splints, which is often used by Physical Therapists, but can be performed by the patients themselves. The purpose of deep massage is to improve the mobility of the muscular tissue and improve the range of movement in your ankle. The massage is deep and can be very sore for people suffering from a a tight calf, however the movement encourages realignment and lengthening of the muscle fibres and will improve your recovery time.

You can buy our favourite roller here!

What Are My Treatment Options?

There are many treatment options available to people who suffer from shin splints! Your rehabilitation and recovery time depend entirely on modifying the activities that increase shin pain, and resting when appropirate. Make sure you get a full assessment from your health care professional before starting any programme.

Rest & Time

Initially, you need to stop doing the activities that caused the shin splints in the first place and prevent agitating them further. Immediately following pain on activity you can commence the RICE protocols:

  • Rest. Rest, relax and protect your lower leg and ankle. Stop, change, or take a break from any activity that may be increasing your pain.
  • Ice. Cold packs will reduce pain and swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Do no place ice directly on to skin, wrap it in a towel first to avoid ice burn! You can find our favourite ice pack here!
  • Compression. Wrapping the lower leg with a compression sleeve will help decrease swelling and improve recovery time. You can find our favourite calf compression sleeve here!
  • Elevation. Elevate your feet to reduce any swelling and bruising in your legs.

Physical Therapy

Although rest is an extremely important component of your recovery process, it doesn’t mean the affected leg has to be completely immobilised. In fact,  the muscles and soft tissue surround the shin splints need to be placed under tensile loads to grow and stay healthy.  The easiest way to do this? Exercise! 

Shin Splints Exercises

1) Towel Stretch

The Calf is made up of two large muscles called the Gastrocnemius and the Soleus. Having a tight calf is one of the major reasons people develop shin splints, so get stretching!

How to do it:

  • Sit on the floor or on your chair with a towel or a resistance loop band wrapped around your injured foot.
  • Gentle pull the band towards you forcing your ankle into dorsiflexion (toes pointing towards you)
  • Pull until your feel a comfortable stretch in your calf muscle and hold for 15 seconds.

Repeat 5 times, three times throughout the day.

2) Resisted ROMs

It’s a great idea to strengthen the muscles in your foot and lower leg to provide support and stability to the ankle joint, and the easiest way to do so is by using a resistance band! Your ankle moves in multiple directions but for the sake of this guide we will be completing dorsiflexion, plantar flexion, inversion and eversion (ankle up/down/side to side). Check out DoctorJo’s video for a full description here!

How to do it:

  • Sit on the floor with a block under your achilles with a theraband tied around your injured foot, holding the other end of the band in your hands.
  • Slowly push and pull your foot towards/away from you forcing your ankle into multiple different directions.
  • Slowly let your foot return to the starting position

Repeat 15 reps, three times throughout the day.

 3) Soleus Stretch

The Soleus stretch targets the Soleus muscle which is deeper, underneath the larger Gastrocnemius muscle. Bending the knee relaxes gastrocnemius, allowing Soleus to be stretched in isolation.

How to do it:

  • Standing with one leg in front of the other, have something in front of you to hold on to.
  • Bend both knees, focusing on the front knee.
  • Move your weight forwards onto your toes ensuring you don’t lift off your heel.
  • Hold for 15 seconds.

Repeat 5 times, three times throughout the day.

4) Stair Stretch

The stair stretch is both a stretching and strengthening exercise, and places a great amount of tensile load through the achilles tendon and belly of the calf muscle which is often tight in people who suffer with shin splints.

How to do it:

  • Standing on a step or a block with the heels of your feet overhanging the edge.
  • Slowly allow your heels to continue going in a downwards direction until you feel a comfortable stretch in your calves.
  • Hold the stretch for 10-15 seconds, before slowly going back to neutral.

Repeat 5 times, three times throughout the day.

 5) Stair Raises

Stair raises are novel yet effective exercise for treating shin splints by stretching and strengthening the Tibialis Anterior muscle. As the name suggests, this exercise is also completed on a step or a curb, however facing downwards rather than upwards.

How to do it:

  • Standing on a step or a block with the heels of your feet on the stair, while the rest of your foot is hanging off (hold a rail for balance)
  • While keeping your legs straight, point your toes downward as far as you can, then lift them up as far as you can. Repeat multiple times for 30 seconds quickly with a full range of movement.
  • After 30 seconds, bend your knees to a 45-degree angle (about half way). complete another 30 seconds of flexing in that position.
  • Rest for a minute or two, then do another set—30 seconds with the legs straight, immediately followed by 30 seconds with the knees bent.

Repeat for 5 sets of 30 seconds each, twice a day.

Running Form

Check out this video by Dr. Mark Cucuzzella on the Principles of Natural Running

It’s more than likely that you don’t have perfect running form and could make some easy adjustments. The efficiency gained from learning an improved form will reduce your chances of injury and make you even faster than ever! It is important to return to running slowly, this is the most crucial part when returning from any injury. When you do start running again, continue with the stretches and exercises noted above! Treat your legs like the shin splints never left. Don’t get lazy and let them come back, stop the problem before it starts! This will ensure that they’ll be gone for a long, long time. Hopefully forever.