Consistency is a key to success when it comes to exercise and fitness goals, however, there is a limit to what the body can recover from. Too much activity with insufficient stretching and recovery can lead to an overuse injury. Shin splint pain is a common example of a preventable and curable overuse injury that can be addressed with corrective stretches and strengthening.
Often referred to as medial tibial stress syndrome (MTSS), shin splints are a cumulative stress disorder of the lower leg. The pain and inflammation occur between the knee and the ankle and can be in one of two anatomical locations.
Posterior shin splints involve the tibialis posterior muscle, which controls the medial arch of the foot. Over-pronation of the foot is known commonly as collapsed arches and will lead to shin pain and discomfort.
Anterior shin splints arise from the tibialis anterior on the front lower leg, which controls plantar flexion and dorsiflexion of the foot. Excessive dorsiflexion will irritate and cause progressively worse shin pain.
In both cases, the stress, tension, and inflammation of the tibialis muscles lead to tibial stress—actual stress on the bone itself. It can manifest as acute or chronic and, when left untreated, can lead to a more serious stress fracture of the tibia. It is important to identify symptoms of shin splints as early as possible and begin to address them with corrective stretches or physical therapy to avoid the development of a more serious condition.
The symptoms of shin splints commonly include some or all of the following:
Pain ranging from dull to sharp on either side of the tibia
Pain that arises during exercise
Inflammation, tenderness, or soreness in the lower leg
Some people will work right through the symptoms and others may be unable to continue activity due to the pain. Corrective exercises and stretching will typically relieve shin splint pain but have your client consult a physician if the pain continues despite treatment.
As a cumulative stress condition, shin splints are a result of repetitive, strenuous activity. Hard cutting and start/stop activities can contribute to foot and leg pain. Running and endurance athletes often report lower leg pain associated with shin splints from the repetitive pounding of running on concrete or hard court. Running up or downhill often and poor stability and strength in the glutes, hamstrings, knees, and ankles can also play a role.
Other causes to consider include poor biomechanics when running, jumping, and cutting or improper equipment, which will be addressed later. General fatigue can also lead to pain in the lower leg leaving anyone from dancers to construction workers susceptible to the condition.
Experts recommend corrective exercise to improve quality of life and quality of movement. It is used by personal trainers, corrective exercise specialists, and physical therapists to address pain and biomechanical dysfunctions and includes stretching for overactive muscles and strengthening underactive muscles. The result will, hopefully, create ideal length-tension relationships and ranges of motion in affected muscles and joints and remedy and prevent overuse injury.
Standing a few feet in front of a wall, have your client take a staggered stance with one foot forward and one behind. Feet will be hip-width and toes pointing forward. Ensure the client keeps the back heel down on the floor. Leaning into the wall with their arms, they will begin to feel a stretch in the calves.
To further stretch the deep soleus and Achilles tendon, have them bend the back knee further while keeping the heel down. Hold the stretch for 30 to 60 seconds before switching legs.
Calf Foam Rolling
Using any type of foam roller, have your client sit and place one calf on the roller. Working slowly from the heel towards the back of the knee, have them roll the calf muscles while being sure to stay on uncomfortable spots (adhesions) for 60-90 seconds to allow maximum relief. While stationary on an adhesion, flexing and extending at the ankle will add more pressure as will crossing the opposite leg over the top of the leg being rolled.
The gastrocnemius and soleus are large muscles and will require several passes of the foam roller with as many angles as possible to truly relieve the tension. Foam rolling will take five to 10 minutes or longer per leg if performed effectively.
Kneeling Tibialis Anterior Stretch
Have your client start on their knees with feet underneath the glutes. With an upright torso, have them relax their feet placing the top of both feet on the floor and sitting as much weight as they are able onto the heels. Assist or have them bring hands to the floor if needed. If hands are on the floor, they can lift their knees and transfer weight to the top of the feet and into the hands to extend the stretch. If hands are off the floor, they can lean the torso back slowly to extend the stretch.
Hold for 30 to 60 seconds if bearable. Repeat three to five times.
Tibialis Anterior Foam Rolling
In the same way the calf is rolled, have the client lay supine with the roller starting just above the ankle. They will slowly roll up the tibia being sure to stay towards the lateral side of the bone to stay on the muscle tissue.
As with the calves, foam rolling will take some time when done correctly. Do not rush and utilize plantar flexion and dorsiflexion of the foot for range of motion and to really dig into the tibialis anterior.
With the support of a wall, have your client set their feet hip-width apart with toes pointing forward. They will slowly dorsiflex and extend at the ankle, raising them to their toes as far as possible.
Have them hold at the top for 10 to 20 seconds before slowly lowering back to the starting position. Repeat 10 to 15 times.
Tibialis Anterior Contraction
Supported if needed, have your client start with feet hip-width apart and toes pointing forward. Keeping weight in the heels, have them slowly lift their toes as high as possible.
They will hold toes up for 10 to 15 seconds before slowly returning to the start position. Repeat 10 to 15 times.
This contraction can be progressed by having the client raise their toes and, with small, deliberate, steps, walk ten to twenty steps on their heels with toes elevated before resting.
To prevent shin splints, apply these stretches and strengthening movements as part of any exercise program. The warm-up is an ideal place to incorporate these therapies to help alleviate shin pain before exercise and promote proper length-tension relationships in the lower legs. The idea is to reduce shin pain and prevent injury.
For clients with severe shin pain that has previously gone untreated, you may need to create a program that consists only of calf and tibialis work, hamstring and glute strengthening, and core work. For runners, endurance athletes, or those you discover to be suffering from an overuse injury from repetitive movement, you will want to address their biomechanics.
Warming up, stretching the calves well, and coaching proper running mechanics are vital for runners and athletes. Key points to teach your clients:
Stay forward on the tripod of the foot
Use proper stride length to prevent excessive dorsiflexion of the foot
Relax the ankle when striding
For athletes who cut and engage in start/stop activities like soccer and tennis, strong knees, core strength and balance, and calf and ankle flexibility will be the focus.
For the average client with a strenuous or repetitive job, take time to identify their repetitive movements and any dysfunctions associated. Injury prevention often goes beyond biomechanics and takes a deeper dive into the shoes, clothing, and accessories the client wears regularly!
Did you know that the average running shoe is effective and supportive for up to 500 miles? Beyond that, the support may not be ideal and may be contributing to shin pain and other overuse injuries. Many of your clients will have never been to see a podiatrist and will have no idea what type of foot arches they have. They probably have no idea what a shin splint is either! Clients who have had pain in the past or even foot and leg surgeries may come prepared with this type of information and knowledge of what may be causing their shin pain.
Getting a good pair of shoes for working out and daily use is no small task. Fortunately, there are knowledgeable running stores all over the country. Your client can speak with experts who will measure and observe their walk and run strides, measure their arches, and help them select the best pair of shoes or boots for exercise or daily wear. Typically, the assessments are free or a minimal cost and they are very much worth it!
Another underutilized tool for those with shin pain is compression gear. Compression gear can range from sleeves for the arms and legs to socks and full shirts. It is more than a fad and it has a real-life purpose!
Compression gear, when sized appropriately, should be relatively tight. The purpose is to put pressure on the covered muscles, aid in blood flow and venous return during activity, and prevent swelling. Compression wear does all of this with minimal fabric and little to no obstruction to movement patterns making it an ideal solution for injury prevention.
As a certified personal trainer, you are tasked with identifying and addressing movement dysfunctions and potential injury in your clients. You also have the obligation to educate them on how to reach their goals safely and effectively.
If you are ready to advance your education and learn more about corrective exercise and corrective programming, get started on your ISSA Corrective Exercise Certification today! Become an elite, trusted resource for the clients you work with.