Shin Splints: A Multifaceted Approach

Todd Sabol MS, AT

Almost 100% of the time, musculoskeletal issues are the result of multiple variables breaking down, and because of that, rehabilitation protocols need to address ALL of those issues. Many times, the combination of weak and tight musculature can cause the onset of symptoms. To definitively determine the issue, a proper evaluation and diagnosis should be conducted. Common signs and symptoms of shin splints are sharp or dull pain that can be constant and get noticeably worse with activity and be painful to touch along the tibia and/or front of the lower leg musculature.

In the case of medial tibial stress syndrome, or commonly known as shin splints, the issue is not only tight calves. I have seen many athletes who have anterior shin pain who try to stretch the heck out of their calves, which is an important aspect of shin splint rehab, but by no means is the only variable. Shin splints are a common lower extremity injury in athletes who are constantly exerting themselves. This stems from overuse and repetitive contractions of the lower extremity musculature without allowing the tissue to heal. Overtime this causes stress reactions of the tibial region. In turn, athletes can experience extreme pain in the anterior, medial and posterior compartments of the lower leg.

This overuse syndrome can be very debilitating to athletes if it is ignored or not properly addressed. If not handled in an adequate period of time, shin splints can progress to abnormal bending of the tibia, abnormal tibal load, injury to the periosteum, tendinitis, exertional compartment syndrome, and stress fractures. Which brings us to two questions, why are these happening and what can we do to correct them?

As I stated before, stretching of the superficial posterior compartment of the leg is commonly warranted, as tight calves are the perceived issue. But in addition to that, the anterior musculature is commonly weak and the deep posterior leg musculature is commonly inactive as well, causing the tibia to not be able to sustain the repetitive load overtime. The gastrocnemius (upper calf muscle) and soleus (lower calf muscle) become tight very easily when repetitive muscle contractions are required during sport. This increased responsibility of the calves can be stemmed from two things 1) anterior weakness and 2) inactive deep posterior and foot musculature. The main culprit involved in anterior weakness is the tibialis anterior, which is the front shin muscle that runs parallel to the tibia. It helps dorsiflex and stabilize the foot and ankle. But when this muscle is weak and cannot sustain the loads and act correctly as an antagonist to the calf muscles, those bone-stress reactions begin to occur. The other aspect of this triad of issues that causes increased amounts of force of the tibia is weakness or inactivation of the deep posterior musculature, specifically the tibialis posterior, flexor digitorum longus and flexor hallicus longus. These muscles originate deep to the gastroc in the calf and they run down the lower leg and wrap around the medial malleolus (big ankle bone on the inside of the ankle) and dive deep into the various layers of muscles in the bottom of the foot. Finally, a quick aspect we need to address here as well is the lateral compartment and ankle everters. These muscles bring the ankle and foot away from the midline of the body. One of the peroneal muscles, specifically the peroneus longus, also dives deep into the plantar surface of the foot and acts as an intrinsic foot muscle. So, we want to cover all of our bases here.

That brings us to the rehabilitation program. A proper program for any injury or syndrome should address all aspects of dysfunction, asymmetries, pain etc. This rehab will focus on what we talked about above: strengthening the weak anterior musculature, stretching the calf musculature and activating the deep intrinsic musculature of the foot. It is also important to note that this is a general rehab program and that if you need something specific please contact your closest sports medicine professional or myself. I’d love to help you out!

#HealByMoving

Repeat 2-3x Per Week for Rehabilitation Purposes

 

Mobility

1. Straight Leg Calf Stretch: 4x30sec

2. Bent Knee Calf Stretch: 4x30sec

3. Big Toe Stretch: 4x30sec (Prop big toe on elevated surface and lean forward)

4. Tissue Release of Your Choice

    *Medial and Lateral aspects of Gastroc and Soleus

    *Plantar Fascia

 

ROM Warmup

1. Ankle Circles Counterclockwise: 1x15

2. Ankle Circles Clockwise: 1x15

3. Ankle Pumps Up/Down: 1x15 (Up and down is 1 rep)

4. Ankle Pumps Side-to-side: 1x15 (Side to side is 1 rep)

 

Strengthening

1. Towel scrunches: 10-15 all the way pulled to you

    *This should be done with you seated and having the towel on a slick surface like a kitchen floor

2. Towel Sweeps: 3x10 (1 rep is back and forth like a windshield wiper)

3. Toe pick-ups: 3x with at least 15 items

    *Again, you will be seated, have something like marbles or stones or any little item that you’re able to pick up with your toes and place in a cup

4. Isometric Toe Curls (Curl your toes on the floor and hold for 10 seconds, repeat 10 reps)

5.Banded Ankle Dorsiflexion: 3x15 (Slow eccentric portion)

6. Banded Ankle Inversion: 3x15 (Slow eccentric portion)

7. Toe Walks: 3x20 Steps

8. Heel Walks: 3x20 Steps

9. Single leg stance w/ weight transfer between hands: 3x30sec

 

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