Medial Tibial Stress Syndrome (Shin Splints)

with Rehab

Medial tibial stress syndrome is also called shin splints. Shin splints is a term that is broadly used to describe pain in the lower leg. Shin splints most commonly involve inflammation of the bone lining (periostitis).

SYMPTOMS

  • Pain in the front, or more commonly, the inner part of the lower half of the leg (shin), above the ankle.

  • Pain that first occurs after exercise, and eventually progresses to pain at the beginning of exercise, that decreases after a short warm up period.

  • With continued exercise and if left untreated, constant pain that eventually causes the athlete to stop playing sports.

CAUSES

Shin splints are an overuse injury, in which the bone lining (periosteum) is broken down at a faster rate than it can be repaired. This leads to inflammation of the periosteum and pain.

RISK INCREASES WITH:

  • Weakness or imbalance of the muscles of the leg and calf.

  • Poor strength and flexibility. Failure to warm up properly before activity.

  • Sports that require repetitive loading or running (marathon running, soccer, walking, jogging), especially on uneven ground or hard surfaces (concrete).

  • Lack of conditioning, early in the season or practice.

  • Poor running technique.

  • Flat feet.

  • Sudden change in activity intensity, frequency, or duration.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Ensure properly fitted and cushioned shoes.

  • Wear cushioned arch supports.

  • Learn and use proper technique and have a coach correct improper technique.

  • Increase activity gradually.

  • Run on surfaces that absorb shock, such as grass, composite track, or sand (beach).

PROGNOSIS

If treated properly with a slow return to activity, shin splints usually heal within 2 to 8 weeks.

RELATED COMPLICATIONS

  • Recurring symptoms, that result in a chronic problem.

  • Longer healing time, if not properly treated or if not given enough time to heal.

  • Altered level of performance or need to end sports participation, due to pain if activity is continued without treatment.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with a therapist. For individuals with flat feet, the use of arch supports (orthotics) may be helpful. Sometimes, taping, casting, or bracing the leg may be advised. Slow return to activity is allowed after pain is gone. Rarely, surgery is attempted to remove the chronically inflamed tissue.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Ointments applied to the skin may be helpful.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 4 to 6 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Medial Tibial Stress Syndrome (Shin Splints)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

STRETCH – Gastroc, Standing

  • Place your hands on a wall.

  • Extend your right / left leg behind you, keeping the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keeping your right / left heel on the floor and your knee straight, shift your weight toward the wall, not allowing your back to arch.

  • You should feel a gentle stretch in the right / left calf. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Soleus, Standing

  • Place your hands on a wall.

  • Extend your right / left leg behind you, keeping the other knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keep your right / left heel on the floor, bend your back knee, and slightly shift your weight over the back leg so that you feel a gentle stretch deep in your back calf.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Gastrocsoleus, Standing

Note: This exercise can place a lot of stress on your foot and ankle. Please complete this exercise only if specifically instructed by your caregiver.

  • Place the ball of your right / left foot on a step, keeping your other foot firmly on the same step.

  • Hold on to the wall or a rail for balance.

  • Slowly lift your other foot, allowing your body weight to press your heel down over the edge of the step.

  • You should feel a stretch in your right / left calf.

  • Hold this position for __________ seconds.

  • Repeat this exercise with a slight bend in your right / left knee.

Repeat __________ times. Complete this stretch __________ times per day.

RANGE OF MOTION - Ankle Eversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the top of your foot and your fingers across the bottom of your foot.

  • Gently push your foot downward with a slight rotation so your littlest toes rise slightly toward the ceiling.

  • You should feel a gentle stretch on the inside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Inversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the bottom of your foot and your fingers across the top of your foot.

  • Gently pull your foot so the smallest toe comes toward you and your thumb pushes the inside of the ball of your foot away from you.

  • You should feel a gentle stretch on the outside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION- Ankle Plantar Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Use your opposite hand to pull the top of your foot and toes toward you.

  • You should feel a gentle stretch on the top of your foot and ankle. Hold this position for __________ seconds.

Repeat __________ times. Complete __________ times per day.

STRENGTHENING EXERCISES - Medial Tibial Stress Syndrome (Shin Splints)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided by your caregiver.

STRENGTH - Dorsiflexors

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) and loop the other end around your right / left foot.

  • Sit on the floor facing the fixed object. The band should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you, using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band, return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Towel Curls

  • Sit in a chair, on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel only by curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, you may add weight at the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ankle Inversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (table, pole). Loop the other end around your foot, just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band, as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercises __________ times per day.