Shin Splints: A Helpful Guide for Home Treatment

Rehabbing Shin Splints at Home

Medial tibial stress syndrome (MTSS), which is colloquially known as “shin splints” is one of the most common lower extremity injuries, especially in runners and other impact athletes.¹ The prevalence ranges from 13% to 35%  in these specific populations.² The nature of the injury involves microdamage to the Tibia over time.³ This comes as a frustration to many patients since the nature of the condition means that there is no quick fix to undo the chronic damage that has accumulated. Because shin splints are an early stress reaction that could lead to more serious stress fractures, later on, it is critical to understand why this condition occurs and how to prevent and/or treat it at home.

What are Shin Splints?

Symptoms

Shin splints are, very simply, a condition of overuse.² For those who have experienced this condition, the symptoms are hard to forget. However, for all who have been fortunate enough to avoid the wrath of MTSS, there are several key features that you should look out for. As the name suggests, this condition refers to exercise-induced pain over the tibia (shinbone).² Specifically, most patients experience pain along the inside edge of the tibia, though it may also develop along the outer edge as well.² What sets this condition apart from others is the fact that it is exercise-induced, meaning the pain is provoked either during or after physical activity and may be reproduced when palpating the area.² Unfortunately, there are no imaging tests that can definitively diagnose shin splints, but often imaging may be required in order to rule out more serious fractures or injuries.²

Pathophysiology

With increasing loads of weight, distance traveled, or impact exercises, the more stress we place on the tibia and the more microdamage accumulates in the tibial bone.³ As this microtrauma accumulates, inflammation develops around the bone injury.² This area of inflammation also happens to correlate with areas of tendinous attachments of the soleus and posterior tibialis.² This leads experts to believe that dysfunction of these muscles may also be implicated in shin splints.³

Epidemiology and Risk Factors

Because shin splints are caused by overuse of the lower extremities and recurrent impact exercises, runners, jumping athletes, and military personnel are especially prone to this condition.^4,5 Other risk factors for developing shin splints include the female gender, a history of MTSS, high BMI, ankle and hip range of motion, and navicular drop (a measure that involves arch height and foot pronation).² Interestingly, research has also noted that bone mineral density in the tibia may also predispose people to develop shin splints.³

Prognosis & Recovery

While shin splints can be quite disabling, it is often not a serious condition. In most cases, patients adhering to these conservative treatments and gradually re-integrating activities are expected to make a full recovery, though the time frame is broad.¹

That being said, MTSS is, by definition, a stress reaction of the tibia due to overuse. There is always the possibility that it may progress to more serious complications if improperly treated, or not treated at all.

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How to Rehab from Shin Splints at Home?

To understand how to best go about treating shin splints, we must first understand the key elements involved and how they work together. When we are participating in impact activities, the tibia (shinbone) absorbs most of the shock and can slightly bend, much like a bridge that is under strain.⁶ This is where our calf muscles come in, which act like strong, supporting cables to counter the bending forces of the bridge (tibia).⁶ However, we want strong calf muscles, not tight ones. If the calf muscles are too tight, they will exert unnecessary tension on the already weakened tibia. Thus, shin splint rehabilitation should first focus on relaxing the muscles of the calf to eliminate this extra tension. Only then should you begin exercises to strengthen the calf muscles, which will help prevent the cycle from occurring all over again.

Rest

Most experts agree that rest is the most effective treatment for shin splints.^1,7 Rest is critical to allow time for the tibia to heal and inflammation to subside. However, for some athletes, prolonged periods of rest is neither ideal nor feasible. In this case, some physicians may recommend “relative rest” by modifying activity duration, intensity, distance, etc.¹

Hot Pack for Pain and Healing

Most previous literature suggests that cryotherapy (the therapeutic use of cooling/freezing temperatures) is the most effective method of treatment for injuries.^1,7 However, research in recent years has suggested that thermotherapy (the therapeutic use of heat/hot temperatures) may be a better modality of treatment for particular injuries.⁸  While cold and heat treatments both decrease pain, heat treatment increases tissue metabolism, blood flow, and tissue stretchability, while cold therapy decreases these effects.⁸  We suggest placing hot packs to the lower leg, which will stimulate more blood flow and help to heal the tibia and surrounding areas. A great option for shin splints is the Inerzen Shin Splint and Calf Hot pack.

Why we like this product:

• Adjustable for all leg sizes and can tighten or loosen to your needs
• Remains hot for a long period of time
• Material is durable yet still breathable

Use an Arch Support to Limit Lower Leg Movement

Having curvature underneath your feet is a normal (and healthy) anatomic quality since this arch helps with shock absorption and energy transfer.⁹ Problems arise when this arch collapses, as it pulls on the muscles in the lower leg and causes an excessive force on our tibialis posterior muscle.10 Using arch support can help to lessen the burden on your tibia, allowing it to heal. We highly recommend Superfeet Arch support for their comfort and success.

Why we like this product:

• The product includes a stabilizer cap to the base of the insole, which provides extra support and stability
• Insole is made of high-density foam for maximum cushioning
• Incredibly durable and made with odor eliminating material

Compression Sleeves

Compression sleeves (or stockings) are designed to place most of the compression at the foot/ankle, and then gradually loosen as it moves up to the calf. The purpose of this is to increase venous return to the heart and reduce peripheral blood pooling and leg swelling.¹¹ This promotes blood flow up to your shins (and even further up to your heart), which is beneficial for healing. Our favorite choice is Crucial Compression Calf Sleeves.

Why we like this product:

• Comes in two sizes to ensure the most appropriate fit for your calf size
• Soft and comfortable material that won’t irritate your skin
• High-quality stitching and product construction so that compression won’t diminish over time

Kinesio Tape for Pain

The Kinesio Taping method is an intentional taping technique that provides support and stability to muscles to promote the body’s natural rehabilitation process.¹² Taping around certain muscles and joints targets somatosensory receptors to alleviate pain. By microscopically lifting the skin, Kinesio taping promotes lymphatic drainage, which decreases interstitial space and allows for inflammation to subside.¹² As seen in this video, Kinesio taping around the posterior tibial tendon can greatly help to provide support and relief to the area

The Best Exercises To Heal and Prevent Shin Splints

Supplementing these above treatments with stretching and strength training, as well as low-impact cross-training, may help to expedite your recovery process.¹ Below, we have gathered some of the best exercises to heal and prevent shin splints:

Foam Roll the Calf and the Whole Lower Leg

Eccentric Calf Raises with a Ball

Seated Ankle Inversion with a Resistance Band

Barefoot Single-leg Deadlift for Balance

Conclusion:

Shin splints are an ever-common occurrence in the athletic world that halt many of us in our tracks. Though it can be frustrating to deal with such an injury-time after time, we hope that understanding the mechanisms by which this condition appears and the best therapeutic options may help to enhance your healing. Even better, we hope that this knowledge will allow you to take preventative measures so you never have to deal with that excruciating shin pain ever again!

Works Referenced:

1. Galbraith, R.M., and Lavallee, M.E. (2009). Medial tibial stress syndrome: Conservative treatment options. Current Reviews in Musculoskeletal Medicine 2, 127–133.
2. Reshef, N., and Guelich, D.R. (2012). Medial Tibial Stress Syndrome. Clinics in Sports Medicine 31, 273–290.
3. Franklyn, M., and Oakes, B. (2015). Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments. World Journal of Orthopaedics 6, 577–589.
4. Yates, B., and White, S. (2004). The Incidence and Risk Factors in the Development of Medial Tibial Stress Syndrome among Naval Recruits. American Journal of Sports Medicine 32, 772–780.
5. Newman, P., Witchalls, J., Waddington, G., and Adams, R. (2013). Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access Journal of Sports Medicine 4, 229.
6. Davis, J. How Improving Calf Strength Can Fix Your Shin Splints.
7. Beck, B.R. (1998). Tibial stress injuries. An aetiological review for the purposes of guiding management. Sports Medicine 26, 265–279.
8. Nadler, S.F., Weingand, K., and Kruse, R.J. (2004). The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain Physician 7, 395–399.
9. Nielsen, R.G., Rathleff, M.S., Simonsen, O.H., and Langberg, H. (2009). Determination of normal values for navicular drop during walking: A new model correcting for foot length and gender. Journal of Foot and Ankle Research 2, 12.
10. Douglas Gross, K., Felson, D.T., Niu, J., Hunter, D.J., Guermazi, A., Roemer, F.W., Dufour, A.B., Gensure, E.H., and Hannan, M.T. (2011). Association of flat feet with knee pain and cartilage damage in older adults. Arthritis Care and Research 63, 937–944.
11. Kerhervé, H.A., Samozino, P., Descombe, F., Pinay, M., Millet, G.Y., Pasqualini, M., and Rupp, T. (2017). Calf compression sleeves change biomechanics but not performance and physiological responses in trail running. Frontiers in Physiology 8.
12. What is the Kinesio Taping Method? | Kinesio Tape.