Understanding Shin Splints by Dr. Jesse Suess

You lace up your shoes for a nice morning jog to clear your mind. You turn the corner, hit the main drag, pick up your pace and there it is again! It’s like somebody is stabbing you in the front of your leg like with an ice pick. As a runner, you’re at an increased risk of developing these types of repetitive stress type of injuries like shin splints. Anybody who has had the displeasure of dealing with shin splints understands how frustrating and mysterious this condition can seem. But in actuality, understanding the origin of this injury can help you alleviate and even prevent these injuries from occurring in the first place.

As a licensed chiropractor who's focus is on biomechanics and mobility these types of repetitive stress type injuries are something that we deal with on a daily basis. These repetitive stress type injuries all have one thing in common, and that one thing is imbalances in the biomechanics. Whether you’re a high school track athlete, a marathon runner, a weekend warrior, or somebody who relies on running as a source of stress relief the last thing that you want to be prescribed is long periods of rest.

My goal for this article is to first educate you on exactly what shin splints are, how to treat them at home, how to recognize when to seek help from a medical professional, and most importantly how to prevent them from occurring in the first place. After all, if shin splints are left untreated they can lead to more serious conditions such as stress fractures or compartment syndrome.

Understanding Shin Splints

The Anatomy and Biomechanics of a Shin Splint

Anatomically, shin splints occur due to the proximity of muscle to bone in the front of the lower leg. In this picture you can see the tibia (shin bone) and a muscle called anterior tibialis, the job of this muscle is dorsiflexion of the foot (pulling your toes up towards your knees). The pain occurs when there is inflammation of this muscle and the tendons/connective tissue that attaches this muscle to the shin bone (tibia). Long-standing muscular imbalances mixed with repetitive stress, such as running, is the perfect concoction to create chronic inflammation.

Biomechanically, every major muscle has something called an antagonist. The job of this muscle is to stabilize the opposite structures of the body while the primary muscle is doing its job. In this example, the calf muscle is the antagonist of the anterior tibialis muscle. So when the anterior tibialis is firing to pull your toes toward the sky right before your heel hits the ground in your stride, the calf on the back of the leg is also contracting to provide stability within the leg. Wait it gets even more confusing, it also works in reverse! So when your calf, who’s job is plantar flexion (pointing your toes down towards the ground) is firing during toe-off in your stride; the anterior tibialis is being that antagonist of the calf muscle providing a stable base for the motion to occur.

I hope your head isn’t spinning too much, and unless you have a minor degree in kinesiology that probably sounded like pig-Latin. But that’s okay! The main take-home point here is that the calf and the anterior tibialis (aka the muscle responsible for shin splints) work together to balance the biomechanics in the lower leg. Shin splints begin to occur when the calf muscle is significantly stronger than that of the anterior tibialis, making it very difficult for the anterior tibialis to perform its job as the antagonist. It’s like playing tug of war against a professional bodybuilder, the bodybuilder is your calf and you are the muscle responsible for shin splints. Let this imbalance occur for prolonged periods, and POOF, you’ve just created shin splints!

The Role of Ankle Pronation in Shin Splints

Pronation is when the stabilizing arches in the foot begin to collapse, causing the ankle and the tibia to rotate inwards. This causes a large amount of stress on the muscles, ligaments, and joints throughout the entire lower body. Ever wonder why over 70% of knee replacement surgeries are unilateral (one-sided), that’s because pronation does not occur symmetrically from side to side. Most often there is one foot/ankle that is more pronated than the other. Patients tend to carry more weight on the side of their body where the pronation is more progressed leaving them more prone to conditions like shin splints, ankle pain, knee pain, hip pain, and low back pain on the side that is more severely pronated. Getting your foot scanned by a medical professional who utilizes FootLevelers technology will help you determine your level of pronation and will determine if adding a custom supportive orthotic to your running shoe would be recommended.

3 At-Home Exercises to Prevent Shin Splints

Band-Resisted Ankle Dorsiflexion

Have a seat on the floor with a straight leg, take a resistance band and wrap it to something nice and sturdy out in front of you. Place the band around the top of your foot so that the band is causing resistance, pulling your toes away from your body. Once the band is in place pull your toes towards your knee in a slow and controlled motion against the resistance of the band. This will help increase the strength of the anterior tibialis muscle and help lessen the strength discrepancy between the calf and the anterior tibialis described above. Always do these exercises bilaterally (both sides) to make sure you are not developing asymmetries.

Calf/Anterior Tibialis Stretches

I always recommend that when you’re performing any at-home type stretching work you always stretch both the muscle at hand and it’s antagonist. As with resistance band injuries, make sure to do these stretches bilaterally. If you notice one side is tighter it is okay to hold the tight side for 5-10 seconds longer than the other side. Here is a good stretch for both:

Shin Splint Stretches (Standing Anterior Tibialis Stretch)

Anterior Tibialis Stretch
Standing in an upright position about 6-12 inches from a wall for support. Place the top of the involved foot on the floor and slightly push down against the floor. You should feel a good stretch in the front of your ankle and into the front of your leg to about the knee level.

Shin Splint Stretches (Standing Calf Stretch)

Calf Stretch
Standing in an upright position place the toes of the non-involved foot up against the wall. Place the involved side behind you in a lunge position about 2 feet behind the front foot (pictured below). Drive the heel of your back foot towards the floor causing a stretch into the calf.

Foam Roll the Calves/Anterior Tibialis

Foam rolling is a great at-home way to help alleviate any underlying muscle fixation or trigger points that may form. The trouble with foam rolling is that most people do it wrong. Most people just roll the foam roller back and forth until they feel good, this is mostly palliative in nature and not clinically beneficial.

Here is the correct way to foam roll:

Get into position with the foam roller perpendicular to the involved muscle group.
Slowly roll the foam roller along the involved muscle. Eventually, you will come across an area that is more tender than the rest. This is called a trigger point.
Once you’ve identified the trigger point hold in the position so that the foam roller is holding still on that trigger point, and hold for about 30-45 seconds before proceeding the roll up the involved muscle.
Repeat this process and hold foam roller over ONLY 3 SPOTS PER MUSCLE GROUP.

Here are some great positions that we recommend you use to foam roll your calf and your anterior tibialis:

When to Seek Guidance from a Medical Professional

Shin splints might seem like more of an annoyance than a legitimate medical concern when you’re experiencing them, but the reality is that they can be a precursor to more severe conditions like a chronic bone bruise, stress fracture, and anterior compartment syndrome. If shin splints are something that you experience regularly, we strongly recommend that you seek the opinion of your local chiropractor or sports medicine doctor in your area. If the symptoms progress to a severe throbbing type with associated numbness, tingling, or paralysis; this can be evidence of a more serious condition called Anterior Compartment Syndrome. This is an emergent situation, and if you experience these types of symptoms you should present to the emergency room immediately.

It’s important to remember that pain is like the smoke alarm of your body, your body’s way of letting you know that there is a problem. We can mask the pain by taking over the counter medications, applying topical creams, or using a TENs unit but this is no different than taking the batteries out your smoke detector when your house is on fire!

Jesse J. Suess, DC CCSP®
Waldwick Family Chiropractic, LLC
22 Wyckoff Ave., Suite 1
Waldwick, NJ 07463
(201) 972-6121
drjesse@waldwickchiropractic.com
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