Most often associated with those who are active, this ailment can be kept at bay by taking time to warm up properly.
Repetitive stress injuries can manifest themselves in a variety of ways and can appear all over the body. In athletes, most repetitive stress injuries manifest as common overuse injuries. This can occur with the “overuse” or continued use of a muscle or tissue without an adequate recovery period. Typically, the pain associated with repetitive stress injuries first appear when an individual is performing the causative activity, like running, for example. But, as the condi- tion worsens, the pain can begin to ap- pear in activities of daily life!
An example of a repetitive stress injury is the dreaded “shin splint” or “tibial stress syndrome.” This condition is divided into two categories, Medial tibial stress syndrome (MTSS) or anterior tibial stress syndrome (ATSS). Both MTSS and ATSS can are known as “shin splints” or tibial periostitis. MTSS is predominantly caused by the posterior tibialis muscle while ATSS is predominantly caused by the anterior tibialis muscle. Both of these muscles are located in the lower leg and near the tibia (shin bone) where the pain is experienced.
Now, some more anatomy! The tibia is wrapped in a “skin” like material called the periosteum. The periosteum is rich in vascular and nerve supply, which is why it can generate pain. With overuse of the posterior and/or anterior tibialis muscles during athletic activity, they can pull excessively on the periosteum. Over time, this can damage the periosteum resulting in pain and inflammation thus leading to shin splints.
Shin splints are a very common condition. It is most often associated with active individuals, particularly those who enjoy long distance running or are involved in sports requiring extensive running, jumping, or kicking.
In its early stages, pain associated with shin splints is generally experienced only during athletic activity. However, as with other repetitive stress injuries, in advanced stages, a patient with shin splints can be in constant pain.
Risk factors for the development of shin splints include:
» Previous running injuries (particularly in the ankle)
» Running on uneven terrain
» Hill running or a sudden change in running training intensity without proper progression
If properly assessed and addressed, a patient with shin splints can respond very well to treatment. An effective way to avoid shin splints is a proper warm- up prior to activity. This can include bal- listic movements.
Warm up properly
Try these three exercises to warm up and prevent the development of shin splints before a major workout. These should be performed slowly for three sets of 10 on both sides.
1. Hip flexion-extension motion (i.e. a straight leg kicking motion)
2. Knee flexion-extension motion (i.e. a traditional kicking motion of the knee)
3. Ankle motion (i.e. clockwise, counter clockwise and up and down)
After a run or athletic activity, it may also be beneficial to stretch the anterior tibialis and posterior tibialis muscles.
Stretching the anterior tibialis muscle (standing and supported) T
he target leg is placed behind in a lunge position, while the top aspect
of the foot is placed on the ground with the big toe pointing in. Then, with gentle downward and simultaneous forward force, the foot is “dragged” slightly until a gentle stretch is felt along the shin. We generally recommend three sets of 10 with a 10–15 second hold of each rep.
Stretching the posterior tibialis muscle (sitting)
Use a long towel to wrap around the forefoot of the target leg (which is extended straight out). Then, with a gentle pull (bringing the foot back with the pinky pulling in) the knee and leg are kept straight until a gentle stretch is experienced. We generally recommend three sets of 10 with a 10–15 second hold of each rep.
When shin splints are present, there are a variety of conservative treatment methods that can be used to help. For example, soft tissue release therapy and targeted muscle stretching and strengthening techniques of various muscle groups of the hip and leg regions can be employed and beneficial.
Alternatively, assistive interventions can also be helpful. For example, kinesiology taping or “sport taping” and custom fit orthotic devices have been shown to relieve pain associated with shin splints. We recommend a thorough physical and biomechanical assessment from a trained and qualified professional in order to identify the cause of shin splints and determine a tailored and safe treatment regimen.
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Authors: Drs. Marco and Paolo De Ciantis are Toronto- based chiropractic doctors and co-owners of Sports Specialist Rehab Centre. The identical twins specialize in pain and injury prevention, working with a range of patients from athletes looking to improve their performance to individuals who simply want day-to-day tasks to be easier, in an effort to restore optimal well-being. They are regular contributors to Optimyz print and digital editions.