Beginning Therapeutic Exercise for Shin Splints

Strengthening:

So, now that you know the importance of it, how do you strengthen to prevent or treat shin splints?  There are a variety of ways and which you choose will depend on:

1. the severity of your shin splints
2. the intensity of the rebound apparatus (impact activities) you’re involved in and
3. your baseline strength level.

My recommendation is that everyone begin with the exercises listed below (on the attached PDF).  These exercises are dosed for daily use – this means they aren’t designed to strengthen by adding bulk.  Rather the goal is to build endurance and retrain the neuromuscular system (basically make these muscles faster and more efficient).  This is why it’s okay to do them everyday.  That said, do them AFTER you practice or workout – not before.  Since they are designed to fatigue, if you do them before practice/exercise, it’s likely your performance will suffer and you might actually increase your risk of injury!

Introductory Therex (Stage 1):

* Note: the dosage is on the attached PDF – the descriptions below are just to help clarify!

Shin splints – introductory therapeutic exercise

Breakdown of the exercises on the sheet:

(see the section in the “rehab modalities” category for the levels of resistance bands)

Page 1:  PREs (progressive resistive exercises)

These exercises are done with resistance bands.  As mentioned before, the muscles that control the ankle are located along the tibia/fibula in the lower leg and are the same muscles that contribute to shin splints.  At the ankle, there are four directions of movement: dorsiflexion (ankle/foot flexion), plantarflexion (ankle/toe point), inversion (tilting the ankle in), and eversion (tilting the ankle out).

1. Theraband resisted dorsiflexion: Hook the band around the ball of your foot while it is pointed (with the heel free to move – either rest the back of the ankle on a towel roll or on the edge of the table) and slowly pull the toes and foot up to a flexed position.  The key to this is a SLOW motion both in the exercise and the return to the starting position.  This will require a partner to hold the band OR you can tie it to a chair/doorknob and do it yourself.
2. Theraband resisted plantarflexion: The exact opposite of the above exercise.  Start with the foot flexed, loop the band around the ball of your foot and point the toes.  You can hold the band yourself with this one, but again – focus on a slow and controlled motion.
3. Theraband resisted inversion: (this is when you pull the ankle INWARDS).  Cross the other leg on top to provide a fulcrum for the band (or have a friend hold it for you).  Wrap the band around the ball of your foot and then loop the length of the band around the other foot.  Without turning the leg, twist the ankle and foot inwards against resistance.
4. Theraband resisted eversion: This is the exact opposite of the last one (this is where you pull the ankle OUTWARDS). Start seated, with your legs about a foot apart.  Wrap the band around the ball of the foot and anchor it around the other foot so you can pull the ankle out (of have a friend hold it for you).

Page 2:

1. Calf stretch (on the step): Stand on a step and hang one heel off the back.  Keeping the leg straight, drop the heel off the step until a stretch is felt in the back of the calf/heel and perhaps into the foot.  Be sure to keep the stretch gentle and have the other foot firmly on the step – it can also be beneficial to have something to hold onto so you aren’t balancing yourself too (this takes away from the stretch).  The ideal hold time is 30 seconds (it takes 20 seconds for the muscle to even begin to stretch).
   Why stretch? Well, if the calf is tight, the gastroc/soleus (main calf muscles) will put additional stress/strain on the anterior lower leg muscles (by overpowering them during activity) which leads to increased force along the periosteum and the interosseus membrane.  As mentioned in the article on shin splints, this overwhelming of forces is a main cause of the associated pain.
   
2. Single leg balance: This trains isometric contraction (meaning contracting without changing muscle length) in the lower leg muscles.  It also improved balance and makes your landings safer and less jarring on the shin.  To make the exercise more challenging, try closing your eyes or standing on a wobbly surface (an 8-inch mat or a pillow work great).
3. Heel raises: Seems simple enough right? Wrong – doing these right involves a SLOW up and down without the ankles rolling out (twisting) and without you moving you feet.  If it feels easy, you’re doing them too fast.  Focus on a slow controlled motion and be sure to tighten all the muscles in your core throughout.
4. Ankle alphabets: Sitting with the ankle free, write the alphabet with your foot and ankle (be sure to keep the lower leg still).  Make BIG, CLEAR letters and go SLOW!

Page 3:

1. Toe curls: (aka towel scrunches) Sitting in a chair, lay a towel out on the floor.  Using the toes and foot, scrunch up the towel.  You can do a certain number of reps (as listed on the PDF) or do it for a set amount of time – I recommend about 3-5 minutes.
2. Seated ankle dorsiflexion: (against gravity with a weight):  Wrap a cuff weight (between 2-5 lbs) around the foot.  Slowly lift the foot up from a pointed to a flexed position and then return.  You should feel this along the length of the shin, but be sure to keep the weight in a comfortable range – you don’t want the “burn” to be more intense than a 3-5 out of 10.

If you have any questions, drop a comment below and I’ll get back to you!  And be certain to ICE afterwards!