Category Archives: Shin Splints

All you’ve ever wanted to know about shin splints…

Taping for shin splints

Materials:

You can use any type of “stretchy” support.  In the following photos and descriptions, the material that I’ve use is called “Powerflex” and it’s made by a company called Andover.  It adheres to itself and does not have any type of “sticky” surface (so no pre-wrap required).

That said, you can also use a sticky tape (but be sure to use pre-wrap so you’re not waxing when you remove it) or an Ace bandage – just be sure to anchor it with tape and not the metal clips (they can fall off/cause cuts and other injuries).

The process:

  • Start with the athlete standing up, partial weight on the affected side.  Slide a roll of tape under their heel to elevate it about 2 inches.  With part of their weight on the toes they will contract the calf.  This prevents the tape from being “too tight” and cutting off circulation after.
    • Begin wrapping the tape from medial to lateral (inside to out) just about the malleoli (the ankle bones on the inside/outside).  Be sure to fully overlap once, and then begin a diagonal up the leg.
    • Continue up the leg.  Pull on the tape somewhat so that there is a moderate stretch (this will compress and anchor the lower leg muscles to the shin, thus decreasing the force on the periosteum).  As you wrap, be sure to overlap the layer below by 1/2 (so each layer is double thick).
    • When you reach the top of the shin, stop at the tibial tuberosity (the bump on the front of the shin just below the knee) and anchor with a full overlap (the same as the start point). Then wrap at a downward angle to anchor.  Tear the tape here.
    • Using sticky, non-stretch tape.  Anchor this piece (so it doesn’t come loose). 
    • Have the athlete move the foot and ankle and check circulation in the foot (make sure there is still pink under the toenails).  The final product should look like the photo below.
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Therapeutic Resistance Bands

So, while there are many levels of resistance bands, I’ll start by describing those that I use in the clinic (and are provided in the Gymkana gym).

The levels are progressive, building from an easy to more difficult level.  Because the band stretches to provide resistance, the amount of resistance increases the more the band is stretched (keep this in mind when you are anchoring it while you are exercising).  Also know that the bands have a breaking point – if you are pulling as hard as you can and you can’t get enough resistance, move up a band (rather than snap it on yourself – it is painful).

The levels progress from easy (1)  to hard (5) and super (6):

  1. Yellow
  2. Red
  3. Green
  4. Blue
  5. Black
  6. Silver (these are not as common)

For you Gymkana folks, there is a box of these bands by the taping table/cabinet.  These are FREE for you all to use.  Feel free to take a band with you, but when you progress please bring it back and exchange it so there are enough to go around!

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!

Shin Splints

Shin splints (also known as medial tibial stress syndrome or tibial periostitis) is the term used to describe pain and inflammation along the tibia in the lower leg.

Etiology:

Shin splints are a common complaint among all rebound athletes (runners, gymnasts, dancers, etc).  Although there are a variety of different causes, shin splints are generally accepted to be a cumulative stress disorder rather than an acute injury.  This means that they are not sudden in onset (though the pain may occur suddenly).  Rather, they consist of many overlapping factors that eventually overwhelm the leg and lead to pain.

Causes:

Traditionally, shin splints occur with unusual loading on the lower leg during activity.  In this case “unusual loading” could be due to an increase in force (weight gain, higher forces with new landings), a sudden increase in activity (too many rebound skills at the beginning of the season or more walking/running than usual), or poor anatomical loading (flat feet, bad footwear, weak & de-conditioned muscles).  The body is designed to “repair” itself by adapting to new forces.  In the case of shin splints, the body is overwhelmed and the bones/muscles can’t keep up.  The end result: lower leg pain with walking, running, jumping, and sometimes just pressure over the area.

Pathophysiology:

The “shin” or lower leg is composed of two bones.  The tibia and the fibula.  The tibia is the weight-bearing bone while the fibula acts as a stabilizer and an attachment point for muscles.  The bone are connected by a thick, fibrous membrane known as the interosseus membrane.  This is what gives the lower leg stability, provides attachments for deep blood vessels/nerves, and anchors many of the lower leg muscles.

The tibia and fibula, like all bones, are covered by a saran-wrap-like cover known as periosteum.  This tissue protects the bone and allows for its nutritional support.  It is very tough and inelastic which prevents it from stretching and gives it its strength.  Small fibers known as Sharpey’s fibers connect the periosteum to the muscles and fascia (connective tissue) of the lower leg.  With normal running/walking, the anterior tibial muscles contract to slow the foot down on heel strike (prevents your foot from “slapping” the ground).  This contraction pulls on the tibia (periosteum) and stresses the surrounding fascia. When an activity changes and the muscles pull on the Sharpey’s fibers (attached to the periosteum) more than usual, the periosteum (and the underlying bone) have to adapt by becoming more thick and dense.  In the case of shin splints, the forces are too great and too frequent, and the periosteum cannot adapt fast enough. It becomes inflamed (swollen) and causes irritation/pain along the length of the bone.  In many cases, the swelling can be palpable (small squishy bumps along the length of the tibia) and even a gentle touch can be very painful.

In severe cases, when pain is ignored and the activity is continued, the tibia itself begins to break down.  Small stress fractures (hairline cracks) develop as the bone cannot build its density up fast enough to deal with the forces placed along it.  If left untreated, the tibia itself becomes more prone to pathologic fracture (meaning fracture with a lower stress than expected).

Gymnasts are more prone to shin splints for several reasons.  First, they train barefoot.  The muscles of the foot and lower leg have to work harder to maintain the shape of the foot and stabilize the ankle without a shoe, thus increasing the pull on the periosteum. Second, the surfaces are more firm and the impact is transferred up into the tibia.  Third, the landings are heavier and more frequent than most other sports.  While a runner’s foot strikes the ground 760 times per mile, it is from a height of 2-4 inches.  A gymnast’s foot strikes the ground less frequently (not including the run in a vaulting/tumbling pass), but from up to 8 or 10 feet off the ground.  I’m not a physicist, but if F = ma then it’s a wonder every gymnast isn’t walking around with this injury.

Treatment:

What you’ve all been waiting for I’m sure…The most commonly accepted treatment for shin splints is rest.  However, while effective, this is useless for the gymnast in training or in the middle of competitive season.  Plus, once you’ve rested, you still have to strengthen to prevent them from a speedy return!

  1. Ice: In the early, middle, and late stages ice is a key factor in dealing with the pain.  Ice over the shin for 15 min after ANY ACTIVITY (this includes walking to and from class) to decrease pain (ice slows the transmission of the pain signal along the nerve) and to decrease swelling (along the periosteum/interroseus membrane).  Be sure to keep a layer between the skin and the ice to prevent ice burn.
  2. Strengthening: using ankle and foot exercises to strengthen the muscles of the lower leg and foot is key.  There are several methods to use (photos to follow soon).
  3. Wearing a shoe with a good arch support (if you’re flat-footed) can help rest the lower leg muscles

    Footwear:  While a change of footwear in the gym isn’t practical, a change for every other activity of your life is.  Toss the flats, the heels, the flip-flops, and the Crocs.  Put on a pair of sneakers with a good sole and cushion.  It doesn’t matter much the type (barefoot, neutral, motion-control, or stability) – rather it’s the support and the shock-absorption that are key.  If you have a very flat foot, try a more supportive shoe (motion-control or stability) whereas if you’ve got a good arch, a barefoot or neutral shoe might work for you.  The reason this matters is that the lower leg muscles support the arch of the foot – so if you add external support for that arch, you give them a rest.  You could even try buying an arch-support insert and putting it in your current shoe (I know money can be tight).

  4. Skill progression: If you’re working new skills, build up your tolerance on that piece of equipment.  Start with 10-15 minutes of DMT/tumbling one day and add up to 5 min to that number per week. (And here’s where I know I’m going to lose some of you).  It takes your body time to adapt, and if you’re pushing through the pain, odds are you are making the problem worse and prolonging your recovery.  Also – try running more on the balls of your feet.  (This means avoid heel striking by taking shorter steps).  This will give those muscles a break and allow you to keep training.
  5. Taping/external bracing: Using an ace wrap around the shin or having a coach do a compression tape can help support the periosteum/muscles in the short-term.  Just know that this is a temporary fix and ultimately strengthening and activity progression are the only true cures!
  6. NSAIDs: Non-steriodal anti-inflammatories.  These common over the counter pain medications can help take the edge of the pain and decrease the inflammation.  Good right?  Well – mostly.  Be sure to stay within the recommended doses, take with food, and only take for a few days time.  They are tough on the digestive system and can slow the rate of healing when used in excess.  As a general rule, check with your doctor if you’re unsure of how these can affect you and/or if you’re on other medication to prevent interactions.
  7. Nutrition: As a general rule, getting the right amount of calcium and protein are essential in preventing and treating shin splints.  If possible, it’s worth avoiding foods that can increase inflammation in the body, such as: fatty meats, fried foods, whole milk, sugary foods, processed grains (white bread, etc), foods with excess salt, and butters/oils.  Be sure to stay hydrated and if you’re really working out hard, add a low-sugar sports drink to replenish minerals and prevent muscle cramping (could make the shin splint pain worse).

Summary:

  • Shin splints is the term for generalized anterior lower leg pain
  • Caused by repetitive impact activities (running, jumping, walking) and the body’s inability to adapt to new forces
  • Treatment: rest (if possible), Ice for 15 min after activity, strengthening (see attached), NSAIDs, and improved footwear when not training (sneakers vs. flats/flip-flops)