Shin Sins
Overload injuries come in all different shapes and sizes, as we load various parts of our body. One of the most common overuse injuries seen is shin pain. ‘Shin splints’ is a broad term for any pain along the shin. There are several different types, the most common of which is Medial Tibial Periostitis (MTP), or more simply, pain on the inside of the shin bone.
SO WHAT IS THE MAIN CAUSE OF MTP?
Generally MTP occurs when you have run too much, too early, too soon for the bone and tendon to adapt. There are two parts to this overload:
1. Pure impact through the tibia (shin bone), a long bone. When a long bone is given impact through its two ends, the bone will bend slightly at its weakest point (mid to three quarters along its length).
2. There is a muscle that assists in holding the arch of your foot up, which originates along the inside of your tibia. Every time you weight bear through your foot, your arch collapses to absorb impact and pulls on the tendon that is attached to the tibia.
SO WHAT IS THE ANSWER?
Loading up the bone progressively! We are referring, of course, to impact activity, such as running and walking. When recovering from MTP, this can be as little as one minute run, then 4 minutes walk repeated for 20 minutes. If you have not had MTP, but want to prevent it, I recommend 3 running sessions per week ensuring a rest day between each run. Increases in running duration should be just 5 minutes per session, per week.
Professional athletes can run greater than 100km per week, running every day. However they have built this up over a period of time, and would have good bone density. Conversely if someone hasn't run for 6 months or more, and suddenly runs 20 minutes, three times a week, this may prove to be too much. A progressive running program must be tailored to your fitness and your needs.
EXTRA HELP
A few other things can help. .
• Impact surfaces. Harder surfaces will load the bone up more. eg concrete Vs dirt or grass.
• Shoes. Old shoes may have less shock absorption and decreased arch support.
• Inserts. Most people will find assistance from both cushioning inserts (improving absorption) and orthotics/arch inserts (arch support). Remember, this is not the answer, but it may increase your tolerance to load.
• Achilles/calf strength. If your calf has good strength and endurance, it will absorb more of the impact rather than transferring it to your shin. You should be able to do at least 20-30 single leg calf raises.
• Range Of Motion (ROM). If you have greater ROM in your ankle you have a greater amount of time to absorb the force and therefore decrease the impact.
Well there it is gang, a quick look at the most common type of shin pain. Keep training, but be smart.
If you have any further questions about this article, email me:
karen@physios-online.com
Karen Finnin
Musculoskeletal Physiotherapist
BAppSc(Physio),MMuscPhys