The pain on the front of lower leg is often referred to as Shin splint. This pain on the front of shin bone can appear due to number of causes. More often it can be categorized into overuse syndrome, resulting from rigorous training..
Gradual onset of pain over the shin bone.
Pain before and after a rigorous training
Pain eases during the training phase.
Shin bone pain is the first worst thing noticed in the morning.
Swelling or lumps and bumps felt along the inside of the bone, particularly in more chronic cases where new bone growth as occured through repeated trauma. Occasionally in severe cases reddening of the skin over the inside of the leg from acute inflammation may be seen.
The Physiotherapist needs to rule out other conditions which can mimic similar symptoms, like
- Tibia stress fracture,
- Chronic compartment syndrome or
- Poplitial artery entrapment.
What are shin splints
It is a common term which can include a number of diagnoses or causes and is not an actual injury or diagnosis in itself. It is the name athletes often give to pain along the inside of the shin bone. Medial tibial stress syndrome or medial tibial traction periostitis is a more accurate description of what is usually going on.
The muscles of the lower leg pull on the periosteum or sheath surrounding the shin bone causing pain and inflammation. This is an over use injury resulting from increasing running mileage too quickly, excessive training on hard surfaces and running on your toes as in sprinting repetitions.
Certain biomechanical factors such as over pronation (rolling in) of the feet may be seen or particularly tight calf muscles can increase the likelihood of developing shin pain.
Medial tibial stress syndrome is the most common cause of shin pain which people generally refer to as shin splints. It is primarily an over use injury where repetitive strain causes traction forces on the sheath surrounding the bone resulting in pain and inflammation.
Although too much running, jumping or sprinting is the obvious cause, there are a number of factors which can increase the likelihood of shin pain developing.
Overpronation occurs when the foot rolls inwards too much flattening the arch of the foot and causing the lower leg to rotate inwards. This in turn increases the stress on the soft tissues of the lower leg resulting in pain and inflammation.
Over supination is where the foot rolls outwards too much during the time the foot is in contact with the ground. If you think you have suspected biomechanical issues then a professional can do gait analysis tests either with a treadmill or using force plates to determine this and whether corrective orthotic inserts for your shoes are needed.
Inadequate footwear such as the wrong type of shoe for your running style or running shoes that are just too old and have lost their support and cushioning can cause injury. Over pronators may require a running shoe with a firmer midsole on the inside to reduce the amount of rolling in (known as a stability shoe or motion control shoe). Supinators usually require a neutral shoe with plenty of cushioning. A specialist running shop can advise.
Increasing training too quickly is one of the more common causes of shin splints. Running on hard surfaces or on your toes as in sprinting and generally doing too much too soon will increase the risk of injury.
Poor flexibility at the ankle can cause increased stress on the soft tissues, muscles and tendons of the lower leg when running. The calf muscles and in particular the tibialis posterior muscle may need stretching. Calf stretches of the use of a plantar fasciitis night splint can help.
Shin splints treatment
Treating shin splints involves reducing pain and inflammation, identifying and correcting training errors and biomechanical problems and restoring muscles to their original condition through stretching, exercises and massage.
Apply the PRICE principles of protection, rest, ice, compression and elevation to reduce initial pain and inflammation. Apply a cold therapy and compression wrap to the painful area of the shin for 10 minutes every hour initially reducing frequency to 3 or 4 times a day as symptoms improve.
Rest – avoid running, jumping or any other activities which make symptoms worse. Replace running with swimming or cycling. If you have to be on your feet a lot then applying a simple shin taping technique can reduce the strain on the lower leg helping rest the soft tissues and often may instantly relieve painful symptoms. Taping can be applied all the time until pain has gone and then occasionally during exercise as activities levels are built up.
Protect and support the area with a shin splint sleeve or compression support. This will help keep the muscles warm and supple as well as providing support to the inflamed tissues.
A doctor may prescribe anti inflammatory medication such as Ibuprofen in the early or acute stage (do not take if you have asthma) and orthotic insoles to correct biomechanical problems of the foot may be prescribed. A full rehabilitation program with exercises, particularly stretching for the calf muscles is important with a very gradually return to full fitness. Finding a shin splints cure involves combining a number of different treatment techniques together.
Sports massage can be used to reduce tension in the muscles of the lower leg which may be causing traction on the bone. Removing any tight lumps, bumps and knots as well as encouraging blood flow may aid the healing process. However, it is important to avoid the bone as massage for shin pain done incorrectly may increase inflammation and pain. Read more detail on treatment & rehabilitation.
Exercises to stretch the muscles of the lower leg are important, in particular calf stretching exercises will stretch the tibialis posterior muscle which is often associated with shin pain. Calf stretching exercises should be done both with the knee straight and bent. Strengthening exercises may also be required although being an overuse injury it is rest and stretching which should be the priority. A gradual return to full fitness is important. Calf raises and toe raise exercises can help get the muscles of the lower leg working again. Read more on exercises for shin splints.
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