Shin Splint Pain: Treatment and Prevention

Shin Splints are incredibly painful and disruptive to athletic training. They are usually the result of a muscular imbalance between the anterior and posterior tibialis muscles. During walking or running, the anterior tibialis eccentrically contracts as the foot lowers after heel strike. The posterior tibialis pronates the foot during midstance and into toe-off. As paired muscles, they must work together in a well-coordinated fashion. If the muscle timing is off on either side, the other muscle is effectively "torn" away from the bone (microavulsion). For this reason, pain is encountered on either the front or back of the shin, often for days after strenuous use.

Isolating the cause requires some investigation. Simple causes include insufficient warm-up or running in sand. In more complicated cases, any anatomical misalignment or imbalance in the foot, ankle, knees, or pelvis can be a contributing factor. Frequent and prolonged sitting can also jam the 4th and 5th lumbar vertebrae, affecting the nerves which trigger these muscles to contract at the proper time. Essentially, the entire kinematic chain, from the feet to the head and jaw, must be considered in chronic cases.

Acute treatment should include mild massage toward the heart, including ice massage, if severe. Rest is important after a flare-up. Essential Fatty Acids (cod liver oil) should be consumed to help with inflammation. Consistent and regular stretching is not only therapeutic, but preventive when executed prior to a race. I have two favorites that I recommend to patients. First, prop up your foot against a wall, keeping your leg straight, then gently lean forward. A stretch should be felt deep within the calf. Next, put the back of your toes on the floor and gently press the ankle forward. A stretch should be felt in front near the shin.

A proper diagnostic work-up should include manual muscle testing of each muscle involved, a visual gait assessment, neurologic exam, and shoe inspection. The chiropractic realm of medicine is especially well-equipped to address spinal issues (which are usually responsible for the timing problem). Shoe wear and gait should also be evaluated by a professional applied kinesiologist to get rapid and lasting results. For information on professional applied kinesiology, visit the International College of Applied Kinesiology online.

Once the muscles, spine, and shoes are corrected, proper warm-up should be sufficient in preventing recurrence. If swelling and/or extreme redness occurs, see a medical doctor immediately, as this is a sign of more serious pathology.