Shin Splints, Orthotics and Physical Therapy

Shin pain can be an aggravating injury, regardless of what time during your season it takes place.

Let’s  define the shins as your tibia, the main bone in your lower leg, and the tibialis posterior, the muscle behind your tibia. Many athletes experience shin pain for a few different reasons. While it’s important to understand why your shins hurt, it’s also convenient to know how to prevent the pain from happening and treat if it surfaces.

Three ways shin pain occurs

Shin pain can simply start when you decided to try a new activity. When your body is not used to a certain activity placing more strain or force on the body, the shins can absorb much of that force and begin to ache.

Shin pain can also begin when you decide to use improper or worn-out footwear.

Lastly, shin pain can come around during the end of an athletic season or at the end of a lengthy training program due to repetitive microtrauma that can eventually lead to an injury.

Prevention

To prevent shin pain, make sure that you enter a training program that is appropriate for your current fitness level. When you are ready to progress in time or intensity, progress wisely and utilize the 10% rule where applicable.  For instance, add 10% more mileage to your run.

Make sure that you are using the proper footwear for your activity and your walking/running style. Most specialty running stores can watch you walk/run and, therefore, suggest the proper footwear for you.

It’s not usually the best idea to run in those shoes that you’ve had for years.

Lastly, be on the lookout for small aches in your lower legs. If the pain is truly your shins, this is your body telling you something is wrong with your training equation. Take a look at what you may be doing and adjust your activity accordingly.

Another name for shin splints is tibialis posterior tendonitis, which is an overuse syndrome.  Reducing the excessive stress through ice and rest is the initial treatment to this condition.  Training that is excessively progressive can result in this tendonitis.  But what if your training is well supervised, but this aggravating condition still occurs?

There is a relatively common condition called a varus foot deformity.  This condition sounds scarier than it is.  A varus foot deformity is where the sole of your foot angles inwards, meaning in your ankle’s neural position you tend to weight bear on the outside of your foot.  Patients who have this foot deformity appear to have a healthy arch of their foot in a non-weight bearing position, but upon weight bearing the arch disappears or collapses.  This collapse of the arch is called over pronation.  The tibial posterior is one of the main muscles that controls pronation.  Pronation of the foot is a common movement after your heel contacts the ground until your toes contact the ground.  This movement absorbs shock and allows your foot to accommodate to the surface it is walking on.  When this pronation becomes excessive, the overuse syndrome occurs causing tibialis posterior tendonitis. iStock_000015504497Medium

Sometimes strengthening the ankle to improve its stability will remedy the problem, but if strengthening is not enough then an orthotic will prevent this over pronation.  Orthotics work differently than arch supports because orthotics support the heel and ball of your foot, while an arch support causes you to weight bear on your arch.  Arch supports do not make theoretical sense because our feet are not designed to weight bear on our arches.  I usually describe how your foot print looks in the sand to describe this.  However, arch supports are widely used because they can provide symptom relief, but are not always successful for posterior tibialis tendonitis.  The best method is to see a skilled physical therapist in orthopaedics to determine the cause of your shin splints and what the best method is for you as an individual with this condition.

Joe Flannery, PT, DPT, OCS, CIMT is the Clinical Director of the Williamsburg location.  He is Direct Access certified and sees patients without a prescription.  For an appointment with Joe, contact the Williamsburg Clinic.

Jared Howell, ATC practices in the Williamsburg Clinic as well and is also the onsite ATC for Walsingham Academy.