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This is compounded by poor body mechanics and alignment issues.  The commonly referred to term ‘shin splints’(Medial Tibial Stress Sydrome) is an issue that arises from poor load transfer between foot/ankle, knee and hip. Pain is usually experienced on the inside, bottom 1/3 of the tibia (shin bone). A simplified explanation of the pathology that occurs here involves a stress response (bone swelling) in the outer surface of the bone that can lead to a breakdown of the deeper bone and eventually stress fractures if untreated.

Shin splints are a load dependent injury, meaning that there onset usually occurs after a significant change in the individuals loading pattern. This includes the average Joe who decides to embark on a serious fitness campaign and runs 10km everyday after 2 years of inactivity, the post partum mother who is determined to lose those last few baby kilos and runs 2km per day and the regular runner who maintains her volume of running but increases the intensity of her workouts by adding hills. Thus exercise history, volume, intensity, duration and frequency of workouts, surfaces and footwear play a significant role in the development of shin splints. The primary aim of shin splint management is a collaborative approach with your physiotherapist to initially identify the causative factors and address them accordingly.

Biomechanical factors also play a major role in shin splints. Excessive pronation (flat feet) of the hindfoot (heel) can overload the inner shin muscles which in turn place excessive stress on the shin bone. Over-pronation can result due to various causes including poor foot mechanics, poor calf muscle strength, poor calf muscle length and poor hip/knee control. It is the job of your physiotherapist to correctly identify and treat these biomechanical abnormalities accordingly.

A good management program for shin splints will be multi-faceted starting with load modification. At the same time aberrant biomechanics are considered with treatment aimed at the causative factors. This may involve soft tissue techniques and dry needling locally around the shin and calf, stretching of calf and tight areas around the hip and muscle retraining and strengthening of hip and calf muscles. The option of providing passive support via orthotics may be an option in cases of heavy pronation. Icing and Non-Steroidal Anti-Inflammatory (NSAID) medication may also be valuable in the early stages to settle the stress response. Timeframes of recovery can be variable. In cases where overload has been the primary factor, and biomechanics are normal, settling the injury with local treatment and load modification, can render improvement in symptoms in 2-4 weeks. In cases where poor biomechanics are the primary issue, a longer muscle retraining program may take 3 months. The amount of time the injury has been present generally correlates with the amount of time required to fix the problem. Thus it is imperative to intervene early with physiotherapy assessment, in order to prevent prolonged periods of forced inactivity.


Shane O’Sullivan
Sports Physiotherapist
Prahran Sports Medicine Centre