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Lower leg pain can be caused by a variety of different issues. A stress fracture of the tibia or fibula can be indicated by increased pain with jumping, pain at rest and at night. Compartment syndrome, pain worsens with exercise and a sense of tightness and maybe a sense of “dead foot”. Once these issues have been eliminated it is usually the inflammation of the lower leg that is causing pain. These are generally categorized into either Anterior-lateral shin pain which is anterior (front), lateral (outer side) of the tibia or posterior-medial pain which is the distal (refers to the structure being furthest away from the root of the limb), medial (inner) posterior (back) of the lower leg. (Lowe 1997)

Anterior-lateral (AL) shin splints is usually caused by over use of the dorsiflexors and often the inversion of the foot, which is when the bottom of the foot turn inwards. Dorsiflexion is when the toes are lifted towards the front of the shin. The muscles used in dorsiflexion of the foot are Tibialis Anterior, Extensor Digitorum Longus and Extensor Hallucis Longus.

What are the muscles and where are they located that involve shin splints?

1.The Tibialis Anterior (TA) runs along the front of the lower leg or the area commonly referred to as the shins.
2.Extensor Hallucis Longus (EHL) starts halfway down to the right of the shin (right leg) and runs all the way down to the big toe.
3.Extensor Digitorium Longus (EDL) starts at the right upper two thirds and top at the front of the lower leg (right leg).and runs to the 4 small toes.

Why is this important to know?

The nerve of the muscles is an important factor in the treatment of the injury. Often individuals incorrectly believe where they feel pain is the only source of the problem. The real issues of an injury often lie elsewhere. On this note it is important to keep mobility in the lumbar back and sacrum, (the part of the spine below the lumbar) to assist with the rehabilitation of this injury. The origins and insertions are also crucial in dealing with an injury so massage can be performed on these sites.

What is it caused from?

Anterior-lateral shin pain often is a result of excessive loading when the foot is extended down, ie when pushing the accelerator down in a car. The extensor muscles which are aggravated in anterior-lateral shin pain is often caused from kicking a football, pedaling a bike, wearing high heels and running especially stairs. (Davies 2004)

Where as the second type of shin splints is located at the calf muscle towards the inside of the leg which is the over use of muscular structures that stop your foot from pronating or tilting to the side (your big toe & heel is on the ground while your toes are in the air) The  primary muscle is tibialis posterior that starts from the middle of your lower legs and runs to under your foot. (Lowe 1997)

How do I treat this problem?

1.Initial treatment to reduce inflammation is R.I.C.E, (rest, ice, compress and elevate). Alas “rest” is not in most athletes vocab!!

2.Applying direct pressure to the skin of the calf muscle (soleus) , Flexor Digitorum longus (the muscle the runs from underneath the calf to underneath the foot) and (TA)Tibialis Anterior.  The effect may be enhanced by pressing your foot up and down whilst this pressure is applied.
Tranverse frictions, (which is oscillating pressure applied transversely to direction of the muscle fibers with no movement between the therapist’s digits and underlying skin) on regions where there is thickening of the soleus and EDL. Sustained longitudional pressure applied to the direction of restriction can be applied parallel to the tibial border. (Brukner 2005) Trigger points in TA, EDL and EHL need to be deactivated also. (Davies 2004)

How to avoid or rehabilitate such an injury?

1.Significant biomechanical abnormalities may need correction with orthodics and training may need to be modified. 2.Wearing appropriate footwear and running on shock absorbent surfaces.
3.Keeping ones body flexible with stretching and maintenance with regular massage will help avoid anterior-lateral shin pain.

Bibliography

•    Brukner & Khan 2005, Clinical Sports Medicine, McGraw Hill, Australia.
•    Davies C 2004, The Trigger Point Therapy Workbook, New Harbinger Publications, USA.
•    Lowe W 1997, Functional Assessment in Massage Therapy, OMERI, USA
•    Stone R & J 2006, Atlas of Skeletal Muscle, McGraw Hill, USA

Kerrie Baumgartner
Diploma of Remedial Massage
Victoria University
0402 125962
rungirlgo@hotmail.com