As a chiropractic sports physician in Los Angeles, Beverly Hills, West Hollywood, and Palm Springs, I see numerous sports injuries limp into my practice. Some are easy to treat, others are tricky. One such injury is shin splints. Shin splints can be difficult to resolve simply because athletes that develop them continue to take part in the sport that exacerbated them, and so this injury becomes a repetitive strain situation. However, shin splints can be treated, and ultimately they can be prevented from recurring allowing the athlete (or weekend warrior) to return to the activities they love doing. Let’s take a look at shin splints.
Causes of Shin Splints
Shin splints, also known as medial tibial stress syndrome (MTSS), is a painful condition of the legs that afflicts runners, basketball players, soccer players, and dancers, or any other athlete that runs for extended periods of time. Shin splints are felt as a pain in the leg either in the front or the back, and can hurt with every step. The shins will usually be sore to the touch, but it’s most commonly a diffuse pain and not spot specific.
Shin splints is called a stress syndrome because over time the stresses that are placed on the tibial bone can ultimately lead to a stress fracture, a similar yet different problem altogether. The shin is comprised of two bones, the tibia which is the sharp bone that runs down the center of shin itself, and the fibula, which is on the outer portion of the leg.
There are a few structures that run along these two bones that are major players in shin splints. The first is a connective tissue called the interosseous membrane, which separates the muscles on the front of the leg from those on the back. This membrane is like a piece of Saran wrap, and if you can visualize crumpling it up, then you can understand what can happen sometimes to this membrane acting as one factor leading to and exacerbating shin splints.
When the interosseous membrane binds up, it prevents the free movement of the tibia on the fibula. This movement is necessary for proper leg biomechanics during walking, running or jumping, and thus if bound up, the leg can’t function through its full range of motion. This can lead to shin splints.
The second structure important to the shin is the tibialis anterior muscle, which also sits between the tibia and fibula bones. This muscle pulls the foot upward in a movement called dorsiflexion. Dorsiflexion is an important movement in walking, running and jumping, and if the tibialis anterior muscle gets weak, shin splints can result. Flat feet, otherwise known as pes planus, can cause the tibialis anterior muscle to become weak. This is a relatively common structural dysfunction that can be corrected; we’ll talk about how later.
The final structures important in shin splints are the calf muscles—the gastrocnemius and soleus. When these muscles get tight, they can inhibit the tibialis anterior and other dorsiflexors of the leg, as well as present extra stress on these muscles fatiguing them. This, in turn, can lead to shin splints.
Treatment for Shin Splints
Shin splints have to be addresses from several angles to bring relief. The way this condition is approached depends on whether the leg pain and discomfort is acute or chronic. In my Beverly Hills and Palm Desert chiropractic clinics, I treat acute shin splints with and ice massage. Ice will reduce any inflammation, pain and swelling caused by acute shin splints.
An ice massage can be done at home by taking a Dixie cup, filling it with water, and then placing it in the freezer for a few hours; you will then have the perfect tool for an ice massage (ice bath). You can run this block ice up and down the front of your leg where you are feeling pain, and temporary relief should occur. For a demonstration on how to use an ice block massager, watch the video below.
Chiropractic Adjustments for Shin Splints
As I discussed above, shin splints can be directly caused or indirectly exacerbated by a bound up interosseous membrane. When this occurs, it is necessary to open up the area. This can be done with a chiropractic adjustment, a chiropractor, and a drop table. Chiropractic drop tables use the force of gravity to make the adjustment. If you watch the next video below, you’ll see a chiropractic drop table adjustment in action. It sounds much worse than it is; in reality, the adjustment feels real good, and when people stand up following the treatment, they experience a ‘lightness” in their step—it’s pretty remarkable how immediate the relief is. Usually a few adjustments are needed for the interosseous membrane to stay unbound. Add in some ice and stretching and you’ll have perfectly sound shins within no time.
Most of my West Hollywood and Coachella Valley chiropractic clients know the weight I place on stretching. Stretching, in my opinion, is so important that if you said you could only do one physical activity in a day, that’s the one I would recommend. When it comes to correcting and treating the leg pain associated with shin splints, stretching is a must.
Remember the muscles we talked about in the beginning—the tibialis anterior and the gastrocnemius/soleus complex. The tibialis anterior is in the front of the shin and it dorsiflexes the foot. Essentially, it pulls the foot upward. When stretching a muscle, one must take it in the opposite direction of how it contracts. Therefore, to stretch the tibialis anterior, one must plantarflex the foot, or point the foot downward, like a ballerina.
There are numerous ways to stretch the tibialis anterior. The one I like the best is something we do in yoga. You basically go down onto your knees with the tops of your feet flat on the floor. You then sit on your feet—this will stretch the tibialis anterior quite nicely. Go ahead, try it now. Feels good doesn’t it? It especially feels good when this muscle is tight, like in people with shin splints.
Tight calves can also cause shin splints so stretching the gastrocnemius and soleus complex is very important. You can do this stretch in many ways also, but my favorite stretch for this area is done by hanging off a stair. If you have tight and painful calves and you reside in the Los Angeles, Beverly Hills or West Hollywood areas, call my chiropractic office. I will assess you, treat you and show you stretches to relieve your calf pain and prevent them from causing shin splints in the future.
Prevention of Shin Splints
Shin splints can be prevented as well. In this regard, you’ll need to engage in the three “S”s—strengthening, stretching and support.
Because shin splints are often caused by weakened, stressed, inhibited, and fatigued muscles, strengthening them is imperative. The muscles that have to be strengthened are the tibialis anterior and other dorsiflexors. This can be accomplished by standing slant against a wall, and lifting the foot and toes toward the ceiling—just the opposite of what you would do during a calf-raise—this strengthens the dorsiflexors very effectively.
Another excellent exercise is walking on your heels. You can do this in three orientations: Heel walk with feet pointed outward, with feet pointed inward, and feet straight ahead. This hits all the dorsiflexors and not just the tibialis anterior.
When you build up a little strength, you can make the heel walk a little more challenging by increasing your stride. Then you can add a little plyometric-type strengthening by jumping on your heels, and also by walking or running down steep hills. A word of caution, though—see your sports chiropractor for a complete evaluation before undertaking either the jumping or downhill walking/running exercises to prevent injuries.
The most common cause of shin splints is dysfunction of the foot. Overpronation or underpronation can both cause weakness in the dorsiflexors muscles. Overpronation occurs as dysfunction in response to pes planus, or flat feet. Flat feet occur as a result of the arch of the feet collapsing. This in turn forces an over turning in of the foot and leg during the “toe-off” phase of the gait cycle. This essentially means that when someone with flat feet launches off their big toe, they turn their foot inward excessive to propel themselves forward. Not a good thing, as it creates a chain of events up the leg and thigh that can lead to a litany of problems, one being tibialis anterior weakness and fatigue. Underpronation, on the other hand, is caused by high arches, and it too can cause many disorders of the feet and legs. The solution to both of these problems is being fit for custom-made orthotics.
Custom orthotics are made for the client’s foot specifically. Everybody is different—that’s no big unearthing, we all know that—so for an orthotic to be effective, it must be made specifically for each persons’ orientation and structure. So why then are people told to buy over-the-counter shoe inserts, like Dr. Scholl’s or even that a particular shoe can help with their foot dysfunction? Exactly, they don’t correct a large portion of foot problems. Saying that, a percentage of people get some relief from some conditions so they are not totally useless, but in many cases, they don’t do squat. Save your fifty bucks—get checked and cast for custom orthotics, especially if you are having a painful condition like shin splints.
If you are having leg pain and calf tightness from shin splints, contact a Los Angeles and Palm Springs sports chiropractor for a complete foot and leg evaluation. If shin splints are your problem, a good sports chiropractor will treat you with ice, a chiropractic adjustment, appropriate stretches and exercises, and custom-made orthotics. In my practice, I treat a lot of athletes like runners, soccer players and dancers. These athletes know how important a full recovery is to returning to the activities they love. At the West Hollywood Healing Art Center we get people back to living the lives they love, because that is what it’s all about.
-February 8, 2010