Case Study: Shin Splints

MEET ANDREW

• 27-year-old male
• Referred by his GP for shin pain
• Recently increased his running to 5kms every second day

We first met Andrew when he came into the clinic with ongoing shin pain. As an enthusiastic runner, he had taken time out from running to rest in an attempt to fix the pain. Unfortunately, it quickly returned as soon as he attempted a 3km run. He was referred to us by his GP to find a long-term solution that would relieve his pain while allowing him to continue running.

ANDREW’S ASSESSMENT

We tested Andrew’s muscle strength, the flexibility of his joints and muscles, conducted a physical exam and assessed his gait during both walking and running. We noted that:

• Pain in the posterior tibial muscles (down the front and inside of both legs)
• Restricted motion at the ankle
• Tight calf muscles
• The inner borders of Andrew’s shoes were collapsing, causing him to excessively pronate (roll his feet inwards)
• Pronation (rolling in) when walking with bare feet

CONNECTING THE DOTS

With the insides of Andrew’s shoes worn down, his posterior tibial tendon was being heavily overworked with every step he took – and ran. This is because this tendon is responsible for helping support and raise the arch. Andrew’s pronation was also a response to the reduced movement capacity in his ankle.

DIAGNOSIS – SHIN SPLINTS

We diagnosed Andrew with shin splints. Shin splints occur when there is some damage to and inflammation of the muscles or tendons that attach to the shin bone (tibia), or of the tissue that surrounds the bone. It causes pain on the front and inside of the shins, and often occurs during physical activities like running.

With his tibialis posterior muscle overloaded and working hard, Andrew’s pain was due to this muscle repetitively pulling at its origin at the inside of the shin bone.

TREATMENT

Andrew’s treatment included:

• New supportive runners – keeping an eye on the wear patterns of the shoes over time to help prevent this from happening again
• Massage to the posterior tibialis and calf muscles
• Stretching of the tight calf muscles
• Prescription orthotics to reduce Andrew’s pronation, hence reducing the workload of the posterior tibialis to facilitate a faster return to running

RESULTS

At Andrew’s two-week review, his symptoms had reduced significantly. He was advised to begin a return-to-running programme which incorporated interval runs, more recovery days and cross-training.

Six weeks later, Andrew’s final review found him pain-free, with all his symptoms fully resolved. He had started increasing the distance of each run incrementally, and was well on the way to reaching his goal of a comfortable 5km run.