Physical Therapy for Shin Splints

Shin splints may prevent you from running.
Your physical therapist can help evaluate and treat your shin splints. Yuri_Arcus/Getty Images

Shin splints is a term for a painful condition called medial tibial stress syndrome.  The hallmark of shin splints is pain in the front of your shin bones of your lower leg or legs.  It is usually caused by overuse or repetitive strain of your anterior tibialis muscle where it attaches to your tibia (shin bone).

Symptoms of Shin Splints

Common symptoms of shin splints include a sharp pain in the front of the lower leg during or after walking or running.

 You may experience a heavy of full sensation in the front of your shin as well.

Symptoms of shin splints are usually brought on or worsened by walking or running and are typically relieved by rest.  In acute cases the pain lasts even while you are resting.  Chronic pain from shin splints may limit your ability to walk or run, and this can have a profound effect on your ability to exercise or participate in sports or other recreational activities.

Causes of Shin Splints

The muscle in the front of your shin, called the anterior tibialis, works to pull your foot and toes up from the ground.  When this muscle and the connective tissue that attaches the muscle to your shin bone gets irritated, pain results.

​One of the challenges of treating shin splints appropriately is that there may be many causes of the pain.  Common theories of the cause of shin splints include:

  • Improper foot position while walking or running
  • Tightness in the calf muscles
  • Weakness in the anterior tibialis muscles
  • Weakness in the hip muscles
  • Overtraining during athletics 

One or many of these problems may be causing your shin splints.  For that reason, it is essential to visit a physical therapist to analyze and assess your condition.  Then the most appropriate course of treatment can be started.

Physical Therapy for Shin Splints

Your first session in physical therapy for shin splints is called an initial evaluation.  During this session, your physical therapist will ask you many questions about the nature of your condition.  Be prepared to answer questions about when your pain started, how it is changing, and what causes your pain to worsen or improve.  Your PT will also ask about your past medical history to ensure that treatment can proceed safely.

During your evaluation for shin splints, your PT will perform various tests to determine the probable cause of your problem and to formulate the best treatment strategy.  Common tests and measures include:

Range of motion:  Your physical therapist will likely use a goniometer to measure the amount of motion around your ankle, knee, and hips joints.  Limitations in your motion may lead to increased stress and strain in your anterior tibialis muscle and be one cause of your shin splints.

Flexibility:  Tightness and imbalance in flexibility in muscles around your ankles may also be a cause of your shin splints.

 Specific muscles that may be tight and cause increased stress through your anterior tibialis include the calf muscle (including the gastrocnemius and soleus), the peroneal muscles, the posterior tibial muscles, or the anterior tibialis muscle itself.

Strength: Your PT will measure your muscle strength in your legs.  Muscle groups measured should include your anterior tibialis and muscles around your ankle, your quadriceps and hamstrings, and your hip muscles (with a focus on your gluteus medius muscle).

Analysis of footwear:  Your physical therapist may take a look at your shoes to see if specific wear patterns exist that may indicate tight or weak muscles around your ankle and foot.  While this analysis is not proven to be the most effective use of time, some therapists may have a look to see if there are any obvious wear patterns are in your shoes.

Palpation:  Palpation is when your physical therapist uses his or her hands to assess specific structures in your body.  Your PT may palpate your anterior tibialis muscle to see if it is painful which may indicate inflammation.  Palpation of your calf and foot muscles may also take place during your physical therapy evaluation.

Gait analysis:  Gait analysis is when your physical therapist watches the way you walk.  Your PT may have you walk or run to see if there are any obvious faults that may be contributing to your shin splints.  Your physical therapist may also use video gait analysis.  This allows your PT to have a recorded image of you walking or running, and your PT may be able to slow down the video to look for any faults with your walking or running technique.

Functional tests: Functional tests are specific movements that tell your physical therapist what may be causing your problem.  During your evaluation for shin splints, your PT may have you step up or down, jump from various heights, or perform single leg balance tests.

Treatment for Shin Splints

​Your specific treatment for shin splints depends upon the findings from your initial physical therapy evaluation.  Your treatment should focus on those impairments that were identified by your physical therapist.

In general, the treatment for shin splints involves managing the inflammatory response and working to change the bio-mechanical factors that may be causing your problems.  Specific treatments that your physical therapist may prescribe include:

Exercise.  Exercise is one of your main tools in making a positive change in your body's mechanics.  Your physical therapist should prescribe specific exercises for you based on the findings of your initial evaluation.  Some different types of exercises may include:

  • Flexibility exercises.  Sometimes, tightness in your gastroc/soleus complex (your calf and Achilles' tendon) may cause excessive strain in the front of your shin.  Simple stretches like the towel calf stretch or the runner's stretch may be necessary to help improve the mobility around your ankle and take stress off of your anterior tibialis muscle.
  • Ankle strengthening exercises.  Your physical therapist may determine that muscles around your ankle are weak, and this is causing your anterior tibialis to overwork and suffer from repetitive strain.  In that case ankle strengthening exercise may be prescribed.  A resistance band can be used to help strengthen the muscles around your ankle to provide more support for your anterior tibialis.  Eccentric calf lowering exercise may also be incorporated to help improve strength of these muscles.
  • Hip strengthening exercises.  Some evidence suggests that weakness in your hip muscles may create a situation where your knee and ankle are in a poor position during weight bearing activities like walking and running.  Strengthening your hips may be in order with simple straight leg raises or more advanced hip strengthening exercises.
  • Balance exercises.  Sometimes, muscular imbalance and poor proprioception can place extra stress on your anterior tibialis muscle and cause shin splints.  If this is the case, balance exercises may be prescribed by your physical therapist.  Single leg stance exercises on various surfaces are a great way to improve your balance at home, and the BAPS board may be used in the clinic to improve your balance.

Therapeutic modalities.  Your physical therapist may choose to use various therapeutic modalities to help treat the pain and inflammation that you may be feeling.  He or she may use ultrasound, electrical stimulation, heat, or ice to help decrease your pain or improve circulation to your injured anterior tibialis muscle.

Remember, passive modalities may feel good, but some evidence suggests that they may not be all that effective in treating many musculoskeletal conditions.  You should always be engaged in an active physical therapy program with appropriate exercises and self-care strategies for your shin splints.

Changing your footwear or adding orthotics.  If you PT feels that a pronated foot position is causing your shin splints, he or she may recommend you wear specific shoes with a medial arch support.  This can be achieved by adding an insert to your shoes to help support your feet and keep them in the correct position.

Kinesiology taping.  A relatively new treatment for many musculoskeletal conditions is kinesiology taping.  The tape can be used to help improve muscular facilitation, or it may be used to inhibit a muscle that is in spasm.  Kinesiology tape can also be used to decrease pain.  Your physical therapist can show you a kinesiology tape method specifically for shin splints.  Other uses of kinesiology tape for shin splints may include using the tape to inhibit your calf muscles or facilitate your gluteus medius muscle in your hip.

Shin splints can be a painful condition that limits your ability to walk, run, or enjoy normal recreational or work activities.  The condition can be confusing, since many different bio-mechanical faults can contribute to your pain.  Therefore, an evaluation by your PT to discover the specific impairments that may be causing your shin splints is essential.

Your physical therapist can analyze your condition to determine the best course of treatment for shin splints.  By starting the correct treatment to manage your symptoms and correct any bio-mechanical  faults you may have, you can be sure to safely and quickly return to your previous level of activity.

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