All that you want to know about SHIN SPLINTS in a simpler way

SHIN SPLINTS  Really...... by Dr. Swapnil Mate

"Not a pathologically precise term"

Categorised as Most Severe and Irritating Sports Injuries.

Runner's, Jumper's and Cyclist Most favorite Injury - THE SHIN SPLINTS

Why Severe Pain - credit goes to Nociceptors (Most Commonly called as "Free Nerve Ending") 

as they are free !!!! they are present everywhere in body....but highly motivated to be present in Periosteum of Bone (Outer covering of the bone)

Why  Irritating  -  Pain from Periosteum will be sharp shooting pain, and Sharp shooting pain experience will never be calm. it's more irritating in nature.

WHERE....

Anterior and Medial border of Tibia (most common)

WHAT HAPPEN EXACTLY....Mechanics...

Repetitive use of ankle movement (basically Up and Down) (DF / PF) :either in weight bearing or non weight bearing causes Tibialis anterior muscle to go into overstress.

Overstress - causes muscle to become tight

Tight tibialis anterior, mechanically shift upward and medial as a muscle group - rubbing against the periosteum of the shin bone (tibia) causing rupture of periosteum layer.

Extreme Foot condition (i.e Flat Foot or Increased Arches) creates faulty biomechanics.

REAL CAUSE

1. Bone Stress - Jumping / Running (hard Surface)

2. Less Vascular Supply.

3. Raised Intracompartmental pressure

4. Nerve Entrapment.



EXAMINATION

important to palpate the site of maximal tenderness.

check the consistency of the soft tissue.

provoke / reproduce the pain by asking them to perform functional movement to check the cause of the pain 
(Ex : running on treadmill / hard surface, jumping, hopping etc...)

Start with 

Observation

• Assess Lower limb alignment (varus / valgus, tibial torsion, pes planus)
• Swelling, bruises, asymmetry 

Active movement

• DF + PF + inversion + Eversion + Combined movt

Passive movement

Resisted movement

Functional test 
(Hopping, jumping, running and calf raise)

Palpation
Tibia + Fibula
Tibialis Anterior + Calf 
Medial + Lateral Compartment


Special test
 stress fracture test
Biomechanical examination


INVESTIGATION

Radiography
Radioisotopic Bone Scan
MRI


TREATMENT

Identify the Cause
Training Habit
Footwear
Foot Assessment


Classic Treatment Plan 
(for Pain relief)
Rest (till weight bearing is Pain free)

USE

Low intensity pulsed Ultrasound ( till palpation over bone is pain free)

Myofascial release 

in all the leg compartment to assess the muscle imbalance

Release tight Gastroc + Soleus and Tibialis Anterior

Dry needling 

MUSCLE - to reduce the tone of tibialis anterior

BONE : Periosteum pecking (13 mm needles on the site of pain)


Cupping (Static or Dynamic) 
Soft tissue release

IASTM (Static or Dynamic) 

Kinesio Taping

Muscle inhibition - Tight TA ( Insertion to origin with 15 - 25 % Stretch)
Muscle Facilitation - CALF ( Origin to Insertion with 15 - 35 % Stretch)

Space Correction (50 - 75 %)
ON SHIN BONE

Stretching....


Once PAIN FREE...

General Mobility and strengthening exercises of ankle, knee 
(Non weight Bearing progress to weight bearing)

Cross training 

Proprioception training 


Prevention
Monitor training load.
Hydration.
Adequate Rest.
Sports Massage.
Proper Warm up and Cool Down.
Ice bath.
Epsom Salt Recovery session.
Proper Diet. 
Nutritional Supplementation. 
Proper orthosis.
Early Rehab in case of relapse.

https://www.youtube.com/watch?v=b6uga_zx9gg

Tibialis Anterior muscular knots